There are two points in time when you and your health care team may face the decision to have a cesarean. The first occurs during pregnancy before labor begins. The other occurs during labor, when it may become necessary to have a cesarean birth.
Deciding before labor that you need a cesarean
The decision to have a cesarean birth prior to labor is not as common as you might think. The vast majority of pregnant women will at least go into labor before the need for a cesarean presents itself. However, there are a few factors that might indicate a planned cesarean is your safest option, including:
Placental location: If the placenta is covering or near the edge of the cervix, the opening to the uterus, a cesarean is the safest option.
Placental abruption: If the placenta begins to separate from the wall of the uterus before birth, which is a medical emergency, a cesarean is the safest route. This can also happen during labor. There can also be complications with the way the placenta has adhered to the uterus, known as a placenta accreta.
Baby’s position: Only 3 to 4 percent of babies will not be in the proper position for birth, head down, at the end of pregnancy. Some of these babies are positioned in a way that may make a cesarean delivery the safest option. This includes babies in a transverse lie (sideways, neither head nor bottom down) and some breech babies (feet, knees, or buttocks down). This can also include twins and other multiples as they are less likely to be in a head-down position.
Certain medical conditions for mother or baby: There are a variety of medical conditions that would make an immediate delivery important — for example, if a woman has eclampsia and is having seizures.
Previous cesarean birth: If you have had a previous cesarean birth, you may be given the option to schedule all future births via cesarean as opposed to having a vaginal birth after cesarean (VBAC). It is important to note that most mothers who have had a previous cesarean are able to safely give birth vaginally.
Deciding during labor that you need a cesarean
The most common time when the decision to have a cesarean is made is during labor. This can be a labor that started on its own or an induced labor. During labor, medical complications sometimes arise that were not apparent prior to labor, which may lead to the baby not tolerating labor very well.
Another reason a cesarean may be done is if labor has not progressed after a certain period of time, meaning that your cervix is not opening quickly enough or your baby is not descending enough. The name for this is dystocia. This can also happen if you have not had the baby within a certain amount of time after your water breaks (when the sac of amniotic fluid is broken).
Not all of these reasons are considered medically sound if the mother and baby are doing well. Mandatory, arbitrary time limits often encourage more cesarean births, even when a vaginal birth is not only possible but potentially safer.
The differences between emergency, unplanned, and planned cesareans
If you schedule a cesarean prior to labor, it’s considered a planned cesarean. If a cesarean is done at any other time, it’s considered unplanned. Not all unplanned cesarean births are emergencies, but some are. An emergency cesarean might happen before or during labor, in medical emergencies like:
- Placental abruption
- Fetal distress
- Maternal distress
In general, there is very little difference between the planned and unplanned cesarean. The biggest exception is when it is an emergency cesarean birth, which may include a general anesthesia and a different type of incision done for speed as opposed to aesthetics.
It’s important to be prepared by learning about a cesarean birth before labor occurs, or even as early as the end of the second trimester. This topic is covered in most childbirth classes in a way that will provide you a good base knowledge, without scaring you. It can also give you some great tips to help you have a positive experience should a cesarean birth become the safest option for you and your baby.
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Robin Elise Weiss, Ph.D., LCCE, CLC, AdvCD(DONA) is a childbirth educator, doula, founder of Childbirth.org, and the award-winning pregnancy and parenting author of “The Complete Illustrated Guide to Pregnancy” and more than 10 other books. Between her nine children, teaching childbirth classes, and attending births for more than two decades, she has built up an impressive and practical knowledge base. You can follow Robin on Twitter @RobinPregnancy, Instagram, and Facebook.