If you’re pregnant or planning a family, it makes sense to have a general understanding of what a caesarean section is, and why you may need one. Although you may want a vaginal birth, sometimes things occur that are out of your control.
During a caesarean birth, the baby is delivered through a cut in the mother’s abdomen and uterus.
Despite the higher risks and longer recovery times, caesareans are a common procedure and are usually a safe method of delivery for you and your baby. They’re generally performed when either the mother or baby’s health is at risk, and these risks outweigh those of a caesarean.
Caesareans can be elective (planned) or emergency (not planned).
Factors that increase the likelihood of a caesarean
The likelihood of having a caesarean increases with age. Mothers aged 40 and over are almost three times more likely to deliver by caesarean, compared with teenage mothers. Pregnant women who are obese are also more likely to deliver via caesarean section.
Reasons you might need an elective caesarean
There are a number of reasons you may need a planned caesarean birth, including:
- You have previously had a caesarean section (although a prior caesarean doesn’t always necessitate another)
- Maternal medical conditions such as diabetes or high blood pressure
- You are having twins or triplets
- The baby is too big to fit through your pelvis
- Your baby is positioned bottom or feet first (breech) or sideways (transverse) and can’t be turned
- You have placenta previa, which means your placenta is blocking your cervix.
It is important to note that not all women will necessarily have caesareans in these circumstances. Each case is different and the decision will depend on your personal situation, and sometimes, preferences.
Reasons you might need an emergency caesarean
An emergency caesarean is required when unforeseen complications arise during labour and surgical intervention is needed to ensure the health of mother and baby. Some of the reasons for an emergency caesarean birth include:
- A maternal health problem, such as high blood pressure, is putting you or your baby at risk
- Your labour fails to progress or the baby’s head doesn’t move down through the pelvis
- Foetal monitoring picks up that your baby is showing signs of distress or that the baby’s health is compromised
- There is a risk the umbilical cord is around the baby’s neck.
What if I could have a vaginal birth but I want to have a caesarean?
The thought of labour can be overwhelming and particularly anxiety-provoking for some women. Because of the increased risks of a caesarean section, your doctor may refer you to a psychologist or counsellor to work through your concerns. If you’d still prefer a caesarean after counselling, discuss it with your obstetrician.
Potential risks and complications
A vaginal birth is generally the safest option for you and your baby. However, caesareans are very common in Australia and are relatively safe. Like any major surgery, caesareans involve some risks and potential complications, including:
- A longer stay in hospital and a longer recovery
- Pain from surgery
- Bladder damage
- Complications from the anaesthetic
- Blood clots in the legs
- Increased maternal blood loss
- Infection in the lining of the uterus
- Infection of the wound
- Increased risks with future attempts at vaginal birth
- A need for a caesarean section for future births.
Some considerations for your baby
Having a caesarean section has not been shown to increase or decrease the risk of your baby having the most serious complications. However, there are some things to be aware of if you have a caesarean.
- Babies born by caesarean section are more likely to have breathing difficulties, particularly babies born prematurely. Babies born after 39 weeks face a similar risk to those delivered via a vaginal birth.
- Having a caesarean is associated with breastfeeding difficulties and some mothers may need additional support to initiate it.
- During a vaginal birth the baby is exposed to vaginal fluid which assists the development of healthy gut flora. Babies born via caesarean can miss out on this bacteria. However, a pilot study has found that swabbing the baby’s mouth with the mother’s vaginal fluid may partially restore it. This isn’t standard practice so speak to your doctor if it interests you.
Australia's mothers and babies 2014 - in brief http://www.aihw.gov.au/publication-detail/?id=60129557656
Having a caesarean section https://www.betterhealth.vic.gov.au/health/healthyliving/caesarean-section
Having a caesarean section http://www.pregnancybirthbaby.org.au/caesarean
Having a caesarean section https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/Pages/cesarean.aspx
Vaginal birth after caesarean https://nichd.nih.gov/health/topics/obstetrics/conditioninfo/pages/after-cesarean.aspx
Pilot study on gut bacteria https://www.nature.com/nm/journal/v22/n3/full/nm.4039.html