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Description
Until recently the operation was usually used as a last resort because of a high rate of maternal complications and death. With the availability of antibiotics to fight infection and the development of modern surgical techniques, the once high maternal mortality rate has dropped dramatically. As a result, the cesarean childbirth rate has increased dramatically.
There are two main types of cesarean operations, each named according the location and direction of the uterine incision:
Cervical, a transverse (horizontal) or vertical incision in the lower uterus
Classical, a vertical incision in the main body of the uterus
Today, the cervical transverse incision is used almost exclusively. It has the lowest incidence of hemorrhage during surgery as well as the least chance of rupturing in later pregnancies.
Sometimes, because of fetal size (very large or very small) or position problems (breech or transverse), a low vertical cesarean may be performed. In the classical operation, a vertical incision allows a greater opening; it is used in some emergency situations as well as for fetal size or position problems. This approach involves more bleeding in surgery and a higher risk of abdominal infection.
Although any uterine incision may rupture during a subsequent labor, the classical is more likely to do so, and more likely to result in death for the mother and fetus than a cervical incision.
There are many reasons why a woman might need to deliver by Cesarean section, although not all doctors agree on when one is really necessary. The most common reason is dystocia, labor that is said to be progressing abnormally. This usually means failure to progress (FTP), where labor has stalled because the cervix has stopped dilating or uterine contractions are weak or have stopped completely. Another cause of dystocia is cephalopelvic disproportion (CPD), a rare condition in which the baby's head is too large to fit through the mother's pelvis.
In addition to dystocia, there can be other reasons for a cesarean:
Malposition of the fetus. In breech position, the baby's buttocks or feet are positioned to come out first instead of the head. Twins might need to be delivered by cesarean if the first baby or both are breech. Malposition of the fetus does not necessarily mean a cesarean delivery.
Fetal distress. The baby is having a serious problem, such as a compressed umbilical cord (which could reduce the flow of oxygen to the baby) or an erratic heartbeat. The most prudent course of action is for the doctor to confirm fetal distress with tests if he or she suspects it, before ruling out vaginal delivery.
Vaginal bleeding/placenta previa/placental abruption. Vaginal bleeding late in pregnancy often indicates placenta previa, a low-lying placenta that covers part or all of the inner opening of the cervix (see Health profile: Placenta Previa). If the bleeding does not stop with bedrest, the doctor probably will perform a cesarean, to prevent hemorrhage. Vaginal bleeding late in pregnancy also may indicate placental abruption, where the placenta separates from the uterine wall before delivery. In some cases of mild abruption, it may be possible to deliver vaginally. If there is heavy bleeding or fetal distress caused by abruption (abruption can lead to maternal shock, which, together with a reduced amount of functioning placenta, can deprive the fetus of adequate oxygen), a cesarean generally is necessary.
Other situations. If you have vaginal herpes, your doctor might do a cesarean to try to prevent your passing on the disease to your baby. If you have a chronic condition, such as diabetes, high blood pressure, or heart or pulmonary disease, a cesarean delivery might be safer than a vaginal birth. Research is still being done on whether a cesarean can prevent transmission of HIV from mother to baby.
Until recently, it was medically accepted that once a woman had a c-section, she should have all of her children by cesarean because of the concern about tearing the incision. Yet studies have shown "once a cesarean, always a cesarean," no longer holds true for most women.
Today, the option of attempting to give birth through the vagina is open to women who have had previous cesarean births, and over half of these have successful vaginal deliveries.
If vaginal delivery is a possibility for you, here are some reasons why you may wish to attempt it:
Less risk. A vaginal delivery usually has fewer complications for the mother than a cesarean birth. As there is no abdominal incision, the risks of infection, bleeding, or other problems resulting from surgery or anesthesia are much lower.
Shorter recovery. Your stay in the hospital is likely to be briefer after vaginal delivery. The average time spent in the hospital is 1 to 3 days, whereas the average stay after a cesarean birth is 3 to 5 days. Recovery at home is faster as well, since women who deliver by cesarean must limit their activity for 4 to 6 weeks to allow the abdominal incision to heal.
More involvement. Some women wish to be awake and fully involved in the birth process. There may also be more limitations on the presence of others in the room during the cesarean birth process.
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