A C-section, also known as a cesarean section, is a surgical procedure used to deliver a baby through incisions in the abdomen and uterus. It is usually done when a vaginal delivery would put the baby or mother at risk. The chances of needing a C-section depend on many factors relating to the mother, baby, and pregnancy. Some of the key factors that can increase the likelihood of having a C-section include:
Previous C-sections
Women who have had one or more previous C-sections are very likely to have a repeat C-section for future births. This is because there is a risk of uterine rupture along the scar line from the previous incision. The risk of rupture may be as high as 1 in 200 for women attempting vaginal birth after cesarean (VBAC). Multiple previous C-sections further increase this risk. Therefore, many doctors and women choose to schedule a repeat C-section rather than plan for VBAC.
Labor complications
Problems that arise during labor and delivery often result in unplanned C-sections. Difficulties such as slow dilation of the cervix, failure of labor to progress, fetal distress, umbilical cord problems, and abnormal fetal position can all prompt a doctor to recommend a C-section. Additionally, when labor is induced, the chances of C-section are increased, especially in first-time mothers. This may be due to inductions resulting in stronger, more difficult to manage contractions.
Health conditions
Maternal health conditions that may make vaginal delivery risky include heart disease, high blood pressure, diabetes, HIV/AIDS, blood clotting disorders, herpes outbreak, eclampsia, and placental problems. Babies who are very large, in the breech position, or have abnormalities may also lead medical teams to opt for C-section. Other risk factors like advanced maternal age and obesity can also influence the chances of needing a surgical delivery.
Multiple births
The chances of C-section are very high with multiple births such as twins, triplets or more. Well over half of twin deliveries in the U.S. are by C-section. The increased risks to both mother and babies during vaginal delivery of multiples often leads medical teams to recommend planned C-section.
Reasons for Increased C-Section Rates
The rates of cesarean sections have risen greatly over the past several decades. In the 1960s, about 1 in 20 births were delivered via C-section. Today, about 1 in 3 women in the U.S. have the surgery. There are a few key reasons behind this dramatic increase:
Lower threshold for surgical delivery
Many experts cite a lower threshold for performing C-sections as a major driver of the upward trend. Providers today are quicker to recommend surgical delivery at the first sign of any complication or difficult labor. Reasons like non-reassuring fetal heart rate that would previously have resulted in more observation now frequently lead straight to C-section.
Higher-risk pregnancies
Over the years, more women have been having babies later in life and utilizing fertility treatments – both of which can increase pregnancy risks. The rates of obesity, diabetes, and high blood pressure have also risen, which are additional risk factors. With higher-risk pregnancies, the chances of needing a C-section are greater as well.
Elective inductions
Rates of electively induced labor before 39 weeks have risen sharply. However, inductions can increase the likelihood of C-section. When labor is artificially started before the woman’s body and baby are necessarily ready, it often does not progress smoothly on its own, which culminates in surgery.
Liability concerns
Many doctors cite fears of liability as a key driver of escalating C-sections. Even when a vaginal delivery is possible, physicians often choose surgery to minimize any potential risks and legal concerns if something goes wrong during labor. The prevailing mentality is often “better safe than sorry.”
Patient preferences
More women today seem to prefer the aspects of safety, convenience, and control associated with planned C-sections. Though vaginal delivery has fewer risks and easier recovery, scheduled surgery can seem predictable. Elective C-sections allow women to avoid labor uncertainty and plan for their delivery date.
Risks of C-section
While a C-section can be life-saving when medically warranted, it does pose more risks than a vaginal delivery. It is major abdominal surgery and requires a longer recovery. Some of the risks include:
Infection
Infection of the surgical incision or uterus occurs in up to 15% of C-sections. Symptoms like fever, foul discharge, and abdominal pain usually arise 3-7 days after delivery if infection develops. Treatment involves IV antibiotics and drainage if pus has formed.
Blood loss
Blood loss of over 1000 mL occurs in about 6% of C-sections. Severe bleeding usually results from issues with the placenta detaching or the uterus contracting and sealing off blood vessels. Blood transfusions may be needed, along with medications to promote uterine contraction.
Blood clots
C-section increases the risk of blood clots in the legs or lungs compared to vaginal delivery. Clots occur due to inactivity after surgery combined with pregnancy-related increased clotting. Preventive blood-thinning medication is often prescribed after C-section.
Injury to other organs
Although rare, accidental nicks or cuts to organs like the bladder or bowel can occur during the surgery, usually resulting in further repair procedures. There are also risks involved with anesthesia such as airway difficulties or adverse reactions to medications.
Hysterectomy
In very rare cases, severe bleeding or infection can require an emergency hysterectomy to stop ongoing complications and save the mother’s life. Future pregnancy is no longer possible after removal of the uterus.
Recovery after C-section
Recovering after a cesarean section typically takes longer than after vaginal birth. Healing occurs for around 6 weeks as the incision mends and internal organs return to normal:
Hospital stay
Most women remain in the hospital 2-4 days after a C-section. Those with complications like excessive bleeding may require a longer stay of up to a week.
Incision pain
Discomfort near the abdominal incision is common for at least the first week after delivery. Medications are given to help manage the post-surgical pain.
Activity restrictions
Doctors advise avoiding stairs, driving, and heavy lifting for 4-6 weeks after C-section. Gradually increasing activity over time is recommended to allow proper healing. Sexual intercourse can usually be resumed after about 4 weeks.
Bowel function
The digestive system can take some time to return to normal after surgery. Anesthesia, pain meds, and inactivity all contribute to post-delivery constipation, gas, and abdominal discomfort.
Future pregnancies
Women often wait around 18 months after a C-section before attempting another pregnancy. This allows the uterus adequate time to heal in order to lower risks in subsequent births.
Conclusion
Cesarean sections can provide critical access to delivery when complications arise. However, the surgery does carry increased risks compared to vaginal birth. Women should be educated on the chances of needing a C-section based on their individual pregnancy circumstances and risks. Doctors should also counsel patients thoroughly on the benefits and drawbacks of planned C-section versus trial of labor. With quality information, women can make informed choices regarding delivery and have the healthiest pregnancies and babies possible.
| Factor | Impact on C-Section Risk |
|---|---|
| Previous C-section(s) | Greatly increases risk due to uterine rupture concerns |
| Labor complications | Issues like slowed dilation or fetal distress often lead to unplanned C-section |
| Maternal health conditions | Problems like diabetes, high blood pressure, etc raise chances of needing surgery |
| Multiple pregnancy | Twins/triplets have very high rates of C-section compared to singletons |
| Advanced maternal age | Older women have higher risks of complications requiring C-section |
| Obesity | Obese women have increased chances of needing unplanned C-section |