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Cesarean Delivery


by Julie S. Moldenhauer, MD

Cesarean delivery (C-section) is surgical delivery of a baby by incision through a woman’s abdomen and uterus.

In the United States, about 2 to 3 in 10 deliveries are cesarean.

Doctors use a cesarean delivery when they think it is safer than vaginal delivery for the woman, the baby, or both, as in the following situations:

  • When labor is prolonged

  • When the fetus is in an abnormal position, such as breech presentation (buttocks first)

  • When the fetus's heart rate is abnormal, indicating fetal distress

  • When vaginal bleeding is excessive, suggesting that the placenta may be separating from the uterus too soon

  • When the woman has had more than one previous cesarean delivery (usually)

In the past, after a woman had one cesarean delivery, doctors recommended a cesarean delivery for all subsequent pregnancies. Doctors were concerned that the scar from the incision in the uterus might open (rupture) during labor (see Uterine Rupture). However, doctors now realize that the risk of rupture is low after a cesarean delivery if the incision was made in the lower part of the uterus. Thus, if women have had only one previous cesarean delivery and the incision was made in the lower part of the uterus, they can choose to have a vaginal delivery. However, if women have had more than one cesarean delivery, most doctors recommend cesarean delivery for all subsequent pregnancies.

If a woman chooses vaginal delivery after having had one previous cesarean delivery, she should plan to have her baby in facilities equipped to rapidly do a cesarean delivery because

  • Vaginal delivery is successful in only about 60 to 80% of women who have had one previous cesarean delivery.

  • There is a very small risk that the uterus might rupture.

Did You Know...

  • If a woman has had only one previous cesarean delivery with a lower incision, she can choose to have a vaginal delivery for her next pregnancy.

An obstetrician, an anesthesiologist, nurses, and sometimes a pediatrician are involved in this surgical procedure. Use of anesthetics, intravenous drugs, antibiotics, and blood transfusions helps make a cesarean delivery safe. Having the woman walk around soon after surgery reduces the risk of blood clots forming in the legs or pelvis, traveling to the lungs, and blocking arteries there (pulmonary embolism). Cesarean delivery results in more overall pain afterward, a longer hospital stay, and a longer recovery time than vaginal delivery.

For a cesarean delivery, an incision can be made in the upper or lower part of the uterus.

  • Lower incision: This type of incision is more common. The lower part of the uterus has fewer blood vessels, and so less blood is usually lost. Also, the healed scar is stronger, so that it is less likely to open in subsequent deliveries. A lower incision is usually horizontal but can be vertical.

  • Upper (classic) incision: Usually, this incision is used when the placenta covers the cervix (a complication called placenta previa), when the fetus lies horizontally across the birth canal, or when the fetus is very premature.

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