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Why Is My Doctor Recommending a C-Section?

By Dr. Matt Young, MD, JD, MBA, CMQ, Esq

In America, around 1 in 3 babies are born via cesarean section. We all know someone who’s had at least one, sometimes planned, and sometimes in an emergency. It’s so routine that we need to stop ourselves to remember that a C-section is major abdominal surgery. We know that C-sections save lives, but why are they so common?

Let’s Look At The Numbers

More than 30 percent of babies in America are born by C-section, but this is not consistent across every hospital. A University of Minnesota study found a 10-fold variation in C-section rates, from as low as 7 percent at one hospital to as high as 70 percent of births at another hospital. So are certain hospitals pushing for more unnecessary surgeries than others, or are women with high-risk pregnancies gravitating toward hospitals with more experience in that area? The answer is probably a little bit of both.

The World Health Organization determined that the ideal rate for C-section births should be between 10 and 15 percent to ensure the best outcomes for moms and babies. The Department of Health and Human Services has set a less ambitious goal of 23 percent of all low-risk births (the ones most likely to be medically unnecessary).

So this raises the question: Why do American doctors perform so many C-sections? If the international healthcare community has found that there’s no difference in the health of mothers or babies when more than 1 in 10 babies are delivered by C-section, does that mean that American doctors are performing unnecessary surgeries? It really depends on the particular patient and the particular clinical situation. But when a life is potentially at risk, most doctors aren’t willing to take any chances.

What May Increase My Risk For A C-Section?

While there are no hard and fast rules for when a C-section is necessary, we know that C-sections can potentially save the life of a mother and/or her baby when used judiciously. Some instances in which a C-section may be life-saving include:

Changes in baby’s heart rate, indicating distress.
Labor is not progressing, meaning the cervix isn’t opening enough despite strong contractions over several hours.
The baby is in an abnormal position, including breech (backward) or transverse (sideways). While some babies could be delivered vaginally in these positions in the past (though it was never completely safe), most doctors and midwives no longer possess the required skill set to assist in this form of delivery. A C-section is usually a much safer option.
Pregnancy with multiples, particularly if the leading baby is in an abnormal position.
Placenta previa, a medical condition in which the placenta covers the opening of the cervix.
Prolapsed umbilical cord, when a loop of the umbilical cord slips through the cervix before the baby has been delivered. Continuing a vaginal birth will put too much pressure on the cord and cut off oxygen.
Maternal health concerns, such as a heart or brain condition (dangerous for mom), or an active genital herpes infection (dangerous for baby).
A physical obstruction, making a baby’s journey through the pelvis impossible, such as a broken hip, or an excess of fluid in the baby’s brain, causing their head to grow too large for a safe delivery (hydrocephalus).
A previous C-section performed with a high vertical cut, which increases the risk of uterine rupture if a vaginal birth is attempted.

While the above reasons can all make a C-section the safest option for mother and baby, numerous studies show other risk factors for a C-section, regardless of any other potential problems (or lack thereof):

– Maternal age over 35 years
– Previous C-section, regardless of the type of cut used
– Lack of prenatal care
– Oxytocin administration to induce labor
– Medical care in the evening shift
– OBGYN doctor with more than 16 years of experience

Is a C-Section Dangerous?

A C-section is done to save lives (and it definitely does when used appropriately), but it’s not a risk-free procedure. Thankfully, C-sections are very safe for babies. Around 1 – 2 percent of babies are accidentally cut during the surgery, but it’s typically a minor nick that heals quickly. Recent studies show that babies born via C-section are twice as likely to develop early childhood asthma and allergies, but research is still ongoing as to whether something can be done to mitigate this risk.

There are far more serious potential risks for mothers to consider, particularly if their C-section is an elective procedure rather than necessary to save a life. Some of the most common risks include:

Infection. While infections can occur with any birth, they’re far more likely in surgical births. Currently, birth-related infections occur in:
– 1-3 percent of vaginal deliveries
– 5-15 percent of scheduled C-sections
– 15-20 percent of non-scheduled C-sections
Bleeding. Blood is lost during every birth, but postpartum hemorrhage (severe blood loss after giving birth) is twice as likely after a C-section than after vaginal birth.
Blood Clots. Pulmonary embolism and deep vein thrombosis, or blood clots in the lungs and legs, can be deadly. While relatively rare (roughly 1 in 330 births), women who give birth by C-section are around four timesmore likely to develop blood clots than women who give birth vaginally.
Increased risk in future pregnancies. The risk of uterine rupture and placenta placement/attachment problems increases with every C-section delivery a woman has.

So What Does It All Mean?

The main takeaway from this is that vaginal birth is the safest option in a normal, healthy pregnancy. There are instances when a C-section may be necessary to save your life or your baby’s life, but it’s essential to make sure that the benefits truly outweigh the risks. While C-sections are generally considered safe, they are still a major abdominal surgical procedure and should be treated as such.

Whether your pregnancy is low or high risk, make sure to speak to your doctor about their views on C-sections and when they might recommend you have one. What percentage of their patients’ pregnancies result in a C-section delivery? Do they only perform them in situations where there is a significant risk to the health of mother or baby if delivery is delayed?

Make sure that you and your doctor agree about what would make a C-section necessary. Once you’re in the delivery room, you likely won’t have as much time or be in the right mindset to ask detailed questions. There’s no chance to carefully weigh the pros and cons when your doctor says you need a C-section now, so it’s essential to be prepared and make sure your doctor understands what you want beforehand. It’s also important to remember that C-sections in many situations are medically urgent or necessary procedures that are intended to decrease the risk of harm to mother or baby. Because these issues are often complicated and individualized, it is important to have a full conversation with your obstetrician before labor begins.


Dr. Matt Young, MD, JD, MBA, CMQ, Esq., is a nationally recognized Harvard-educated attorney and physician, and patient safety advocate working for Ross Feller Casey, LLP in Philadelphia. He is board-certified by the American Board of Medical Quality (ABMQ) in medical quality, having received the designation of CMQ (Certified in Medical Quality). Dr. Young is nationally recognized in healthcare quality and patient safety and was selected as a National Quality Scholar by the American College of Medical Quality (ACMQ) for his significant work in advancing healthcare quality. He is also a peer reviewer for the Journal of Patient Safety.




Disclaimer: The views and opinions expressed in this article are those of the authors and do not (necessarily) reflect the views of can in no way whatsoever be held responsible for the content of such views nor can it be held liable for any direct or indirect damage that may arise from such views.

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