Caesarean section

• why you need this operation

• what it will be like
• how it will affect you
• what risks are involved
• any alternatives.

What is a Caesarean section?

Reasons connected with the mother

• Cephalopelvic disproportion - This is when the mother’s pelvis is too narrow or the baby’s head is too large to allow a vaginal delivery. This can obstruct labour and need a Caesarean delivery.
• Pre-eclampsia - This condition causes the mother’s blood pressure to rise. It may lead to a fit or stroke. Drugs may reduce the high blood pressure but sometimes the only treatment is to deliver the baby as quickly as possible. Normal delivery may be unsafe as the blood pressure can reach dangerously high levels while waiting for labour to start.
• Previous Caesarean section - Needing a Caesarean section is much more likely if you have had one in the past. The scar on the uterus from the previous Caesarean could give way during labour. You can have what is called a ‘trial of scar’ to see if you will deliver normally. You may still have a good chance of a vaginal delivery after one previous Caesarean section. However, the chances are much lower if you had more than one previous section. If we feel normal delivery is not safe, then we will do a Caesarean section.
• Fibroids - These are non-cancerous growths in the uterus. They can block the baby’s passage through the cervix.
• Medical or surgical reasons - There are a number of other reasons for having a Caesarean. For example, we will advise it if the mother is HIV positive. The mother may have had an injury or previous spine or pelvis surgery, which may prevent them from having a normal delivery. It is important to tell your doctor of any illness and any previous operations or medical history.
• Maternal request - Some mothers request a Caesarean section for personal reasons, such as convenience or fear of labour. Your doctor will discuss your reasons for wanting this and outline the risks and benefits compared to a vaginal birth. You may be offered counselling if the reason is fear of labour. If your doctor feels your decision is not justified he can decline your request and will offer to refer you to another doctor for a second opinion.

Reasons connected with the baby

• Fetal distress - This is when not enough oxygen reaches the baby. Changes in the baby’s heart rate may be seen on a fetal monitor. Changes in heart rate may be enough to diagnose fetal distress or we may confirm it by testing a sample of the baby’s blood, called a fetal blood sample or FBS. If we confirm fetal distress we need to deliver the baby. If a vaginal delivery is not possible or would cause further distress we would deliver the baby by Caesarean section.

• Wrong presentation - The baby needs to come out head first for a normal delivery. If the baby is lying feet or buttocks first this is called a breech presentation. If the baby lies across the tummy this is called a transverse presentation. In either case, we will recommend a Caesarean section.
• Wrong position of baby’s head - The correct position for the baby’s head during labour is called occipito-anterior or OA for short. This is when the back of the baby’s head, called the vertex, is towards the front of the mother’s pelvis. In this position the smallest width passes through the birth canal. If the baby’s head is in any other position the delivery will take longer and be more difficult. If the baby’s head comes through the birth canal with the top of the head presenting instead of the vertex this is called a brow presentation. The increased width may lead to the baby becoming stuck and a Caesarean delivery is then needed. Other common abnormal positions of the baby’s head could be:

• Occipito-posterior, or OP for short, when the back of the baby’s head is towards the back of its mother
• Occipito-transverse, or OT for short, when the back of the baby’s head is towards the side of its mother’s pelvis.

• Multiple births - Sometimes it is safer to deliver twins by Caesarean section. Reasons for this include fetal distress and wrong position of the first twin. You may need a Caesarean section for delivery of the second twin even if the first is delivered vaginally. We deliver most triplets or more by Caesarean section because it is much safer.

Reasons connected with the placenta

• Bleeding from the placenta - The placenta can bleed if it comes away from the wall of the uterus too early. This is called an abruption. This can happen during labour or pregnancy. If the bleeding is severe enough it will cause shock in the mother. It can also distress the baby, as there is not enough blood flowing to it. A Caesarean section may be the safest way to deliver and stop the bleeding. In a rare condition called vasa previa there are abnormally placed blood vessels in the membranes from the placenta. These can burst causing bleeding and distress to the baby. A Caesarean section will be needed to safely deliver the baby.
• Placenta previa - If the placenta is placed abnormally low in the uterus it may block the cervix. It may stop the baby passing into the vagina or cause severe bleeding during labour. There are different types of placenta previa where the cervix is completely obstructed or only partly obstructed. In the more severe types a Caesarean section may be the safest way to deliver the baby.

• Cord prolapse - Sometimes the umbilical cord, which connects the baby to the placenta, comes through the birth canal. This is an emergency situation, as the baby’s blood supply, and hence its oxygen, may be cut off. An emergency Caesarean section may be the safest way to deliver the baby if an assisted delivery cannot be performed.

The aim

The benefits

Are there any alternatives?

What if you do nothing?

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