A cesarean section is a surgical procedure in which the baby is delivered through an incision made in mother’s abdomen. The rate of cesarean delivery in the United States is steadily rising; from 3-5% in 1970 to 29% in 2004. Since more and more women in the United States undergo cesarean section, a lot of questions remain unanswered.
Question: If I had a Cesarean section in the past, does that mean I will always need a cesarean section?
Dr. Bekker : No, you can have a vaginal delivery. It is very important to mention to your doctor early in pregnancy that you desire information on vaginal delivery after cesarean section. You and your obstetrician will determine if you are a good candidate for vaginal birth or if you should plan for an elective repeat cesarean section.
Question:What are the advantages of vaginal birth after cesarean section vs. planned elective cesarean section?
Dr. Bekker: Cesarean section is a surgical procedure, so it is associated with all the risks that surgery entails, such as risk of infection, major bleeding, risk of developing blood clots, longer hospital stay, more pain after surgery, abdominal scar, just to mention the most common.
However, there are some advantages to scheduled cesarean section: known time of delivery, eliminating the fear of unknown and eliminating rare but potentially serious complication of vaginal birth after cesarean delivery, uterine rupture (the separation of the uterine scar from previous surgery).
Question: Is there a maximum number of cesarean sections that are “safe”?
Dr. Bekker : There is no “magic number”. However, as the number of cesarean sections increases, so does the risk of complications. The most common complications are abnormal position of placenta, dense adhesions (scar tissue) inside the abdomen, and longer time of surgery.
Question: Can I request a cesarean delivery by choice?
Dr. Bekker : Yes, you can. Recently, the incidence of cesarean section on maternal request became more accepted by doctors. In 2002 2 % of all births were via cesarean delivery by choice. However, you should bring up this issue with you obstetrician early in the pregnancy, so you can have a detailed discussion on risks and benefits of this elective surgical procedure and that both you and your doctor feel comfortable with the decision.
Question: What are the most common reasons to perform a cesarean delivery?
Dr. Bekker : There are numerous reasons for cesarean delivery, I will just mention the most common reasons.
— Labor is not progressing as it should: cervix is not dilating or baby is not descending down the birth canal
—The baby is not tolerating labor well as suggested by baby’s heart rate tracing
—The baby is in the wrong position (e.g. lies across the mother’s abdomen or buttocks first)
—Heavy vaginal bleeding
—Mother had a previous cesarean delivery and either does not want or can not have a vaginal delivery
—The baby is too big
—The placenta is covering the cervix
Genia Bekker , MD