Cesarean Section (C-Section)

Most healthy pregnant women with no risk factors for problems during labor or delivery have their babies vaginally. Still, the rate of babies born by cesarean section (c-section) in the U.S. is on the rise.  According to the National Center for Health Statistics, 1 in 3 babies in the United States is delivered by cesarean section. 

The following information, adapted from the 4woman, March of Dimes, and Medem websites, will help you understand what a C-section is and how you may be affected by a C-section.

During a c-section, the doctor makes a cut in the mother's abdomen and uterus and removes the baby. So, the baby is delivered through surgery instead of coming out of the vagina. Most women get assistance with pain management (spinal or epidural anesthesia) during a c-section.

C-section can be a lifesaving operation when either you or your baby face certain problems before or during labor and delivery. Many women who deliver surgically do not expect it. Most cesarean sections go well for both the mother and the baby.  Some health care experts believe that many c-sections are medically unnecessary. A cesarean section is major surgery and should be done only when the health of the mother or baby is at risk.

Most healthy pregnant women with no risk factors for problems during labor or delivery have their babies vaginally. However, the rate of babies born by cesarean section (c-section) in the United States is on the rise. In 2004, 29% of babies were born by c-section in this country.

Many experts think that up to half of all c-sections are unnecessary and the U.S. government is trying to reduce the rate. So it is important for pregnant women to get the facts about c-sections before they deliver. Women should find out what c-sections are, why they are performed, and the pros and cons of this surgery.

There are many reasons why a cesarean birth may be used to deliver your baby. It may be the best approach for both you and your baby. A cesarean delivery may be planned in advance when certain conditions are known. In some cases, if problems arise, the decision is made during labor.  Studies show that the benefits of having a c-section may outweigh the risks when:

Can I choose to have a C-section if I want it?

Some women may prefer to have a cesarean section instead of a vaginal birth, even without medical need. It may be appealing for both the woman and the health care provider to consider cesarean because it helps them plan their schedules. Some women ask for c-section because they are worried about the pain of vaginal delivery. Others like the convenience of being able to decide when and how to deliver their baby. Still others fear the risks of vaginal delivery including tearing and sexual problems.

But is it safe and ethical for doctors to allow women to make medical decisions? The answer is unclear and many obstetricians feel it is their ethical obligation to talk women out of elective c-sections. Others believe that women should be able to choose a c-section if they understand the risks and benefits. And others C-sections should only be performed for medical reasons point to the risks.

If you are planning to have several children, cesarean section by request is not recommended.

Can I have a vaginal birth after I have had a C-section birth?

Some women who have delivered previous babies by c-section would like to have their next baby vaginally. This is called vaginal delivery after c-section or VBAC. Women give many reasons for wanting a VBAC. Some want to avoid the risks and long recovery of surgery. Others want to experience vaginal delivery.

Studies show that VBACs are more risky for the woman and baby than a repeat c-section. The most serious danger of VBACs is the chance that the c-section scar on the uterus will open up during labor and delivery. This is called uterine rupture. While very rare, uterine rupture is very dangerous for the mother and baby. Less than 1 percent of VBACs lead to uterine rupture.

Choosing to try a VBAC is a difficult decision for many women. If you are interested in a VBAC, talk to your doctor and read up on the subject. Only you and your doctor can decide what is best for you. The American College of Obstetricians and Gynecologists (ACOG) recommends that doctors consider VBACS when:

What are the risks involved in a C-section?

When c-sections are done, most women and babies do well. But c-section is a major operation with risks from the surgery itself and from anesthesia.

A woman who has a c-section usually takes longer to recover than a woman who has had a vaginal birth. Women can expect to stay 3 to 4 days in the hospital after a c-section. Full recovery usually takes 4 to 6 weeks. Usually, the hospital stay for vaginal birth is 2 days, with full recovery taking less time than a cesarean.

C-sections can be dangerous for the mother and baby. This major surgery increases the risk of infection, bleeding and pain in the mother. C-sections also increase the risk of problems in future pregnancies. Women who have had c-sections have a higher risk of uterine rupture. If the uterus ruptures, the life of the baby and mother is in danger.

A few women have one or more of these complications after a c-section:

C-sections may contribute to the growing number of babies who are born late preterm, between 34 and 36 weeks gestation. While babies born at this time are usually considered healthy, they are more likely to have medical problems than babies born a few weeks later at full term.  It can be hard to pinpoint the date your baby was conceived. Being off by just a week or two can result in a premature birth. This may make a difference in your baby's health. Compared to a full-term baby, an infant born between 34 and 36 weeks gestation is more likely to have problems with breathing, feeding, maintaining body temperature, and jaundice.

Some babies are affected by the drugs given to the mother for anesthesia during surgery and they may cause the baby to be inactive or sluggish. Even if they are full-term, babies born by c-section are more likely to have breathing problems than are babies who are delivered vaginally.