Top 5 Reasons for Cesarean Birth

About one in three births are delivered by Cesarean Section, though this varies by province, country, and even community. About half of those are planned, also called “elective,” while the other half are emergency, or unplanned. Keep in mind that the term “emergency cesarean” is used to mean that delivery via cesarean section was not a birth preference, but does not always mean a true medical emergency which has to be performed as quickly as humanly possible. Join Drs. Sarah & Alicia as they share with us the top reasons Cesarean Sections are performed, both elective and unplanned.

Elective Cesarean Sections | Planned

1. Previous Cesarean Section: about half of people who choose to schedule a cesarean section do so because they have previously delivered a baby via cesarean section. Often it is medically recommended to do so for a variety of reasons, one of which is if your previous incision was up and down (vertical) instead of side to side (horizontal). This is due to the dexterity of the skin in this area, and how it is affected during contractions. 

Note: the outer scar may not reflect the direction of the uterine incision! Though the type of incision made should have been communicated around the time or after the initial birth, it can also be found in your operative notes. Tune it to today’s episode for more details of how and why your previous delivery may affect your ability to have a vaginal birth.

1. Previous Uterine Surgery: in the same vein, a previous surgery on your uterus could make it dangerous to labor. The most common uterine surgery is a particular type of fibroid surgery called a myomectomy. Fibroids are an abnormal growth of tissues formed in the muscle wall of the uterus that can impact fertility, cause heavy periods, and significant cramping. Note that not all fibroid surgeries are the same, so it’s important to check-in with your provider and verify your particular case history.
2. Placenta Previa: generally speaking, placenta previa or low-lying placenta, is when your placenta sits in the bottom of your uterus over the cervix, covering the opening of the uterus to the vaginal canal, which could lead to significant blood loss. For more information about Placenta Previa, tune in to our podcast What is Placenta Previa!
3. Preference: maternal choice is another valid reason for an elective Cesarean Section. Whatever the reason, may it be a history of trauma, or severe pain from conditions such as vulvodynia or vaginismus and you just do not want the trial of a vaginal labour, is a valid rationale to elect birth via Cesarean Section.
4. Fetal Malposition: this means your baby is not positioned head down toward the birth canal. The most common malposition is breach, meaning feet or bum down, or at times they can be transverse or side-to-side. Breech deliveries are possible, but more complicated, therefore a nuanced conversation with your provider on how best to proceed is recommended.

Emergency Cesarean Sections | Unplanned

As mentioned above, often “emergency Cesarean Sections” are not a true medical emergency, but rather there is approximately 30 minutes to an hour to talk over your options with your provider or partner and make as informed a decision as possible on how to proceed. However, usually some type of unpredicted issue is necessitating an unplanned Cesarean Section, such as:

1. Non-Reassuring Fetal Heart Rate: listening to baby's heart rate is one of the very few ways to track how baby is doing in labour. While a normal heart rate is between 110 to 160 beats per minute, it can vary up or down by about 10 beats per minute. However, a long deceleration, or a drop in heart rate for over several minutes, is not ideal and may be cause for an emergency c-section. Not acting on a non-reassuring fetal heart rate can lead to other issues concerning blood flow to the brain and placenta that Drs. Sarah & Alicia describe in greater detail in the episode.
2. Length of Pregnancy: if you are post your due date, your placenta may not function at full capacity, reducing blood flow to baby. Likewise, if baby is significantly preterm, it may not have the same capacity to deal with the stress of labour as a full-term baby. 
3. Uterine Infection: an infection in the uterus can cause baby’s heart rate to increase drastically, and generally babies do not cope well with infection. This may be another reason to pursue an emergency c-section
4. Failure to Progress: failure to progress (a term that in our opinion is disheartening and should be changed!), medically called dystocia, means that despite adequately strong contractions, the cervix is not dilating or baby is not coming down the birth canal. Generally three factors play into this: power, passage, and passenger:
1. Power: power refers to the pushing or strength of the contractions that for whatever reason are not very strong, not very frequent, or not lasting in duration
2. Passage: passage refers to the birth canal or the pelvis. The birth canal runs through an intricate muscle system and bony structure, some of which are shaped in such a way that does not allow a baby to pass. This trait could be hereditary! 
3. Passenger: the passenger - aka your baby - may not be helping you out in the birth process for a few reasons, such as their position or their size! Ideally baby is faced toward your bum, but at times they can be on their side or “sunny side up” (facing up) which can create complications. Likewise, a larger baby makes passage through the canal difficult, sometimes resulting in an emergency c-section!

Now not all of these scenarios absolutely necessitate an emergency c-section - sometimes the issue can be resolved with tools that assist in expediting delivery, such as forceps or a vacuum. Most providers do not want to intervene if they don't have to. But sometimes it is a necessary and life saving measure, and we feel the more informed you are about when and why it may be so, the more prepared you will be in the eventuality it may be necessary.

This is why we recommend all pregnant people to empower themselves through education, such as with our Pregnancy to Parenthood Masterclass, taking you from anxious and overwhelmed to confident during your childbirth experience: