A caesarean section is an operation in which your baby is delivered through a cut made in your lower abdomen and womb (uterus). It’s a common procedure – most of us would know someone who has been born via caesarean section or know a mother who has had a caesarean section. Furthermore, the proportion of women giving birth via caesarean section has increased over the years. In 2019, 38% of mothers who gave birth at the Mercy Hospital for Women in Melbourne had a caesarean section, compared to 29% in 2010.1
When might a caesarean section be required?
Caesarean sections may be planned, meaning that the decision to perform a caesarean section is made before you go into labour. This is usually due to medical reasons that preclude a vaginal delivery, such as:
- Malpresentation: Ideally, your baby’s head should be down prior to the beginning of labour. If your baby is positioned bottom or feet first (breech) or lying sideways (transverse), a caesarean section may be preferred to attempting to turn the baby.
- Placenta praevia: This is a condition where the placenta — which provides your baby with oxygen and nutrients — lies close to or crosses the cervix (the opening of the uterus through which the baby exits). Placenta praevia can cause a massive bleed during labour, so a vaginal delivery is usually too risky.
- Multiple pregnancy: Twins can sometimes be delivered via vaginal birth – however, if the first baby is positioned feet or bottom first (breech), or if other complications have developed, a caesarean section will be required. If there are three or more babies, a caesarean section will be necessary.
- Past history of caesarean section: If you’ve previously had a caesarean section, you may still be able to have a vaginal birth for future pregnancies. However, a VBAC (vaginal birth after caesarean) does carry more risk than a standard vaginal birth – and the more caesarean sections you have had, the greater the risk. Depending on your individual circumstances, a previous caesarean section may be sufficient reason to have another.
Caesarean sections are sometimes necessary in emergency situations. This happens if you have already gone into labour, but your baby must be delivered quickly due to complications that have arisen. These complications may include:
- Inadequate progress during labour or obstructed labour: If your labour is progressing very slowly, or not progressing at all, a caesarean section may be required to safely deliver your baby. This decision will be based on how tired you and your baby are during the labour.
- Distress of the baby: If your baby shows signs of distress late in your pregnancy (e.g. reduced movements), or at any time during your labour (e.g. increased or decreased heart rate), you may need a caesarean section to deliver your baby quickly.
- Chorioamnionitis: Chorioamnionitis is an infection of the fluid and sac surrounding your baby. It is a medical emergency and requires prompt delivery. Therefore, a caesarean section will be necessary.
- Severe bleeding: If you have a severe bleed while you are pregnant, or at any time during your labour, a caesarean section can be lifesaving – for both you and your baby.
- Cord prolapse: Sometimes the umbilical cord (which transports vital oxygen and nutrients from your body to your baby) can slip out of the uterus before your baby does – this is known as a cord prolapse. When this happens, your baby may compress the cord as it moves down the birth canal. This prevents oxygen from reaching your baby, which can be fatal for the baby. In this situation, an immediate caesarean section will be required.
- Placental abruption: Placental abruption is the separation of the placenta from the uterus. This cuts off your baby’s supply of oxygen and can be life-threatening to the baby. It can also put you in significant danger, due to the risk of a massive bleed. Therefore, it necessitates prompt delivery via caesarean section.
Lastly, a caesarean section may be ‘elective’. This is when a woman chooses to have a caesarean section. Women often make this decision when they want to avoid the complications that can occur during a vaginal delivery or they deem it to be the safest option for their baby.
What are the pros and cons of having a caesarean section?
The main advantage of a caesarean section is that when a vaginal delivery is too risky for medical reasons, a caesarean section allows you to safely give birth to your baby. In the end, this is what’s most important.
Caesarean sections are also associated with a reduced risk of later incontinence and pelvic organ prolapse. This is because a caesarean avoids the need for a forceps delivery. This kind of instrumental delivery can place significant stress on a woman’s pelvic floor. It also usually requires a surgical cut to be made at the opening of the vagina (called an ‘episiotomy’).
Many women assume that their recovery from a caesarean will be harder and longer than a vaginal delivery. In fact, whilst the immediate recovery from a caesarean is more painful over the first few days, it is frequently a quicker overall recovery than a vaginal delivery, especially when compared to a complicated vaginal delivery. In general, the time it will take you to recover from childbirth will depend on your age, how fit you are, your pain tolerance, and the number and mode of any previous deliveries. A woman’s first vaginal delivery usually takes the longest to recover from, with recovery becoming increasingly faster and easier with each subsequent vaginal delivery. In comparison, recovery from a caesarean sits somewhere in the middle – it’s not as hard and long as a woman’s first vaginal delivery but not as quick or easy as her second.
For some patients, the certainty that comes with a planned caesarean – e.g. known delivery date, optimal timing of delivery, reassurance that the pregnancy won’t go past the due date and expose the baby to post-maturity complications – is a real benefit. Other women prefer a planned caesarean because it means they can avoid going into labour and the pain associated with it.
Lastly, women who have an elective caesarean also have the option of undergoing other surgical procedures straight after the caesarean – most commonly, tubal ligation (‘tube-tying’) to provide permanent contraception.
On the other side of the coin, there are some risks involved with a caesarean section. Similar to any surgical procedure, there is always a risk of bleeding, infection and damage to other organs close to the womb (e.g. the bowel and bladder). But, overall, the danger posed by these risks is low. Infection occurs following approximately 3–4% of caesareans. The other complications mentioned are rare.
Prior to a caesarean section, you will also have a spinal anaesthetic. This anaesthetic is injected via a needle between the bones of your spine. While this blocks pain from your chest down, you will usually still feel some tugging and pulling during the caesarean section. However, the anaesthetic can cause nausea, low blood pressure or a headache. Rarely, it may lead to temporary nerve damage, resulting in a loss or change of sensation to your lower body. However, this normally resolves.
In both the public and private setting, you will typically stay in hospital for four nights following a caesarean section. This is the same length of a time a woman will stay in a private hospital if she has had a vaginal delivery – even if the delivery was uncomplicated. In the public hospital setting, women who have had an uncomplicated vaginal delivery will usually go home after one night.
Lastly, due to the scar in your uterus after a caesarean section, there is a slightly higher risk of complications for future pregnancies if you end up having multiple, repeat caesarean deliveries.
Will a caesarean section affect my baby?
Following a caesarean section, your baby has a higher chance of having temporary breathing difficulties. This occurs because the natural labour process clears fluid from your baby’s lungs, by physically ‘squeezing out’ the fluid as your baby goes through the birth canal. The risk of this temporary breathing difficulty is lower with longer pregnancies (i.e. there is a smaller risk of it occurring at 39 weeks’ gestation compared with 37 weeks’ gestation). Therefore, I usually aim to schedule caesarean sections at around 39 weeks’ gestation, if an earlier delivery is not required for other reasons. Rates of breathing difficulty at 39 weeks are similar (about 1%) when babies born by caesarean versus vaginal delivery are compared.
There used to be a concern that caesarean delivery upsets the baby’s microbiome (bacterial colonisation of the gut), potentially leading to allergies in the future. However, this has been debunked by recent research showing that babies born vaginally and by caesarean have identical gut flora by Day 3. More important factors that can adversely affect a baby’s microbiome are the use of formula (versus breast milk) and extremely low fat intake during pregnancy!
Finally, if instruments (forceps or vacuum) are used to assist the delivery of your baby during a caesarean section, this can bruise your baby’s head. However, this type of bruising can also occur (and is actually more common) when these instruments are used during a vaginal delivery. In either case, bruising generally resolves rapidly over a few days.
Want to discuss your options for birth?
Deciding between a caesarean section and vaginal delivery is highly individual and requires consideration of your specific circumstances. As an obstetrician, I will work with you to determine what’s best for you – to ultimately ensure that you have a healthy baby at the end of your pregnancy. If you would like to make an appointment, please call (03) 9418 8299 or book online.
Dr Michael Rasmussen. Internal Audit, Mercy Hospital for Women, Heidelberg, Victoria. Data on file, April 2020. ↩︎