In the United States, up to 30% of 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 the fetus is in an abnormal position Abnormal Position and Presentation of the Fetus Position refers to whether the fetus is facing rearward (toward the woman’s back—that is, face down when the woman lies on her back) or forward (face up). Presentation refers to the part of... read more , 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 (placental abruption Placental Abruption Placental abruption is the premature detachment of a normally positioned placenta from the wall of the uterus, usually after 20 weeks of pregnancy. Women may have vaginal bleeding and/or severe... read more )
When the woman has had one or more previous cesarean deliveries (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 (uterine rupture Uterine Rupture Uterine rupture is a spontaneous tearing open of the uterus that may result in the fetus floating in the abdomen. Rupture of the uterus is very rare. It is an emergency requiring immediate treatment... read more ) during labor. 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 and is horizontal. Thus, if women have had only one previous cesarean delivery and a horizontal incision was made in the lower part of the uterus, they can choose to have a vaginal delivery—called a vaginal birth after cesarean (VBAC). However, if women have had more than one cesarean delivery, most doctors recommend cesarean delivery for all subsequent pregnancies. Women should discuss the risks with their doctor before deciding whether to attempt VBAC. Many centers use checklists to make sure that women and their babies are good candidates for a safe and successful VBAC.
If a woman chooses vaginal delivery after having had one previous cesarean delivery, she should plan to have her baby in a facility equipped to rapidly do a cesarean delivery because
An obstetrician, an anesthesiologist, nurses, and sometimes a pediatrician are involved in a cesarean delivery. Use of anesthetics, drugs given intravenously, antibiotics, and blood transfusions helps make a cesarean delivery safe.
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 is very thin and 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. A vertical incision is made only if there are certain risks, such as abnormalities in the placenta or in the size or position of the fetus.
Upper (classical) incision: Usually, this incision is used when the placenta covers the cervix (a complication called placenta previa Placenta Previa Placenta previa is attachment (implantation) of the placenta over the opening of the cervix, in the lower rather than the upper part of the uterus. Women may have painless, sometimes profuse... read more ), when the fetus lies horizontally across the birth canal, when the fetus is very premature, or when the fetus has a birth defect.
Women are encouraged to walk around soon after a cesarean delivery to reduce the risk of blood clots forming in the legs or pelvis, then traveling to the lungs and blocking arteries there (pulmonary embolism Pulmonary Embolism (PE) Pulmonary embolism is the blocking of an artery of the lung (pulmonary artery) by a collection of solid material brought through the bloodstream (embolus)—usually a blood clot (thrombus) or... read more ).
Cesarean delivery results in more overall pain afterward, a longer hospital stay, and a longer recovery time than vaginal delivery.
The following is an English-language resources that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
Childbirth Connection: This web site provide tips for having a healthy baby and safe delivery. The importance of medical care before, during, and after delivery is emphasized.