C-section or caesarean delivery is an alternative method for vaginal delivery of a baby.
In a C-section or CS, doctors make a surgical cut into both the walls of the woman's abdomen and then the uterus in order to extract the baby.
Why though is it necessary?
Now, this may sound obvious - but some women may not understand why they cannot undergo vaginal delivery.
After all, everyone should know it is a procedure to reduce the risk of problems to 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-Section?
There are 2 types of CS.
A planned or elective CS - in which case obvious reasons emerge ahead of time 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 very rapidly indicating that if prompt action is doesn't happen within minutes, there may be loss of life.
So, that's a brief look at what a C-section involves. In the next segment, we'll look at the common reasons 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 is to reduce respiratory distress in the neonate – known as Transient Tachypnoea of the Newborn.
By this stage, we believe the baby's lungs are mature enough to cope after they are born.
C-Section for Mum's sake
- Previous C-Section.
- 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 both Mum and baby from break down 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 be as a result of 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 for instance from 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 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 descent of the baby into the birth canal.
- This is called the 'presentation' of the head.
- In a lot of cases, however, other parts of the baby present instead.
- If the baby has turned so that 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 the example the 'lie' of the baby being unstable.
- Usually, the lie of the baby is cephalic in which its head is leading 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 my 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 cephalic to transverse lie which is also known as an unstable lie.
- As you can see, an unstable lie will cause problems for a vaginal delivery.
- There are other problems with a baby's presentation and position that may require a caesarean section.
- Infection in the baby
- If it were thought that the baby has developed an infection in the womb, the priority would be for prompt delivery; and if vaginal delivery is felt unsuitable; then a C-section would be advised.
- 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.
- Multiple pregnancies
- 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 vaginal birth is attempted
- 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 so the placenta is crucial to its survival.
- It is an organ rich with blood vessels so that damage to the placenta can lead to a lot of bleeding in a very short time.
- 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 cephalopelvic disproportion.
- Basically this means that the baby's head is larger than the Mum's pelvis so that if she tries to deliver vaginally, the baby's head may be stuck which could cause death and 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.
Other conditions may arise which will need a discussion and counselling to establish the best way forward for both mum and baby.
So we've had a long look at some reasons why a woman may need a c section
Have you found this post helpful? Like and let me know in the comments. Till next time - keep safe and keep those hands clean.