Cesarean Birth

PRE-OPERATIVE INSTRUCTIONS – Getting Ready for Scheduled Procedure.

POST-OPERATIVE INSTRUCTIONS – Recovering (Scheduled or Unscheduled Procedure).



BE PREPARED:  Cesarean deliveries are sometimes planned for specific reasons.  However, most first-time Cesarean sections happen unexpectedly.   Events can move quickly if you’re in labor and a decision is made for a cesarean section. Occasionally, you may not have time to grasp your situation and find out about the procedure.  It is a good idea to at least be familiar with cesarean section.  That way, should the need arise, you’ll be better prepared.

A SPECIAL RESPONSIBILITY:  I / We are ethically obligated to BOTH protect you from unnecessary Cesarean Section yet at the same time try our best to use Cesarean Section wisely when it may represent the best way to foster a safer or better outcome for the baby or mother.  This task requires very careful attention, knowledge, experience and all decisions (vaginal birth or cesarean section) involve some degree of risk.

Labor does not progress normally
Baby’s heartbeat abnormality
Baby is in an abnormal position
Baby’s head in the wrong position
Serious maternal health problem
The first episode of herpes
Twins, triplets or more!
A problem with the placenta
The umbilical cord in an unsafe position
Baby is very large
Previous Cesarean birth
Baby has a health problem

TRUST IS KEY:   discuss the possibility of Cesarean delivery before your due date. This discussion should create trust between you and your provider.  This trust should help deal with events on the day of your baby’s birth.   If a Cesarean is planned in advance you should ask every question that comes to mind. Speak up about your concerns or uncertainties, repeatedly, if need be – to understand why a Cesarean is the best option for you.

SOMETIMES A QUICK DECISION:  Emergency Cesarean deliveries are often hurried, for good reason: They’re performed when continued labor is no longer in you or your baby’s best interest.  If this happens, there may not be time to ask all your questions.  If you have general knowledge about Caesarean section and trust your doctor,  it will be easier to deal with unfolding events.  Please keep your eye on your key goals:  a healthy baby AND a healthy mom.

Labor does not progress normally. 1/3 of all Cesareans are done because labor progress stops or is extremely slow.  This may happen if contractions are too weak to cause the cervix to dilate or if the baby is too big to pass through your pelvis.
Baby’s heartbeat abnormality. During labor certain fetal heart patterns may indicate a problem with the baby getting enough oxygen.  However, the heart rate changes that cause concern don’t ALWAYS mean the baby is in trouble.  The Obstetrician must consider other things in deciding whether to do a Caesarean.  If the baby is past its due date or delivery seems unlikely within a reasonable time, a Cesarean may be the recommended route.
The baby is in an abnormal position.   A breech delivery, in which the buttocks or feet enter the birth canal before the head can be difficult and risky for your baby.  Also,  if the baby is lying cross-ways across your uterus (transverse lie) it cannot deliver through the birth canal and Cesarean section is required.
Baby’s head in the wrong position. When the baby enters the pelvis, he or she should be “looking at the floor” head-down and facedown. If the baby is facing upward “sunny side up”  the fit can be very tight.  Even with complete cervical dilation, the baby may not be unable to fit through the birth canal.
Serious maternal health problem. Diabetes, heart disease, lung disease, or high blood pressure may give reason to induce labor early.  However, induced labor may give rise to fetal heart rate problems or fail to cause progress in labor.  In these cases, it’s more likely to result in Cesarean delivery.   Nonetheless, unless problems occur, vaginal delivery is generally better.
The first episode of herpes infection in the genital tract generally requires a Cesarean delivery to dramatically reduce the risks of spreading the infection to the baby, giving rise to dangerous newborn infection.
Twins, triplets or more! In multiple pregnancies, at least one baby is usually breech or transverse.  In this situation, the Cesarean section is thought to be safer than vaginal birth, especially for the second-born baby.
A problem with the placenta. Placental separation may occur from the inner wall of your uterus before labor begins. This is known as placental abruption and can cause life-threatening problems for you and your baby.  Placenta previa is In another possible placental problem where the placenta is low in the uterus and at least partially covers the cervix. There is no reasonable way for a vaginal birth to occur in this situation.
The umbilical cord in an unsafe position. A portion of the umbilical cord can slip out of the cervix before the baby is born. This is called umbilical cord prolapse and may be very dangerous for your baby. Sometimes, the cord can become trapped between the baby’s head and your pelvic sidewall.  If it becomes compressed it can deprive the baby of oxygen.
The baby is very large. Big babies or a small pelvis can make vaginal birth difficult, dangerous, damaging to the baby, or impossible.  If your baby is very large Cesarean birth is more likely.  Still, most mothers with large babies attempt vaginal delivery instead of electing to have a Caesarean delivery. If it becomes apparent that the baby is too big to deliver vaginally, the doctor can still perform a Caesarean.
Previous Caesarean birth.   Previous Cesarean sections may lead to a decision to have another cesarean section.  But a trial of labor after previous cesarean may be tried (TOLAC)  in an attempt to achieve a vaginal birth after cesarean section (VBAC).  This requires careful discussion of benefits and risks.
Baby has a health problem. Cesarean birth is sometimes recommended if tests show your baby has a problem such as spina bifida  (part of the spinal cord is exposed) or hydrocephalus (fluid-filled cavities in the brain). In these situations, a Caesarean birth should be discussed.  It might prevent damage to the baby.