Health Library







Categories > Pregnancy and Childbirth > Cesarean sections

When is C-section a mother’s best option?
Borrowers who practice responsible
Going for safety


Once a cesarean, not always a cesarean
Once a cesarean, not always a cesarean

If you’ve gone through one cesarean birth, you may think that the rest of your pregnancies are destined to end in cesareans, too. But that’s not necessarily true. Today, many women who have had C-sections are encouraged to try to deliver subsequent babies vaginally… and most who try are succeeding.

Why should you even consider vaginal birth after cesarean (VBAC)? Because it’s somewhat safer than a C-section. Although cesarean delivery is much safer today than it was in 1916, when the phrase “once a cesarean, always a cesarean” was coined, it’s still major surgery. Opting for VBAC instead reduces your risk of infection, blood loss and blood clots, urinary tract and bowel injuries, negative reactions to anesthesia and subsequent infertility.

In addition, vaginal birth results in a shorter hospital stay and a shorter recovery period than cesarean birth. If you have another C-section, you may not be able to resume a full schedule of activity, without any major limitations, for four to six weeks.

In the last 35 years, the cesarean section rate has increased from about 5 percent to about 26 percent of births in the United States. That means the average woman’s chance of having a C-section is between one-in-four and one-in-five.

Why the rise? Several factors have contributed, including:

  • Improvements in surgical and pediatric care have made cesarean delivery much safer for both mother and baby than in years past.
  • Improvements in care for premature babies have made C-section an option in more cases when a problem is detected before labor begins.
  • Obstetricians have learned that in some cases cesarean birth is better for the baby than a drawn-out labor and a difficult vaginal birth.
  • Technological advances in fetal monitoring have allowed doctors to better detect babies that may not fare well with vaginal delivery or continued labor.

There are many reasons a C-section might be chosen as the safest—or only—way to deliver a baby. One of the most common is cephalopelvic disproportion, which means that the baby is too big to pass safely through the mother’s pelvis. Breech presentation, in which a baby is buttocks or feet downward, is another reason.

Cesareans are also performed when there’s a problem with the placenta. Placenta previa is a condition in which the placenta is below the baby and covers part or all of the cervix. A normally placed placenta also can cause trouble—for example, when it separates from the baby before delivery, cutting off oxygen and nourishment.

Going for safety

Other reasons for C-section include fetal distress (such as slowing of the heart rate), prolonged labor (more than 20 hours) and maternal medical complications (such as diabetes, high blood pressure, heart disease, genital herpes or kidney disease). The most common reason for having a cesarean section, however, is having had one before. From the early 1900’s until recently, physicians felt that if a woman delivered a baby once by cesarean, all future pregnancies should end in a cesarean because the original scar could rupture during labor.

That concern was a very real one when surgeons used “high vertical” incisions extending from the navel to the pubic bone. However, since the 1950’s more than 99 percent of C-sections in this country have been done with a “low transverse” incision extending from side to side just above the pubic hairline.

Studies show that this type of incision ruptures in less than 1 percent of all cases. For that reason, more and more women who have had babies by cesarean are choosing vaginal birth after cesarean, commonly referred to as VBAC (pronounced “veeback”), the next time around. More than half of the women who choose to try VBAC are able to deliver vaginally and avoid another C-section.

As you can see, cesarean sections are performed for a range of health and safety reasons. So, if you find yourself among the nearly one million or so women who will have a C-section this year, there’s no reason to feel that you’ve failed in any way. No matter how hard you try, you can’t control the unexpected events that sometimes make a cesarean the safest course. Remember, the method of delivery is less important than the overall well-being of you and your baby.