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Reasons for performing a Caesarean

Reasons for performing a Caesarean

A Caesarean operation can be performed for many reasons. It could be that:

  • The woman or the baby has a life threatening illness that means a Caesarean is necessary OR
  • Complications have arisen in the pregnancy or labour OR
  • A vaginal birth is considered not possible or has increased health risks for the woman and / or baby when compared to the risks of a Caesarean birth OR
  • It is the caregiver or woman's preference.

Reasons for performing a Caesarean can be divided into medical and non-medical reasons. These are discussed in the next section.

Medical reasons for a Caesarean birth

Other reasons for a Caesarean birth

Medical reasons for a Caesarean birth

Intervening to perform a Caesarean operation can be based on 'medical reasons' or 'medical indications'. It is in most of these circumstances that the perceived risks of the operation have FAR OUTWEIGHED the risks of continuing the pregnancy or allowing the woman to labour and give birth vaginally.

Medical reasons for performing a Caesarean operation can include:

Placenta previa

Placental abruption

Fetal distress

Cord prolapse

The mother is unwell

Unsuccessful Induction

The baby is in an unusual position

The labour is not progressing

You have twins or more

Very premature baby(s)

The baby is too large to be born vaginally

Previous uterine surgery

A previous 4th degree tear

It is felt that a vaginal birth may put the baby at risk

Placenta previa.

This is when the placenta is lying low in the uterus and in rare cases covers the opening of the cervix to a large degree. This variation makes it impossible for the baby to be born vaginally. You can read more on this in placenta previa.

Placental abruption.

This is when the placenta separates from the wall of the uterus before the baby is born. It usually causes heavy bleeding inside the uterus and can be life threatening for the baby and sometimes for the woman. You can read more on this in placental abruption.

Fetal distress.

This is when the baby becomes unwell or is not coping in the uterus during the pregnancy, labour or before the second stage (or pushing phase) of the labour. The labour itself may be causing some distress and if the baby is already unwell, the baby will need to be born relatively quickly. If the cervix is not fully dilated or a forceps or ventouse delivery seems unreasonable, this will mean a Caesarean operation.

Caesareans for fetal distress are more common when there are complications such as the baby being small for dates, due to the placenta not functioning efficiently, or the labour is induced or augmented and the uterus is being overstimulated to contract too vigorously. You may wish to read fetal distress.

Cord prolapse.

This is a rare complication that can happen if the baby's cord comes down in front of the baby's head into the woman's vagina. If this occurs it will usually cause compression of the cord, reducing (or cutting off) the blood supply from the placenta to the baby. This can be a life threatening complication for the baby. You may wish to read more on this in cord prolapse.

The mother is unwell.

In some cases the mother can be unwell and sometimes unable to tolerate labour or it may be that her illness is affecting the wellbeing of the baby. Alternatively in these circumstances, there may not be enough time to wait for an induction to work (to attempt a vaginal birth), meaning that a Caesarean will be needed. This can include high blood pressure, diabetes, heart disease or kidney disease.

Unsuccessful induction.

If an induction of labour has not been successful and the waters have been broken for a lengthy period of time then a Caesarean section will need to be performed. This is covered extensively in Class 4 under induction of labour.

The baby is in an unusual position.

If the baby is not in the usual head 'tucked in' and down position, then a Caesarean may be required. This can include if the baby is in a transverse lie, or presenting in a brow, face or breech presentation. It should be noted that not all of these positions would necessarily mean that a Caesarean will be needed and the decision to perform a Caesarean should be judged on the individual situation.

The labour is not progressing.

This can happen if the cervix is not dilating or the baby is in an unusual position or if an induction or augmentation has not been successful. It could be that the baby's head is not tucked in well or is 'deflexed', meaning that the crown of the head is not sitting on the cervix snugly to stimulate the cervix to open. If the labour is prolonged and the cervix is not completely open, then a Caesarean may be performed.

You have twins or more.

Most twins can be born vaginally if the first twin closest to the cervix is in a head first position. A vaginal birth may not be possible if the first twin is in an unusual position or if there are complications. It is rare for triplets or higher multiples to be born vaginally these days with most caregivers preferring to perform a routine Caesarean operation for these babies. You may wish to read more in twins or more-giving birth.

Very premature baby(s).

Very premature (or 'preterm') babies are more likely to require a Caesarean because they are not in a head down (or bottom down) position or there are other health complications. You may wish to read more in premature baby.

The baby is too large to be born vaginally.

This is usually only the case if the mother has Diabetes or the baby has an abnormality. Most babies will 'fit' unless they are in an unusual position. You may wish to read more in large babies.

Previous uterine surgery.

This is usually only limited to the type of surgery that needed to cut through the full thickness of the muscle of the upper part of the uterus. If the cut has gone completely through the thick upper segment of the uterus, the chances of rupture of the uterus in labour can be increased (to about 10% from 0.3 to 0.7%).

The removal of a fibroid can sometimes entail an incision completely through the full thickness of the upper uterus (but not always) and a previous Caesarean where the incision was a vertical one, up the middle of the uterus (known as a Classical Caesarean) involves this. You may need to obtain previous medical records to find out the actual procedure that took place in these cases, as the scar on your belly may not be a good indication. This is covered in more detail later in this class.

A previous 4th degree tear.

A 4th degree tear is a rare complication. It can happen when the woman tears (with a previous vaginal birth), but the tear extends completely though to the anus. The anal sphincter may be torn and sometimes the internal wall of the rectum or bowel. It may be that the woman chooses to have a Caesarean birth for a subsequent baby, especially if she has experienced complications with the tear. This is discussed in depth in 3rd and 4th degree tears.

It is felt that a vaginal birth may put the baby at risk.

It is now recognised that if the mother is known to be HIV positive, she has less chance of passing the virus on to her baby if an elective Caesarean is performed. A Caesarean may also be recommended if the mother has an active outbreak of genital herpes when the labour commences.

Last revised: Friday, 7 December 2012

This article contains general information only and is not intended to replace advice from a qualified health professional.

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