When Do I Need A C-Section

1. What are the specific risks associated with the decision to have a  C-section? 

You may be a cesarean section candidate if vaginal delivery of your baby poses a risk to your health or to your baby’s health with a vaginal birth. These reasons could include high blood pressure, diabetes, certain infections, such as genital herpes, kidney disease, and heart disease. These conditions might make a vaginal delivery too risky.     Once you are in labor, additional reasons may arise which makes you a candidate for a C-section. These include complications during labor, failure to progress in labor, fetal distress, abnormal fetal positioning, or you have had a previous C-section.    

2. What is an abnormal fetal heart rate?

When you entered the hospital in labor, a fetal monitor was attached to your abdomen. This measures the length of your contractions and also your baby’s hear rate. When your baby’s heart rate goes down after you have had a contraction, it is called a late deceleration. This decrease in our baby’s heart rate after you have a contraction indicates your baby isn’t getting the oxygen it needs between your contractions.  This can lead to an emergency c-section to deliver your baby.

You should be aware that the fetal heart rate monitor can be very misleading, not because the monitor is inconsistent, but because there can be considerable variation in the way your doctor interprets the output of the fetal monitor. Many C-sections are undertaken because the doctor reading the output suspects fetal distress when there
really isn’t any. The person reading the fetal monitor must understand what readings show genuine distress and what readings simply look like fetal distress. 

3. What is malpresentation?

Malpresentation is an abnormal fetal position for delivery. For example, some babies don’t turn head downward in preparation for labor. They span your stomach left to right, lying across your stomach. This is called a transverse lie. Babies positioned in this way will never deliver vaginally. However, they can sometimes be repositioned manually so their head is down and able to enter the birth canal and be be delivered. 

The shoulder presentation is also another position your baby may take which makes vaginal delivery impossible. However, if the delivery staff acts quickly enough, the shoulder presentation can be repositioned with the head-first for vaginal delivery.  

Breech presentations, with your baby’s feet or buttocks against the birth canal can also be a problem. Some breech presentations are deliverable vaginally and some are not. 

4. Is a prolapsed umbilical cord a reason to do a C-section?

When your baby’s umbilical cord delivers before your baby, it is called a prolapsed cord. In this situation, the umbilical cord can become compressed, which decreases the blood and oxygen supply to your baby. If your baby’s umbilical cord becomes compresses, a C-section would be necessary. However, if the cord isn’t compressed, a vaginal birth is possible without injury to your baby.

5. Do I have to have a C-section if I’m having twins?

Twins can easily be delivered vaginally. With twins, the most common presentation is for the first baby to be head first. There are people who are worried about delivering the second twin if the second baby is breech, but it can be done. I have even delivered twins when both were breech. 

6. Can you deliver a baby with placenta previa vaginally?

When a placenta covers the cervix, partially or completely, it is called placenta previa. When the placenta encroaches very little on the cervix, it may become more involved as the cervix dilates. 

During labor, when the placenta gets in the way between
the baby’s head and the mother’s cervix, there can be
significant bleeding and possible loss of the baby’s life. 

7. What is a placental abruption?

Placental abruption is the name given to the separation of a
part or all of the placenta from the wall of the uterus. Abruptions seldom occur suddenly or catastrophically. For the most part, there are weeks or even months of warning. For example, if there is a small amount of
bleeding at 27 weeks, the best thing is to wait. I used to put my patients with placental abruption in the hospital, especially if they lived over 80 miles away from the hospital. 

8. What is fetal macrosomia?

Macrosomia is a big word for a big baby. If the baby is
considered to be too large to pass through mother’s pelvis, a C-section may be considered. The problem is that we often don’t
estimate babies’ weights very well. Ultrasound can be
helpful but there’s no guarantee that that will do a better job than the obstetrician’s estimation. 

About 9 percent of babies worldwide weigh more than 8 lbs. 13 oz. Probably more important than the absolute weight is why is the baby big? Babies born to diabetic mothers tend to have shoulder dystocia more than other babies born with the same weight to mothers who aren’t diabetic. The average weight for a full-term baby is around 7 pounds.

9. What is your doctor’s C-section rate?

The national average in the U.S. for C-sections is about 33 percent, much higher than in many other developed countries. Be sure to talk with your doctor about your preferences for induction and C-sections. If you pefer a natural birth without induction, be sure to let your doctor know.