When and why C-sections are needed

What is a C-section?

A cesarean birth is also known as a C-section. It's a surgery in which a fetus is delivered through an incision in the mother's lower belly and womb.

The infant is delivered through the incision. After the delivery, the incision is closed with stitches which will later dissolve.

Why are C-sections needed?

A pregnant mother wants her child's birth to be safe for herself and her child. Even if a pregnant mother wants to have a vaginal birth, there are times when a C-section may be needed for the health of the baby and mother.

“Everything we do for the mother and baby is designed to promote a safe, vaginal birth if possible for a woman’s specific situation,” said Sarah Oman, MD, a physician in The Polyclinic ob/gyn department. 

Ob/gyn stands for obstetrics and gynecology. Ob/gyn doctors care for women during pregnancy and childbirth. 

Most births are vaginal births

About one in three women in the United States will have a C-section to deliver their baby.

The Polyclinic ob/gyn doctors promote safe, vaginal delivery through the department's culture of provider-shared coverage.

"We have a group that works with each patient family and their goals, no matter the doctor on call," said Katherine Schwab, MD, an ob/gyn at The Polyclinic.

"There's an effort across the country to do fewer first C-sections when there are ways we could safely help with vaginal birth," said Dr. Schwab. She also noted that not doing a first C-section lowers the chances of needing a C-section in the future.

C-section rates are down in Seattle

Dr. Oman talked about how emergency C-section rates for first-time, healthy moms are going down in Seattle. She and Dr. Schwab credit the lower rates to better communication and Polyclinic guidelines.

"Across the medical field, there has been more of a standard way of understanding delivery," said Dr. Oman.

She noted that care guidelines have been developed to help the medical team practice patience during different rates of labor progress. These guidelines do not increase the chances of problems for mom or baby during delivery.

Focus on safety during delivery

Advanced monitoring technology offers more accurate readings of electronic fetal heart tracing, which measures the infant's stress during labor. This information adds to the safety of the patient during labor.

"Our providers are patient," said Dr. Schwab. "We're happy to wait out a mother's labor, help as needed, and give mom and baby every chance for a safe vaginal birth."

If a C-section is needed

Some patients have pre-existing conditions (a medical problem they had before pregnancy) for which a planned C-section is the safest way to deliver.

"There are mothers who've had uterine surgery, have a placental abnormality that makes labor unsafe, or have a condition that makes it unsafe for them to push," said Dr. Oman.

Sometimes having twins or multiples (more than one baby at a time) means it's best to have a planned C-section. Other women may reach a point in labor where a C-section becomes the best method for the safety of mother and child. These situations include:

• Labor isn't progressing, despite patience and augmentation (help from the doctor) to make contractions stronger
• The baby is not tolerating the labor or when the baby isn't doing well during the labor
• The placenta is covering the cervix (opening of the uterus or womb), blocking the baby's exit (placenta previa) 

Another time when labor may raise the chances of problems for the mother is when she has pre-eclampsia (acute or sudden and serious high blood pressure). If this happens, a quick delivery is the safest way for the birth to happen.

A C-section can be a good thing

An emergency C-section may not be what a woman has in mind for her birth plan.

"We prepare patients throughout pregnancy for what to expect at delivery," said Dr. Schwab. "Patients understand that while a vaginal birth may be their first choice, each delivery is unique, and when needed, we will do a C-section.

"Talking with your doctor before your baby's birth may not take care of all your fears, but it will give you a sense of knowing what to expect if we need to do a C-section."

C-section problems

The following conditions may make it more likely that you'll have a C-section:

• Having a pre-existing health problem
• Gaining too much weight while pregnant
• The baby is in a breech position (feet first in the uterus instead of the usual head first)

If the baby is in breech position, you can have an external cephalic version (ECV) procedure. This is when the doctor helps turn the fetus to the correct or head-down position before the birth.

Your doctor may suggest some of the following to help the birth and labor go safely and smoothly:

• Induction of labor (when doctors help to start labor)
• Labor augmentation (when doctors help make contractions stronger during the delivery)
• Tools like forceps or a vacuum

"It's common for people to be skeptical about medical intervention [having a doctor help with delivery], believing it will lead to a less satisfying birth," said Dr. Oman. "But this doesn't give appropriate credit to the safety benefits that a C-section may offer.

"We play the hand that nature deals us as pregnancy and labor progress, and we see how mom and baby are doing throughout the process."

Fortunately, nature is assisted by our team of expert ob/gyn doctors. In the end, how a woman gives birth is a small part of having a baby. The health and safety of the mother and child are what matters most.

Source

• Centers for Disease Control and Prevention. Birth Data. Accessed November 3, 2020.

The information provided is for general informational purposes only and is not intended to be medical advice or a substitute for professional health care. You should consult an appropriate health care professional for your specific needs.