The ins and outs of a Cesarean Section (C-section): Part 1

What is a c-section, prevalence of a c-section, indications for a c-section, risks involved in a c-section, and how to prevent a c-section

There are two methods to deliver a child; the first is vaginal and the second is through a cesarean section (c-section). Most of us are familiar with both, but let’s take a closer look at what a c-section entails from what it is, the prevalence of c-sections in the U.S and world, what situations would require a c-section, the risks involved, and how to prevent a c-section. This is a two part post and is meant to explain and demystify cesarean sections.

A c-section is when a fetus is delivered via an incision in the abdomen and uterus when a vaginal delivery cannot be performed.  A c-section can be either unplanned or planned.  In the United States, about 32% of babies are delivered via c-section compared to the global average of 21%.  Since the 1990s, the global c-section rate has been steadily rising: from 7% to 21% according to the World Health Organization (WHO).  While the c-section rate in the United States is above average, some countries such Brazil, Egypt, Turkey, Dominican Republic deliver close to 50% of babies via c-section!  The rates of c-section rates in less developed countries, such as those in Western Africa, average about 8%.  Interestingly enough, the WHO suggests that c-section rates greater than 10% of the population are not associated with a reduction in maternal and newborn mortality rates. Increases in the rate of c-sections correlates to an increase in labor inductions, a decrease in instrument delivery, and an increase in birthing person requests for a c-section versus a vaginal delivery.

Baby being delivered via c-section.

What instances warrant a c-section?

There is a fair amount of planned c-sections that are completed upon the birthing person’s request despite no medical indication for the procedure.  These requests are most often made because of fear of vaginal delivery.  Elective c-sections with no medical indications are becoming increasingly more common, however, remain controversial in the medical community. 

Historically, patients that have undergone a previous c-section would automatically be scheduled for subsequent c-sections, however, it is now recommended that patients attempt a vaginal birth after cesarean, called a VBAC.  General recommendations support VBAC deliveries if there are no other circumstances requiring a c-section..

Furthermore, recommendations for those with pre-eclampsia are to deliver vaginally if vitals are stable and the fetus is not in distress.  Should the eclampsia progress during labor putting the birthing person or baby in distress, a c-section will be completed.

Conditions that absolutely require a c-section:

• Placenta previa

• Breech

• Shoulder dystocia (shoulder gets caught in the birth canal)

• Fetal distress 

• Absolute disproportion (the pelvis of the birthing person makes vaginal birth impossible)

• Chorioamnionitis (infection of the placenta and possibly the fetus)

• Pelvic deformity (vaginal birth is impossible due to shape of the birthing persons pelvis)

• Eclampsia and HELLP syndrome

• Umbilical cord prolapse

  • When the umbilical cord is between the head of the fetus and the vaginal opening 

• Uterine rupture

Pfannenstiel incision is the most popular type of incision for a c-section.

Conditions that may warrant a c-section, but vary depending on the situation are the following: 

• Pathological cardiotocography (acute hypoxia or fetal asphyxia)

• Failure to progress in labor (prolonged labor)

• Previous c-section

• Fetal macrosomia

Risks for a c-section

As with any surgery, cesarean sections are not without risk to both the mother and the baby.  

Risks to the mother include: 

• Bleeding and possible blood transfusion

• Hysterectomy

• Infection

• Organ injuries

Possible risks for future pregnancies include:

• Rupture of the uterus

• Infertility

• Placenta anomalies: placenta previa, increta, or accreta

Risks to the infant include:

• Development of type I diabetes

• Bronchial asthma

• Allergic rhinitis

Interventions to reduce c-sections

• Use of doulas

  • What is a doula? A doula is a support person present during birth that helps the birthing person and their partner during delivery.  A doula helps provide comfort measures to facilitate vaginal delivery.

• Childbirth training workshops to education increase spontaneous vaginal birth, and decrease overall anxiety and misconceptions surrounding birth

• Nurse led relaxation training programs

• Midwifery-labourist care with an OB provider on-call

Should your baby not turn, you develop pre-eclampsia, or labor fails to progress and you must have a c-section, it is okay! C-sections are a procedure to save lives and it is not your fault if you plan for a vaginal delivery and you end up having a c-section. As long as you and baby are healthy, this is everyone’s ultimate goal! Remember to be kind to yourself during this process!

References

Adshead D, Wrench I, Woolnough M. Enhanced recovery for elective Caesarean section. BJA Educ. 2020;20(10):354-357. doi:10.1016/j.bjae.2020.05.003

Chen I, Opiyo N, Tavender E, et al. Non-clinical interventions for reducing unnecessary caesarean section. Cochrane Database Syst Rev. 2018;9(9):CD005528. Published 2018 Sep 28. doi:10.1002/14651858.CD005528.pub3

da Silva Charvalho P, Hansson Bittár M, Vladic Stjernholm Y. Indications for increase in caesarean delivery. Reprod Health. 2019;16(1):72. Published 2019 May 30. doi:10.1186/s12978-019-0723-8

Miseljic N, Ibrahimovic S. Health Implications of Increased Cesarean Section Rates. Mater Sociomed. 2020;32(2):123-126. doi:10.5455/msm.2020.32.123-126