You might have a certain vision for how you want to deliver your child. That’s great, but remember that birth can’t fully be planned, and every labor is different. We recommend educating yourself about the other scenarios so that you feel empowered no matter what birth brings. Our mantra is that every childbirth is natural. Some babies just take the window instead of the door.
What’s a C-section, anyways?
Short for Cesarean section, and so named from the lore that Julius Caesar was delivered by this method, a C-section occurs when the baby is surgically removed from the mother during childbirth. It’s a major medical procedure—and it’s on the rise. According to a report by NPR, the rate of Cesarean deliveries has tripled globally since 1990. In the U.S., 32% of all births were delivered by C-section in 2015.
But why?
Emergency C-section vs. planned C-section
In general, there are two types of Cesarean sections: planned, or elective, and emergency. A planned C-section is when the procedure is scheduled ahead of time with your doctor. There are many reasons to plan a C-section, including many of the medical issues listed below. Some women also choose a scheduled Cesarean if they are experiencing difficulties, or if they had one with a previous pregnancy.
Emergency C-sections, on the other hand, occur when there’s an unexpected medical issue or problem during labor, such as blood clots or poor oxygen flow. If your health or your baby’s health is in danger, your doctor may order a C-section despite your plans to deliver vaginally. One thing to note: There’s some controversy over what constitutes a true medical emergency. The increased rates we’re seeing are due mainly to an increase of elective C-sections, and the confluence of three factors: financial, legal and technical, Holly Kennedy, a professor of midwifery at the Yale School of Nursing, told NPR. “As an obstetrician told me … “you’re going to pay me more [to do a C-section], you’re not going to sue me and I’ll be done in an hour,’ ” Kennedy says.That’s a systemic issue that one individual can’t really control. But if you want to give vaginal delivery the old college try, one way to reduce the risk of a C-section is to work with a doula. Doulas, also known as birth coaches, will work with you and your partner during your pregnancy. They will help you develop the best plan for your birth. According to research from the University of Minnesota’s School of Public Health, having a doula present during labor reduces the likelihood of an unplanned or emergency C-section by 60 percent.
But what about the other reasons for C-sections? And can anything be done about them?
Reason for C-section: Abnormal positioning
In a vaginal birth, the optimal position for the baby is head first near the birth canal. A breech birth occurs when the baby’s feet or buttocks face the birth canal, while shoulder or side first is known as a transverse birth.
When the baby is in one of these alternate positions, it can cause complications during labor, including the umbilical cord wrapping around the baby’s head and cutting of your baby’s oxygen supply Once you hit 36-weeks, your provider will start checking baby’s position, by feel and sometimes by handheld ultrasound. Anecdotally, your provider may tell you that once the baby is head-down, you’re in the clear. If your baby is in the breech position at 36 weeks and this is your first pregnancy, there’s a 1 in 8 chance your baby will move itself into the proper position before birth. If this is your second or subsequent baby, the chance is about 1 in 3.
It’s not uncommon for doctors to order C-sections due to this positioning. Sometimes these are planned, and sometimes these are emergencies, such as if the baby turns
However, some women have had success delivering breech, or working on turning the baby. But having the option to attempt a breech delivery will depend on your provider and hospital policy, as it’s uncommonly approved because of XYZ risk. You can learn more about attempting to spin a breech baby at Spinning Babies
Reason for C-section: Prolonged labor
Prolonged labor, also known as stalled labor or “failure to progress,” accounts for nearly one-third of all C-sections. This accounts for a lot of the controversy: many feel that this blurs the line around what constitutes a medical emergency and what is an unnecesary medical intervention. For new moms, labor is considered prolonged when it takes 20 hours or more. For women who have given birth before, the threshold is lower, at 14 hours.
Both the mother and the baby are at risk for several complications, including infections, if the amniotic sac has been ruptured for a long time and the birth doesn’t follow.
Prolonged labor can also take a toll on the mother’s health. A doctor may order an emergency C-section because of prolonged labor to avoid these issues. Granted, it’s hard to control this. But there are some general tips for how to keep labor progressing.
- Start moving and change positions: There’s some evidence that shows an active upright labor can help improve labor length while keeping you more comfortable, in part because you feel more in control. This way, too, gravity is on your side.
- One thing to bear in mind about active upright labor is that you can’t really do that once you get an epidural. You may have heard that epidurals slow down labor. But in fact, the jury’s still out on that one. Bottom line? Epidurals don’t increase your chances of needing a C-section, and epidurals can help a woman relax, which actually helps move labor along.
- If you have the option, try to labor at home or wherever you feel most relaxed. Work with your provider to understand how long you can wait before coming in to the hospital.
- Remember it’s OK to be scared. Because fear can also unleash hormones that interfere with your labor, try to remember that fear is natural, and that you can conquer it.
- Be patient and don’t panic. Relaxing can help with the contractions and make sure they do their job.
Reason for C-section: Birth defects
Certain known birth defects may also necessitate a C-section. In these cases, C-sections might be planned in advance or become necessary as an emergency procedure during vaginal delivery. Your doctor will advise you on the safest way to deliver the baby. A C-section may be preferred to vaginal delivery if the baby has excess fluid in the brain, congenital heart disease, or medical issues requiring immediate surgery post-birth.
Reason for C-section: Chronic health issues
With certain chronic health issues, a C-section may be required for the mother’s health. Issues such as high blood pressure, gestational diabetes, and heart disease can place an additional strain on vaginal delivery, so a doctor may suggest a C-section as an alternative. In these cases, though, ask questions! It’s not always black-and-white.
Additionally, C-sections are also recommended when the mom-to-be has genital herpes, HIV, or other infections that could potentially pass to the baby during a vaginal delivery.
Reason for C-section: Carrying multiples
Women who are expecting twins or triplets may often elect to have a Cesarean section because carrying multiples increases the risk of complications during birth. Multiples are more likely to have prolonged labor, and it’s also common for one or more babies to be in an abnormal position.
By recommending a C-section for delivery of multiples, doctors often are trying to ensure each baby is healthy and free from complications. A C-section may also be recommended if the babies have health issues related to being premature because the C-section is a bit more of a controlled environment.
Reason for C-section: Placenta issues or cord prolapse
Occasionally, a doctor may insist on performing a C-section when the mother has placenta issues. In a condition known as placenta previa, the placenta shifts and covers the woman’s cervix, making vaginal delivery risky because it can cause major bleeding during labor. For that reason, doctors may recommend scheduling a C-section as soon as the lungs are fully developed, or as developed as possible, at 36 or 37 weeks.
Another placenta issue that may require an emergency C-section is called placenta abruption. The exact cause of this isn’t known, which means it can’t be prevented, but what happens is that the placenta separates from the lining of the uterus, usually in the last few weeks of pregnancy. It’s pretty rare, but also serious, because the placenta is the critical pathway for the baby to receive oxygen and nutrients.
Cord prolapse may also require a C-section. It occurs in one of about every 300 births, and essentially means that the umbilical cord exits the cervix before the baby. This can cut off the baby’s blood supply and can result in a variety of complications. When cord prolapse occurs, a doctor is likely to order an emergency C-section.
There’s no right or wrong way to give birth
There’s no right or wrong way to deliver your child. If you’re told one path isn’t an option for you, ask questions. Among the many reasons for C-sections, some are truly emergencies. But other scenarios that tend to lead to a C-section can be managed—at least long enough for you to take a beat to try something different. That’s why we think it’s important to research the reasons for C-sections and make an informed, empowered decision along with your provider. Whether you’re considering a C-section or vaginal birth, or are told that one is better for you, you can still work on your birth plan and develop the best path for you and your baby.