A cesarean section, or C-section, may be performed in emergency circumstances to save a mother or child’s life. If there are known vaginal birth risks, a C-section may also be scheduled in advance. C-section injury poses greater risks than vaginal delivery. This surgical procedure was developed for traumatic situations and should only be used when medically necessary.
Reasons for C-Section
Suspected medical conditions, such as macrosomia, may cause the mother to prefer a cesarean section. A petite mother will endanger her child if she attempts a vaginal birth with an infant that is large for the gestational age. It is a common concern that the infant’s shoulder bone could catch on the mother’s hip, resulting with asphyxia or brachial plexus injury. Planning for a C-section allows the parents to avoid vaginal birth complications that may be predicted.
There are many reasons why a C-section may be needed, but some major indications are:
- Weakened uterine wall in mother, typically after previous C-section injury
- Placental problems in mother, typically after previous C-section injury
- Contracted maternal pelvis
- Possibility of passing sexually transmitted infections to infant
- Macrosomia, or large fetal size for gestational age
- Cephalopelvic disproportion (CPD), where infant’s head is larger than maternal pelvis
- Hypertension or hypotension in the infant
- Multiple births, such as twins or triplets
- Prolonged labor
- Dystocia, or a failure of birth progression
- Forceps failure to assist birth
- Vacuum failure to assist birth
- Birth defects
- Fetal distress
- Umbilical cord prolapse, an emergency where the cord exits the uterus before the infant
- Lack of obstetric ability for handling multiple deliveries, breech births, etc.
- Improper use of Electronic Fetal Monitoring (EFM), used to evaluate fetal heart stability
Debating Delivery Alternatives
The purpose of a cesarean section is to ensure the health of the infant in cases where vaginal delivery may be detrimental. A C-section places greater health risks on the mother. However, it is possible for a C-section injury to happen to the infant as well. If the health care provider suggests a scheduled C-section, the expecting parents need to consider why the surgery was suggested.
There may be alternatives to aid in vaginal birth if the C-section is not a necessity. Expecting parents may request that the obstetrician provided a written comparison of all health risks associated with their options. This list will offer a better understanding of the medical indications for the C-section, enabling the parents to plan for the safest delivery of their child.
Risk of Fetal C-Section Injury
The infant’s safety is typically the first concern of expecting parents. A mother may not mind her increased risk of C-section injury, as long as she knows her child will be healthy. It is important that expecting parents know the hazards of C-section injury for the infant as well. Individual risk may vary, depending on personal factors such as pregnancy complications, how the C-section is performed, and whether it was a planned or emergency procedure.
C-section injury to the infant may include:
- Premature birth – In some cases, the obstetrician may cause C-section injury by incorrectly calculating the gestational age.
- Breathing difficulty – Studies show that infants are more likely to require respiratory assistance after a C-section delivery than a vaginal delivery.
- Wet lung – The fluid within an infant’s lungs is typically expelled during labor contractions. Without the pressure of contractions, fluid may remain in the infant’s lungs. This will cause C-section injury to the child.
- Fetal incisions and punctures – Approximately 2 per 100 infants delivered by C-section are cut during the procedure.
- Low Apgar score – Natural stimulation is provided for the infant during vaginal delivery. Anesthesia used during the cesarean section may also harm the infant. C-section procedures increase the probability of a low Apgar score by 50%.
- Increased infant mortality – The death rate during the first 28 days of life for infants delivered by cesarean section is approximately 1.77 per 1000 births. The death rate of infant death after vaginal delivery is about .62 per 1000 births.
- Postnatal weight loss – An infant delivered by C-section is more likely to experience postnatal weight-loss and may require formulaic supplementation.
- Increased childhood type 1 diabetes – Studies have found that infants delivered by cesarean section have a 20% higher risk of childhood type 1 diabetes than infants delivered vaginally. This is believed to correlate with a weaker immune system.
- Increase childhood obesity – Studies show that 15.7% of infants delivered by C-section develop childhood obesity by the age of 3. This is a little more than double the 7.5% of infants delivered vaginally that develop obesity concerns by the age of 3.