Cesarean Delivery

Cesarean delivery is surgical delivery of a baby by incision through a woman’s abdomen and uterus.

In the United States, over 30% of deliveries are cesarean.

Doctors use a cesarean delivery when they think it is safer than vaginal birth for the woman, the baby, or both, such as when:

• Labor progresses too slowly

• The fetus is in an abnormal position, such as breech presentation (buttocks first)

• The fetus's heart rate is abnormal, indicating fetal distress

• Vaginal bleeding is excessive, suggesting that the placenta may be separating from the uterus too soon (placental abruption)

• The placenta covers the cervix (placenta previa)

• The woman has had one or more previous cesarean deliveries (usually)

In the past, after a woman had one cesarean delivery, doctors recommended a cesarean delivery for all subsequent pregnancies. Doctors were concerned that the scar from the incision in the uterus might open (uterine rupture) during labor. However, doctors now realize that the risk of rupture is low after a cesarean delivery if the incision was made in the lower part of the uterus and is horizontal. Thus, if women have had only one previous cesarean delivery and a horizontal incision was made in the lower part of the uterus, they can choose to have a vaginal birth—called a trial of labor after cesarean (TOLAC). However, if women have had more than one cesarean delivery, most doctors recommend cesarean delivery for all subsequent pregnancies. Women should discuss the risks with their doctor before deciding whether to attempt TOLAC. Many centers use checklists to make sure that women and their babies are good candidates for a safe and successful TOLAC.

If a woman chooses vaginal birth after having had one previous cesarean delivery, she should plan to have her baby in a facility equipped to rapidly do a cesarean delivery because

• Vaginal birth is successful in only about 60 to 80% of women who have had one previous cesarean delivery with a lower horizontal incision.

• There is a very small risk that the uterus might rupture.

Cesarean Delivery

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An obstetrician, an anesthesiologist, nurses, and sometimes a pediatrician are involved in a cesarean delivery. Use of anesthetics, medications given intravenously, antibiotics, and blood transfusions help make a cesarean delivery safe.

For a cesarean delivery, an incision can be made in the upper or lower part of the uterus.

• Lower incision: This type of incision is more common. The lower part of the uterus is very thin and has fewer blood vessels, and so less blood is usually lost. Also, the healed scar is stronger, so that it is less likely to open in subsequent deliveries. A lower incision is usually horizontal. A vertical incision is made only if there are certain risks, such as abnormalities in the placenta or in the size or position of the fetus.

• Upper (classical) incision: Usually, this incision is used when the placenta covers the cervix (a complication called placenta previa), when the fetus lies horizontally across the birth canal, when the fetus is premature, or when the fetus has a birth defect.

Cesarean Delivery

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Women are encouraged to walk around soon after a cesarean delivery to reduce the risk of blood clots forming in the legs or pelvis, then traveling to the lungs and blocking arteries there (pulmonary embolism).

Cesarean delivery results in more overall pain afterward, a longer hospital stay, and a longer recovery time than vaginal birth.