Cesarean sections are necessary in some situations

Although you may assume your baby will be born vaginally, events don't always unfold as planned during labor. It's possible that your provider will advise you in advance that a cesarean section (c-section) may be necessary. A cesarean section is the surgical delivery of a baby through an incision in the abdomen and the uterus.

Because the procedure is so common, it's easy to forget that it's surgery. A cesarean should only be done when the health of the baby or mother is at risk, according to the March of Dimes. Estimates place the cesarean rate as high as 25 percent in the United States. Some people feel that's too high, but it's hard to know what an ideal rate is.

You may feel disappointed at having a cesarean or relieved to resolve the events leading up to the cesarean. Either way there are good reasons why the surgery may be necessary.

When is a cesarean birth necessary?

Big baby. Sometimes a baby is just too big to pass through the pelvis. Excellent nutrition or Mom's diabetes are reasons a baby can be large.
Multiple pregnancies. It's much more common for women carrying two or more babies to need a cesarean. Many women with twins deliver vaginally, but with more babies vaginal delivery can cause more risk to the babies.
Difficult labor. About one-third of all cesareans are performed because labor stops, according to the American College of Obstetricians and Gynecologists.
Umbilical cord problems. If the cord gets pinched and not enough blood is flowing to the baby, a cesarean may be necessary.
Placenta problems. Delivery can be blocked by a condition called placenta previa, in which the placenta is below the baby and covers the cervix. There is another problem called abruptio placenta, in which the placenta separates before the baby is born and cuts off oxygen to the baby.
Medical conditions. If you have diabetes, high blood pressure or an active herpes infection, a vaginal birth may not be safe in some circumstances.
Previous cesarean. Many women who have had a cesarean have a successful vaginal delivery with a later child (Vaginal Birth After Cesarean or VBAC). Some women will need to have a cesarean again. The decision is usually based on the type of incision that was used.

What does a cesarean involve?

A nurse may wash and shave your lower abdomen. You will receive some anesthesia so you won't feel pain during the surgery. Usually an epidural block or spinal block is given. You remain awake. In rare instances, such as a need for an immediate emergency cesarean, a general anesthetic is used. Both an epidural block or a spinal block involve numbing the lower half of your body. The anesthesiologist will talk to you about the kind of anesthesia you want and take your preferences into account.

A low horizontal incision is preferred over a vertical one. There is less bleeding and a stronger scar. The baby will be delivered through the incision.

You will probably stay in the hospital for 2-3 days if you have a cesarean. When you go home you will need to take care of yourself and limit your activities. After all, you will have birthed a baby AND had surgery all at once.

Date last reviewed: April 2005.

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