Medical and Non-Medical Reasons for Cesarean Births

An Elective Cesarean section is a planned C-section, as opposed to an Emergency Cesarean section which is performed during labor.

Note: It is much better for mom and baby if a C-section is not performed until labor has begun spontaneously. This way you know for sure the baby is ready to be born and the hormones that help with birth, breastfeeding, etc have begun flowing. 


Why Doctors and Mothers choose Elective Cesareans for Non-Medical reasons:

1. The woman's pelvic floor will remain undamaged and this will save her from being incontinent of urine or feces.
To assume that stretching the vagina, one of the things it is made to do, will cause permanent damage is a misleading assumption. Studies have found that by middle age, there is no difference in the rate of incontinence among women who have had cesareans, vaginal deliveries, or those who have never given birth.

2. A desire to avoid the stresses and complications that might arise in a vaginal birth, such as long duration, exhaustion, fetal distress, the need for forceps or vacuum extractor. They perceive the potential for these risks to be more frightening than those accompanying cesarean birth.

3. Social reasons - convenience control over timing, apparent simplicity (scheduling it and baby is born in an hour).  This is really more convenient for the doctor, who is done in an hour, than for the mother who must recover for weeks. This is based on lack of information about risks of cesarean sections and the length and hardships of recovery.


Why Doctors and Mothers choose Elective Cesareans for Medical Reasons:

1. Doctors suggest the fearful possibilities that the baby will be too large to deliver vaginally, a failed induction can lead to an unplanned cesarean anyway, you may have a delay in getting an epidural and have to suffer pain, your labor is overdue, or the possibility of a uterine rupture during a VBAC (if mom has had a previous Cesarean section). Even if doctor coerces the mother into choosing a cesarean for these reasons, it is written down in her paperwork as "maternal request."

2. A breech baby (legs and/or butt first). Breech babies can be turned during pregnancy (ie, external version, I'm planning a post on this soon) or even during labor. Even un-turned breech babies can be delivered vaginally, but many doctors won't allow it and insist that if a baby is still breech at the due date than a C-section is necessary.
Obstetricians debate whether Cesarean section is always best for Breech babies (Washington Post)

3. Mother has a serious illness (heart disease, diabetes, preeclampsia) or injury.  Sometimes the doctor will allow the mother to attempt to labor under supervision.

Why Elective Cesareans are Riskier than Vaginal Births, International Cesarean Awareness Network (ICAN)




Medical Reasons for Cesarean Birth:
Although cesareans are not always necessary in these circumstances, they are almost always considered and very often performed.


1. Emergencies:
- Prolapsed Cord
- Serious hemorrhage (excessive bleeding) in the mother.

2. Arrested Labor/Failure to Progress:
* Note that when the doctor decides you have failed to progress may actually mean he just thinks you are taking too long, such as at the 8 hour mark, or when his shift is almost done for the day. (Recall that birth can take 24 or more hours).  Experts agree that far too many c-sections are performed for failure to wait. *
- Abnormal presentation of baby
- Inadequate uterine contractions
- A poor fit between baby's head and the mother's pelvis (sometimes given as a reason ahead of time, but is difficult to measure or predict)

3. Problems with the Fetus:
- Fetal distress. This is indicated by what the fetal heart monitor records or by checking the amniotic fluid for meconium (when baby is stressed it poops). It is another reason that frequent unnecesareans are performed, as the monitor can be wrong or interpreted incorrectly.
- Pre or post maturity.

4. Problems with the mother:
- A genital herpes sore
- A previous cesarean section and the VBAC is not going well

 
     "Cesarean rates are up to 50 percent or higher in some hospitals. Doctors often feel they must do a C-section to protect themselves from a malpractice suit. And many of them seem to feel that a C-section is actually better than vaginal birth. A lot of women are being given unnecessary surgery."
     "I had a C-section, but in my case it was necessary."
     "Tell me about it."
     "Well, the baby's heart rate started to drop on the fetal monitor, and the doctor was worried that she wasn't handling labor very well. So he said a C-section was the safest thing to do."
     Its an awkward conversation to say the least. I would never want to make any woman feel bad about the birth of her child... Having been told by both a doctor and a reliable-looking and expensive piece of machinery that her baby could be in trouble, my acquaintance probably made the best decision she could make in that moment. By the time sh reached the point when that decision was made, it could, in fact -- after hours of beeping noises on the fetal monitor, the suspense of the hospital atmosphere, and loads of chemicals pumping into her body -- have been the only choice available.
     Some percentage of women who think their C-sections were necessary -- because of fluctuating heart rates, large babies, failure to progress, previous C-sections, difficult birth positions, and on --- have actually had unnecessary C-sections. I know this because the World Health Organization says that any time a country's cesarean-section rate rises above 15 percent, the dangers of C-section surgery outweigh the life-saving benefits it is supposed to provide. In the US the overall C-section rate has now reached [over] 30.2 percent. -- From Cesarean Birth in a Culture of Fear, by Wendy Pointe