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Avoid a Cesarean: Know the Facts

Written by Pathways Magazine   
Tuesday, 01 December 2009 00:00
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These facts are presented by the International Cesarean Awareness Network with the hope that parents, childbirth educators, doulas, nurses, midwives and doctors together can effectively reduce the rate of unnecessary cesarean sections and their effects.

A cesarean section is major abdominal surgery used for the delivery of an infant through an incision in the mother’s abdomen and uterus. The incision may be made across the bottom of the abdomen above the pubic area (transverse) or in rare instances, in a line from the belly button to the pubic area (vertical).

Many reasons given for a cesarean, especially prior to labor, can and should be questioned. These include macrosomia (large baby), maternal age and parity, assisted reproductive technology, CPD, dystocia, failure to progress, breech, fetal distress and even prolonged second stage. There are very few true indications for a cesarean section in which the risks of surgery will outweigh the risks of vaginal birth.

When a cesarean is necessary, it can be a lifesaving procedure for both mother and baby. However, psychological outcomes such as negative feelings, fear, guilt, anger and postpartum depression are common consequences of both emergent and elective cesarean sections. A cesarean section is only indicated in the following situations:

  • complete placenta previa at term

  • transverse lie at complete dilation

  • prolapsed cord

  • abrupted placenta

  • eclampsia or HELLP with failed induction of labor

  • large uterine tumor that blocks the cervix at complete dilation (most fibroids will move upwards as the cervix opens, moving it out of baby’s path).

  • true fetal distress, confirmed with a fetal scalp sampling or biophysical profile

  • true absolute cephalopelvic disproportion or CPD (baby too large for pelvis). This is extremely rare and only associated with a pelvic deformity (or an incorrectly healed pelvic break). Fetal positioning during labor and maternal positioning during second stage, most notably when women are in a semi-sitting position, cause most CPD diagnosed in current obstetrics.

  • initial outbreak of active herpes at the onset of labor

  • uterine rupture