Once a Cesarean, Always a Cesarean?
Cesarean section is the delivery of a fetus through the abdominal wall and uterus. In the 1970s, when the cesarean section rate tripled, the medical mantra was "once a cesarean, always a cesarean." These days, most women who have had at least one child delivered by C-section will have to decide whether to try to deliver a child that follows vaginally . This is a decision colored by a complex set of factors, including:
- A woman's own experience
- The reason for the original C-section
- Her subsequent recovery
- Her overall health
- Her personal preference
- Her doctor's experience
Reducing the C-section RateA C-section is considered major surgery. Blood loss during a C-section is much greater than with vaginal delivery. The risk of serious complications like hemorrhaging and infection after delivery are also greater. It is not clear whether all cesareans are necessary. In fact, many organizations are advising doctors to work to lower the rate.
Looking at VBACHaving a vaginal birth after a C-section (VBAC) is an area that researchers have been investigating. What are the benefits and risks? Some studies have concluded that there is not enough evidence to come up with a clear recommendation. Other studies, have found that VBAC is as safe as a planned C-section. Nevertheless, there are risks involved with VBAC. Women who have a VBAC may have a higher risk of uterine rupture. Uterine rupture may put you and your baby at risk of harm including death, and may lead to an emergency hysterectomy. This complicates a mother’s recovery and can put an end to her childbearing—a result that may be less likely after C-section.
Examining the Reason for C-sectionsThe reason a woman had a cesarean in the first place often influences her decision about a trial of labor for her next delivery. For example, women who have C-sections after long and difficult labors that did not progress may face similar difficulties with subsequent deliveries. Some of these women will choose to deliver a subsequent baby by C-section, especially if the pelvis is unfavorable for vaginal birth.The reasons for scheduled cesareans can include:
- Fetal or maternal illness—This could make labor risky for mother and/or child.
- Fetal distress—This, too, can be controversial because fetal monitors can be misread and because normal readings are subjective.
- Labor that fails to progress—This means labor does not progress normally.
- Placenta previa —The placenta blocks the cervix and is at risk of detaching before the baby is born.
- Baby in breech position—When the baby's head will not come out first, it is safest to deliver the baby via cesarean section.
- Multiple pregnancy
- Cephalopelvic disproportion—This occurs when a baby's head is too large for the mother's pelvis. This is considered a controversial reason for C-section because the proportion is difficult to measure. Small pelvises do often accommodate large babies during labor.
- Infection in the mother
- Previous C-section