The top medical reasons for a c section - Ruth Health

The top medical reasons for a c section

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Fast facts:

  • While c sections are overprescribed in the U.S. and other countries, they are an important, potentially life-saving procedure during high-risk pregnancies and labors.
  • Understanding the medical reasons for a c section can help you advocate for yourself if you have concerns about your care team’s recommendations.
  • Medically necessary c sections may be planned in advance due to pregnancy complications or health factors that make vaginal delivery unsafe. Some are performed unexpectedly due to prolonged labor or health risks that emerge during the birthing process.
  • Consider working one-on-one with a doula to determine the safest delivery option for your pregnancy.

A cesarean section is the surgical delivery of a baby through incisions in the abdomen and uterus. It is an important, potentially life-saving procedure that can protect the health of both birthing person and baby during high-risk pregnancies or labors.

The risks and benefits of cesarean deliveries vary by circumstances. C sections are major surgeries with the potential for complications such as blood loss, blood clots, and infections. 

Many health experts consider vaginal delivery the safest option for most healthy pregnancies. In recent years, the U.S.’s c section rate has consistently hovered above 30%, far exceeding the World Health Organization (WHO) recommendation of 10-15%.

But despite the overuse of c sections in the U.S. and many other countries, they are medically necessary and safer than vaginal births in some cases.

Understanding the medical reasons for c section can help you advocate for yourself if you have concerns about your care team’s recommendations for delivery.

Learn when a scheduled or emergency c section may be the safest option.

What is a c section?

During a c section, a doctor makes surgical incisions in the abdomen and uterus to deliver a baby.

There are three types of uterine incisions commonly used during a c section:

  • A low transverse incision, which runs horizontally across the lower part of the uterus. It is the most common uterine incision and the least likely to rupture during a trial of labor after cesarean (TOLC).
  • A low vertical incision, which runs vertically in the lower, thinner part of the uterus. It carries a higher risk of uterine rupture than a low transverse incision during a TOLC.
  • A high vertical, or “classical,” incision, which runs vertically in the upper part of the uterus. It has the highest risk of uterine rupture during a TOLC.

You have the right to choose your c section incision. If you are planning to have a c section but may want to deliver vaginally in the future, discuss incision options with your OB/GYN.

Most cesarean deliveries are performed under regional anesthesia — which numbs the lower part of your body and allows you to be awake when your baby is born — but general anesthesia is medically necessary during some c sections.

C section recovery is a gradual process. It typically requires a hospital stay of two to three days. You should be able to safely resume daily activities and wear regular clothes without discomfort after six to eight weeks. 

Full recovery, in terms of overall physical rehabilitation, often takes 6-12 months or more.

What is a medically necessary c section?

Medically necessary c sections, in contrast to elective ones, are performed to protect the health of a birthing person and/or their baby. There are planned and emergency c sections.

  • A planned c section is scheduled in advance based on existing health conditions or pregnancy complications.
  • An emergency c section is performed immediately if a birthing person or baby’s health becomes high risk before or during labor.

What are medical reasons for a planned c section?

A provider may recommend a planned c section due to pregnancy complications or health factors that make vaginal delivery unsafe.

These are the most common reasons for a planned c section.

Abnormal positioning

The optimal position of a baby during a vaginal delivery is headfirst near the birth canal. If a baby is breech (feet positioned toward the birth canal) or transverse (lying on their side or shoulder first), some hospitals require delivery by cesarean section for health and safety reasons.

However, a vaginal breech delivery may be possible with an experienced provider. Birthing centers and home births also have a high success rate of vaginal breech births.

Birth defects

Certain birth defects such as congenital heart disease or severe hydrocephalus — the accumulation of fluid in a baby’s brain — may require a c section to lower the risk of delivery complications.

Placenta previa or placental abruption

A c section is medically necessary when pregnancy complications affect the placenta.

There are two main types of complications that may occur:

  • Placenta previa, a condition in which the placenta covers the cervix, at full gestation
  • Placental abruption, a condition in which the placenta separates from the uterus, potentially depriving a baby of oxygen

Carrying multiples

Some providers recommend c sections for multiple births, which are sometimes associated with prolonged labor or abnormal positioning of one or more babies.

(Note that prolonged labor on its own should not be a reason for a c section unless a birthing person feels it’s necessary.)

Chronic health condition

Doctors may recommend a planned c section if a chronic health condition makes vaginal delivery unsafe for a birthing person — for example, heart disease or high blood pressure

A c section is also medically necessary when the birthing person has a disease that could be transmitted to the baby during a vaginal birth, such as HIV or genital herpes.

Previous cesarean delivery

Many women are able to safely deliver vaginally after a c section, but a doctor may recommend a repeat c section if the potential for complications such as uterine rupture is high.

Your risk of uterine rupture — a rare but serious complication — depends significantly on the type of uterine scar you have from your previous cesarean.

A vaginal birth after cesarean (VBAC) is not recommended for those who had a high vertical incision in a prior c section.

What are the reasons for an emergency c section?

Sometimes a c section becomes medically necessary during the birthing process. Below are the most common reasons for an emergency c section.

Even if you intend to deliver vaginally, include your preferences for a c section in your birth plan in the event of an unplanned c section.

Prolonged labor

An unplanned c section may be performed to prevent complications if labor does not progress at a safe rate.

The definition of prolonged labor varies by hospital, often ranging anywhere between 12-36 hours. (The specific definition depends on your state, whether the hospital is public or private, and your provider’s experience.)

Large birth size and slow cervical thinning are common factors in prolonged labor. Birthing multiples can also stall labor, which is why a doctor may recommend a scheduled c section if a woman is carrying multiples.

A doctor may perform an emergency c section if:

  • The umbilical cord is pinched or slips into the birth canal before the baby during labor, also referred to as umbilical cord prolapse.
  • The placenta begins to separate from the uterine wall during the birthing process.
  • Fetal monitoring detects an irregular heartbeat and/or that a baby is not getting enough oxygen. (Irregular heartbeats are typically monitored for several contractions before a doctor determines if a c section is necessary.)

How can a doula offer support?

Doulas are non-medically trained birthing professionals who offer individualized emotional, physical, and practical support throughout the prenatal to postpartum journey.

They are consistently a factor in better birth outcomes. One of their main responsibilities is to act as a liaison with the rest of your care team and advocate for your needs.

Given that c sections are overprescribed in the U.S., it’s important to understand the underlying reason for a recommended c section.

Working one-on-one with a doula can help you express potential concerns and prioritize your care preferences to the fullest extent possible.

Ask A Doula by Ruth Health is a new service that offers unlimited texting access to a doula. You can get personalized support with postpartum planning, feeding, and anything else pregnancy or postpartum-related. Spaces are limited, so sign up today!

If medical reasons make a c section the safest delivery option for your pregnancy, a doula can offer support throughout the birthing process and recovery.

Book a c section recovery session with Ruth Health

We’re here to help you heal. Our c section recovery program provides emotional, physical, and mental support, with gentle movement, stabilizing physical therapy, strength training, and breathwork.

You can start safely as early as 24 hours postpartum. Learn more or book a session.

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