And, yes, this may sound obvious – but some women may not understand why they cannot undergo vaginal delivery.
After all, it seems clear CS is necessary to reduce the risk of problems for Mum and baby that may happen in a vaginal birth.
But what specific conditions will make it necessary for a woman to undergo a C-section?
We will address specific causes shortly, but first:
What are the Types of C-Sections?
There are 2 types of CS.
A planned or elective CS – in which case obvious reasons emerge ahead of delivery that could make the vaginal birth dangerous to the mum and baby.
This is one of the key reasons antenatal care during your pregnancy is so important.
It helps your doctors and nurses identify possible risks that may mean that vaginal birth is not safe for you or the baby.
On the other hand, in an emergency caesarean section, events happen rapidly, indicating that if prompt action doesn’t happen within minutes, there may be a loss of life.
So, that’s a brief look at what a C-section involves. Now, we’ll examine why a woman may need a CS.
Reasons for C-Section
The reasons for a planned CS may be due to issues with the mother or baby.
In some cases, it may affect both mum and baby.
An elective C-Section usually happens after 39 weeks of pregnancy.
This reduces any problems in the new baby (like breathing problems) that may happen because of immature organs.
By this stage, we believe the baby’s lungs are mature enough to cope with life after birth.
C-Section Reasons for Mum’s sake
Most often, women who have had C-sections in the past will be offered a C-section again.
This is especially following more than 1 previous C-section.
Doing so significantly reduces the risk of harm to Mum and baby from the breakdown of a C-Section scar if she has a vaginal birth.
However, following just one previous C-section, some women may wish to consider a vaginal birth (VBAC).
Problem with Mum’s delivery canal – for a variety of reasons.
Problems in the pelvis that could prevent the baby’s smooth transition to the vaginal canal during labour – like Fibroids.
Problems in the lower genital tract, like the neck of the womb or vagina.
These could be from cancer, fibroids, or any other problem which can obstruct the birth canal.
It could also result from an infection like Primary Genital Herpes (HSV) in the third trimester.
This is because, by this stage, maternal antibodies to Herpes have not had enough time to develop and cross the placenta to protect the baby.
A vaginal birth would place the baby at risk of developing Herpes.
Other problems may be previous injuries to the mum’s perineum, such as severe cuts or tears, possibly from previous pregnancies. (3rd or 4th-degree perineal tears)
Heart disease in the mum which could lead to severe strain if she proceeds to deliver vaginally.
Other transmissible infections like poorly controlled HIV.
There is a risk that infection may transmit from mum to baby as the baby passes through the birth canal if there is poor control of the disease.
C-section Reasons for Baby’s sake
These are problems that affect the baby if it is allowed to attempt passage through the birth canal.
Abnormal presentations. In a normal vaginal delivery, the baby’s head leads the baby’s descent into the birth canal.
This is called the normal ‘presentation’ of the head. In many cases, however, other parts of the baby ‘present’ instead.
If the baby has turned, so its bottom is presenting, this is called a breech presentation.
A breech presentation at term will usually lead to a caesarean section.
There are other abnormal presentations – for example, the ‘lie’ of the baby being unstable.
Usually, the baby’s lie is cephalic, in which its head leads into the mum’s pelvis.
Towards the end of the 3rd trimester, most babies will adopt the cephalic lie and maintain that into labour.
However, other types of lie may occur – a transverse lie where the baby is lying across in the womb.
Or an oblique lie.
In addition, the baby may switch from an oblique to a cephalic to a transverse lie, also known as an unstable one.
As you can see, an unstable lie will cause problems with a vaginal delivery.
Other problems with a baby’s presentation and the position may require a caesarean section.
Infection in the baby
If we think that the baby has developed an infection in the womb, the priority would be prompt delivery. If vaginal delivery is felt unsuitable, then a C-section would be the next step.
Abnormal development of the baby.
This could be from early-onset growth and development problems, or abnormalities picked up early on fetal scans.
In these cases, it may be that the baby will not be able to cope with a vaginal birth.
This will include twin or other multiple births where the first baby is not presenting with the head (cephalic).
C-section for both Mum and Baby’s sake
These are reasons that put both mum and baby at risk if they attempt to deliver via the vaginal route.
Problems with the placenta.
The placenta is the organ through which the baby is fed and receives its blood supply from the mum.
Before birth, the baby’s organs are not yet functioning, and the placenta is crucial to its survival.
It is an organ rich in blood vessels, so damage to the placenta can quickly lead to much bleeding.
Problems with the placenta can range from an abnormally positioned placenta (placenta previa) to one that is too deeply embedded in the womb (placenta accreta).
These could result in severe bleeding if vaginal birth is attempted compromising both baby and Mum.
Abnormal labour due to size problems.
Basically, this means that the baby’s head is larger than the Mum’s hips (pelvis) so that if she tries to deliver vaginally, the baby’s head may be stuck, leading to death or other serious complications.
Maternal conditions like Diabetes can cause babies to grow quite large – weight more than 4.5kg.
Vaginal delivery could lead to prolonged labour or obstruction and other complications.
This is not an exhaustive list of reasons for C/section and being pregnant; you should be familiar with some of the reasons it may become necessary.
Remember, you may be unable to prevent some, but being aware and paying prompt attention if a C/S becomes necessary means better results.
Other conditions may arise, which will need discussion and counselling to establish the best way forward for both mum and baby.
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