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A
Cesarean Section Question and Answer Sheet from the New Jersey
Hospital Association
 What is a Cesarean Section?
A c-section is the surgical delivery of
a baby through an incision (cut) in the abdomen and uterus.
C-sections should be performed only when considered safer––for
both mother and baby––than a vaginal delivery
Why would a Cesarean Section be necessary?
There are many reasons why a c-section
may be done.
They include:
- Size - The baby is too large
to fit through the mother’s pelvis.
- Stalled Labor - Labor does not
progress, putting mother or baby at risk. Many physicians
are now practicing “active management of labor”––protocol
that determines what should happen at each phase of labor.
If the labor is not progressing accordingly physicians then
stimulate labor through physiological intervention or medication
before opting for a c-section.
- Abnormal Positioning - Sometimes
the baby’s head is not the first part to appear in
the birth canal. Shoulders, buttocks or other body parts
can appear first, making vaginal delivery more difficult.
More and more often, in cases where an unusual position
is detected prior to labor, physicians are trying to turn
the baby––using their hands on the mother’s
abdomen.
- Medical complications - If the
mother has a severe infection, diabetes, heart disease,
high blood pressure or other health problem.
- Fetal Distress - The baby is
in danger––has an erratic heart rate or is not
getting enough oxygen.
- Multiple Births – Sometimes––but
not always––twins, or more than two infants, can
complicate delivery
- Problems with the Placenta -
If the placenta (afterbirth) is bleeding, or if it is positioned
to exit the uterus before the baby does or if it is over
the opening of the birth canal (placenta previa).
- Cord Prolapse - The baby’s
umbilical cord falls through the birth canal.
- Late Child Bearing - Many women
are delaying pregnancy until later in life when the risk
of complications is higher.
Who determines if a C-Section is necessary?
Your physician or midwife; but you should
be part of the decision too. You should take an active role
by talking with your physician or midwife and asking specific
questions such as when a c-section would be recommended; what
steps would be taken prior to performing a c-section; whether
to seek a second opinion; and whether vaginal delivery is
encouraged after a previous c-section. It is important that
you feel comfortable with the views of your physician or midwife
on c-section deliveries.
Is it possible to deliver vaginally
after a C-Section?
Yes. The procedure is known as VBAC, or
vaginal birth after cesarean. Some physicians used to feel
that “once a cesarean section, always a cesarean section,”
fearing that the scar on the uterus may rupture during a vaginal
delivery. However, new ways of performing the c-section operation
have greatly reduced the risks of that happening. One of the
greatest obstacles associated with VBACs is fear by women
that they “can’t do it.” Some women––tired
of being pregnant, fearful of vaginal delivery after a previous
c-section, or simply looking for the convenience of a “scheduled”
delivery––will request a c-section. But the truth
is that women who have had repeat c-sections experience more
complications than women who deliver by VBAC. Together, with
your physician or midwife. you should discuss if a VBAC is
a good choice for you.
What can I expect in terms of recovery?
Will I have a permanent scar?
Again, it’s important to remember
that a c-section is major abdominal surgery, and the recovery
period is that of any major operation. One common side effect
of c-section delivery is gas pain, resulting from opening
the abdominal cavity and uterus. These pains may occur in
the abdomen, back, even shoulders, and in some women are quite
severe. You can expect a permanent scar, which in most cases,
will be small and horizontal. The recuperation period from
a c-section is much longer than that of a vaginal delivery.
Is it more expensive to deliver by Cesarean?
Typically the cost for c-section delivery
is higher due to additional expenses, a longer hospital stay
and extended recuperation period. In New Jersey women who
deliver by c-section are entitled, by law, to remain in the
hospital for 96 hours.
What is a Cesarean Section rate and
how is it determined?
There are two types of c-section rates
that measure how frequently c-sections are performed––total
c-section rates and primary c-section rates. The total c-section
rate is determined by dividing the number of cesarean sections
by the total number of deliveries for a specific period. This
is the rate typically published in newspaper and consumer
reports.
The primary c-section rate is considered
more accurate because it looks at first-time c-sections, thereby
ruling out patient preference. The primary c-section rate
is determined by dividing the number of women having a c-section
for the first time by the total number of deliveries by women
who have never had a c-section. Women who have had repeat
c-sections or VBACs are not included in primary c-section
rates.
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