A cesarean delivery is a birth through an incision in the abdominal wall and uterus rather than
through the vagina. There has been a gradual increase in cesarean births over the past 30 years. In November of
2005, the Centers for Disease Control and Prevention (CDC) reported the national cesarean birth rate was the
highest ever at 29.1%, which is over a quarter of all deliveries. This means that over 1 in 4 women will experience
a cesarean delivery. The World Health Organization has stated that every region globally really should not have a
cesarean rate higher than 10-15%.
What are the Reasons that Cesarean Deliveries are
There are many reasons why a health care provider may feel that you need to have a cesarean
delivery. Some cesareans occur in critical situations, some are used to prevent critical situations and some are
Placenta previa: This occurs when the placenta lies low in the uterus and partially or
completely covers the cervix. 1 in every 200 pregnant women will experience placenta previa during their third
trimester. The treatment involves bed rest and frequent monitoring. If a complete or partial placenta previa has
been diagnosed, a cesarean is usually necessary. If a marginal placenta previa has been diagnosed, a vaginal
delivery may be an option.
Placental abruption: This is the separation of the placenta from the uterine lining that usually
occurs in the third trimester. Approximately 1% of all pregnant women will experience placental abruption. The
mother will experience bleeding from the site of the separation and pain in the uterus. This separation can
interfere with oxygen getting to the baby and depending on the severity, an emergency cesarean may be
Uterine rupture: In approximately 1 in every 1,500 births the uterus tears
during pregnancy or labor. This can lead to hemorrhaging in the mother and interfere with the babies oxygen supply.
This is a reason for immediate cesarean.
Breech position: When dealing with a breech baby, a cesarean delivery is often the only option,
although a vaginal delivery can be done under certain circumstances. However, if the baby is in distress or has
cord prolapse (which is more common in breech babies) a cesarean is necessary. A cesarean may also be done if the
baby is premature.
Cord prolapse: This situation does not occur often but when it does an
emergency cesarean is done. A cord prolapse is when the umbilical cord slips through the cervix and protrudes from
the vagina before the baby is born. When the uterus contracts it causes pressure on the umbilical cord which
diminishes the blood flow to the baby.
Fetal distress: The most common cause of fetal distress is lack of oxygen to
the baby. If fetal monitoring detects a problem with the amount of oxygen that your baby is receiving, then an
emergency cesarean may be performed.
Failure to progress in labor: This can occur when the cervix has not dilated
completely, labor has slowed down or stopped, or the baby is not in an optimal delivery position. This can be
diagnosed correctly once the women is in the second phase (beyond 5 centimeters dilation), since the first phase of
labor (0-4 centimeters dilation) is almost always slow.
Repeat cesarean: You may be surprised to find out that 90% of women who have
had a cesarean are candidates for a vaginal birth after cesarean for their next birth (VBAC). The biggest risk
involved in a VBAC is uterine rupture, which happens in 0.2-1.5% of VBACs. However, there is a criteria you must
meet in order to have a VBAC. Consult with your health care provider about your current situation and your
Cephalopelvic Disproportion (CPD): A true diagnosis of CPD occurs when a baby's
head is too large or a mother pelvis is too small to allow the baby to pass through.
Active genital herpes: If the mother has an active outbreak of genital herpes
(diagnosed by a positive culture or actual lesions), a cesarean may be scheduled to prevent the baby from being
exposed to the virus while passing through the birth canal.
Diabetes: If you develop gestational diabetes during your pregnancy or are
diabetic, you may have a large baby or other complications. This increases your chance of having a cesarean.
Preeclampsia: Preeclampsia is a condition of high blood pressure during pregnancy. This
condition could prevent the placenta from getting the proper amount of blood needed and decrease oxygen flow to the
baby. Delivery is sometimes recommended as a treatment for this condition. Only with severe preeclampsia is a
Birth defects: If a baby has been diagnosed with a birth defect, a cesarean may
be done to help reduce any further complications during delivery.
Multiple births: Twins may be delivered vaginally depending on their positions,
estimated weights and gestational age. Multiples of three or more are less likely to be delivered vaginally.