It's approaching that time—you've already decorated your nursery, and now you're thinking about your birth plan.
In the US, most babies are born vaginally. But about one-third are born through Cesarean section (C-section)—when the baby is taken out through her mother's abdomen surgically.
Emergencies and complications can lead to a C-section, but you might be surprised to hear that some women choose to have a C-section without a medical reason. This is called an elective C-section.
To Push Or Not To Push: Elective C-Sections
The number of elective C-sections has been on the rise in the US. There are a variety of reasons—from the fear of pain during labor to the belief that a vaginal birth can cause sexual dysfunction. In some cases, it may even be because a scheduled C-section seems more convenient.
But it's not necessarily a "done deal" if you want one. As with any surgery, there are risks. So if you're thinking about an elective C-section, your doctor will probably ask questions.
"When a woman asks for a C-section with no medical reason, the first thing I do is find out why," says Sindhu K. Srinivas, MD, MSCE, vice-chair for quality and safety for the Department of Obstetrics & Gynecology at Penn Medicine.
"Once I know why she wants to go that route, I can clear up misconceptions and, also, remind her of why vaginal birth can be beneficial for both her and her baby."
Women who give birth vaginally have lower infection rates, quicker recovery, and shorter hospital stays. Their babies have a lower risk of health problems like respiratory infections or celiac disease, and it may even have an impact on the immune[5] systems.
"Some conversations change a woman's mind, or allow us to come to a different resolution rather than just an outright C-section," Dr. Srinivas says. "We try to present all of the information generally, and do not encourage elective C-sections. If there's no medical reason, it's really not our practice to do them."
When the Time is Right: The Necessity Of C-Sections
That being said, there is a time and place for C-sections.
"Since we do encourage vaginal birth, some women believe that C-sections are never necessary," says Dr. Srinivas. "It's very important to know that this is a myth. Under certain circumstances, a C-section birth is the safest option for the mother and child."
These circumstances may include:
- A large baby that won't fit through the vaginal canal.
- Problems with a woman's placenta, which can cause dangerous bleeding during birth.
- A baby who is not positioned with his head down.
- A pinched or compressed umbilical cord.
- Signs of fetal distress (changes in the fetal heart rate).
- The mother has certain medical conditions, like high blood pressure or diabetes.
- The mother has an infection, like HIV or herpes.
- Labor is too slow, or stops completely.
Dr. Srinivas assures patients that while a C-section does have some risks—like bleeding or infection—it is generally a very safe surgery. Serious complications are rare, and most mothers and babies do very well after the procedure.
Sindhu K. Srinivas, MD, MSCE
"We don't try to do C-sections on everyone it's a balancing act. We want to support women in their birth plan, and give them he experience they want. However, they shouldn't lose sight of the fact that the outcome of the experience is to have everyone be safe. It may not always happen the way you hope it will, but in the end, it's about having a healthy mom and baby."
Sindhu K. Srinivas, MD, MSCE
Vice-chair for Quality and Safety for the Department of Obstetrics & Gynecology
Penn Medicine
But timing is important. The American College of Obstetrics and Gynecology generally does not recommend scheduled C-sections before 39 weeks' gestation unless there is a medical or surgical need.
Vaginal Birth After A C-Section
The idea that once a woman has a C-section, she will always need to deliver via C-section is an older school of thought. In fact, 90 percent of women who have had C-sections are candidates for vaginal birth after C-section (VBAC). About 60 percent to 80 percent of women who try VBAC are successful.
"We definitely encourage women who have had C-sections in the past to try VBAC—as long as they're the right candidates," Dr. Srinivas says. "A good candidate has a high chance of success and a low risk of complications. Someone for whom the benefits will be worth the small risks."
The main risk of VBAC is a rupture of the uterus and the potential resulting problems for the baby. However, it's very rare—only occurring in less than 1 percent of women.
After A C-Section
Giving birth comes with a flood of emotions. And a C-section—especially an unplanned one—can bring on even more.
A woman who has to have a last-minute C-section may feel guilty. She might feel like it's her fault—that as a woman, her body was supposed to be made to give birth, but she wasn't capable of doing it.
Dr. Srinivas recognizes that having a C-section after attempting vaginal delivery can be disappointing.
"Many women want childbirth to be natural. They don't want to over-medicalize it," she says. "So when they need a medical procedure, they may feel like they've lost that experience."
"We work very hard to get help women work through those feelings, and remind women that sometimes, these things happen. It's about doing what's safest for mom and baby, and it is absolutely not a woman's fault."