The Most Frequent Reasons for Performing a Cesarean Childbirth

The most frequent reasons for performing a cesarean delivery are discussed below.

Repeat cesarean delivery: There are two types of uterine incisions - a low transverse
incision and a vertical uterine incision. The direction of the incision on the skin (up and
down or side to side) does not necessarily match the direction of the incision made in the
uterus.
o As the name implies, the low transverse incision is a horizontal cut across the
lower part of the uterus. In the United States, whenever possible, a low skin
incision below or at the bikini line with a low transverse uterine incision is the
approach of choice.
o A vertical incision on the uterus may be used for delivering preterm babies,
abnormally positioned placentas, pregnancies with more than one fetus, and in
extreme emergencies.
o In the last decade, studies have shown that women who have had a prior cesarean
section with a low transverse incision may safely and successfully go through
labor and have a vaginal delivery in later pregnancies. The same, however, cannot
be said of women who have had vertical incisions on the uterus if the incision is
in the higher portion of the uterus.

In women with high vertical uterine incisions, the uterus is at a greater risk
to rupture (break open) in a subsequent pregnancy.

The uterus may rupture even before labor begins in half of these women.

Uterine rupture can be dangerous to the fetus even if delivery is

accomplished immediately after a uterine rupture. Diagnosing a uterine
rupture can be difficult, and signs of a rupture can include increased
bleeding, increased pain, or an abnormal fetal heart rate tracing.

Previous cesarean deliveries: Women with a prior history of more than one low
transverse cesarean section are at slightly increased risk for uterine rupture. This risk
increases significantly when the woman has had three cesarean deliveries. If an
abdominal delivery is planned and a trial of labor is not an option, the best time for
delivery is determined when the lungs of the fetus are mature.

Lack of labor progression: If the woman is having adequate contractions but no change
in the cervix (opening to the uterus) beyond 3 centimeters dilation or the woman is
unable to deliver the fetus despite complete dilation of the cervix and "adequate" pushing
for (generally for 2 to 3 hours or more), cesarean delivery may be performed.

Abnormal position of the fetus: In a normal delivery, the baby presents head first. This
is the way it happens in most births. The smallest diameter of the human skull is
presented to the pelvis in the most advantageous way. This increases the success of a
vaginal delivery.
o There are various other presentations of the fetus, which make vaginal delivery
difficult, including the commonly known breech position (when the baby's
buttocks are in the lower portion of the uterus). Certain forms of breech delivery
have a very low increased risk to the fetus. Breech deliveries may cause more
complications, including death and neurologic disability.
o Careful counseling, analysis of the exact type of breech position, an estimate of
the baby's weight, and other information are required before making any decision
about an attempted vaginal delivery or delivery by cesarean section.

Fetal status: Although an attractive and much-used tool, the fetal heart rate monitor has
not improved birth outcomes as once expected. Some believe the lack of improved
outcomes is because many current practicing doctors are poorly trained in interpreting the
subtleties of fetal heart rate patterns. Since the use of continuous fetal heart rate
monitoring in labor was begun, however, birth experts say death of a fetus during labor is
much more rare than in the past.

Emergency situations: If the woman is severely ill or has a life-threatening injury or

illness with interruption of the normal heart or lung function, she may be a candidate for
an emergency cesarean section. When performed within 6-10 minutes of the onset of
cardiac arrest, the procedure may save the newborn and improve the resuscitation rate for
the mother. This procedure is performed only in the most dire of circumstances.

Elective sterilization: A desire for elective sterilization is not an indication for cesarean
delivery. Sterilization after a vaginal delivery can be performed via a tiny 3-cm incision
along the lower edge of the umbilicus or as a delayed procedure 6 weeks after delivery
with laparoscopic surgery or vaginal surgery.