Related topics: •  Book Review: The Essential C-Section Guide

Cesarean surgeries have saved the lives of many babies and their mothers, usually as a last resort in difficult birthing situations. In recent years, the number of children delivered by c-section has risen dramatically -- in 2003, more than one in four children were delivered through c-section, the highest rate in the United States ever -- and the reasons for this increase remain controversial.

A c-section is a major surgical procedure by which doctors open the pregnant woman's abdomen and uterus and deliver the baby through the incision. In nearly all cases the mother is awake but anesthetized from the chest down by epidural or spinal anesthesia.

Most of the time, c-sections are performed when the health of either the mother or the baby is in jeopardy. In some cases, physicians will deliver babies by c-section at the mother's request, but that is a different and very controversial topic. Some of the most common circumstances that result in a cesarean birth include:

•The mother is pregnant with multiples. When twins or other multiples are ready to be born too early, or are in the uterus in positions considered unsafe for delivery when labor begins -- in breech position, for example -- there is a likelihood of a c-section birth.

•The mother's labor stalls. According to the American College of Obstetricians and Gynecologists, one third of c-section births are performed because labor doesn't progress. For instance, contractions may not be strong enough to open the cervix for the baby to get through.

•The mother has problems with the placenta. There are two placental problems that may cause a c-section to be performed: placenta previa, when the placenta covers the cervix either partly or fully; or placental abruption, when the placenta separates from the wall of the uterus and the baby can't get oxygen.

•The mother has already had one c-section delivery. Previous cesarean birth is one of the biggest reasons that women today have c-sections.

•The mother has an abnormal pelvis. A previous injury or condition may rule out a vaginal birth.

•The mother has a severe illness or other condition, such as diabetes, herpes, a heart problem, or ovarian cysts, in which delivery is not safe for the baby.

•The mother is advised that delivery is necessary, but she is not in labor. Some reasons may include a severe infection or preeclampsia.

•The baby is in distress. During labor, the umbilical cord can become compressed, preventing blood flow from the placenta. If the fetal monitor tells the birth attendants that the baby is in distress, a c-section may be in order.

•The baby's head is too large or she enters the birth canal in a breech position. In this situation, the baby's feet and buttocks enter the birth canal first, instead of the head.

•The baby has a medical condition such as spina bifida, a birth defect that affects the backbone and spinal cord, and needs to be delivered by c-section.

•Get prenatal care and take care of yourself. Certain health-related issues increase your odds of having a c-section. For example, if you are significantly overweight or if you have diabetes or high blood pressure, your odds of having a c-section delivery go up. Seeing a health care provider regularly during your pregnancy means that any potential conditions that can be treated will be addressed. Getting adequate prenatal care certainly doesn't guarantee that you won't have a c-section, but it's an important measure for your own health and that of your baby.

•Ask your doctor about his or her c-section rate. Some physicians have higher rates of c-section deliveries than others. When you interview doctors, talk with them about your wish to have a vaginal birth and your philosophy about pregnancy and childbirth to determine if they are compatible. Some physicians are more willing than others to work with patients to help them achieve the kind of birth the patient desires.

•Consider teaming up with a midwife and/or a doula to assist in your care and delivery. According to researchers from The Cochrane Collaboration, an international organization of 11,000 medical professionals most of whom voluntarily review health care research and product trials, women who had continuous support from a doula or midwife during birth were less likely to require pain medication or have c-section deliveries.

Email the American College of Obstetricians and Gynecologists (ACOG) at resources@acog.org and request a free copy of its pamphlet Cesarean Birth. Include your full name and mailing address.

It used to be that if a woman had had one cesarean section, her doctor almost always recommended the procedure for the next delivery. These days, vaginal birth after cesarean (VBAC) is possible. However, because of the risk of uterine rupture in giving birth vaginally, VBAC should still be approached with caution.

The best way to avoid this difficult choice is to do all you can to avoid having a c-section in the first place. It's impossible to control everything, but you can reduce your chances by being in shape before and during pregnancy, working closely with your doctor on your birth plan, and having supportive people around you during labor and delivery.

If you've already had a c-section and hope to deliver your next baby vaginally, write to ACOG and request a free copy of Vaginal Birth After Cesarean Delivery.

By learning all you can about a c-section, you can ask the right questions when and if your doctor recommends one.

-- Dana Sullivan is a writer in Reno, Nevada. Her work has appeared in several national magazines, including Parenting, Parents, Fit Pregnancy, Real Simple, and Self. She is co-author of The Essential C-Section Guide (Broadway Books/Random House, 2004).

References

First published August 15, 2005
Last updated June 26, 2008
Copyright © 2005 Consumer Health Interactive

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