A cesarean delivery is a surgical procedure in which a fetus is delivered through an incision in the mother's abdomen and uterus. According to the CDC, in 2010, almost 33% of births were by cesarean delivery. According to the Agency for Healthcare Research and Quality, the number of cesarean deliveries between 1997 and 2008 increased by 72%.
A cesarean delivery may be necessary if:
• A woman is carrying more than one fetus. A pregnancy with multiple fetuses, particularly when the woman is carrying more than two, may cause preterm labor. A cesarean delivery may be necessary if complications occur with the delivery or fetal heart rates.
• Complications in labor occur, such as labor not progressing normally. This can occur if the cervix does not dilate normally.
• The infant's health is in danger. This could include problems with the umbilical cord or when fetal monitoring detects an abnormal heart rate.
• The fetus is too large. Women with gestational diabetes, especially if their blood sugar levels are not well controlled, are at increased risk for large infants that require a cesarean delivery to prevent complications at delivery such as shoulder dystocia, when the infant's head is delivered through the vagina but the shoulders are stuck.
• There is a breech presentation, meaning the infant is upside down, and the feet instead of the head would be delivered first.
• The mother has an infection such as HIV or herpes. In this case, cesarean delivery could help prevent transmission of the virus to the infant.
• There are problems with the placenta. Sometimes the placenta is not formed or working correctly, is in the wrong place in the uterus, or is implanted too deeply or firmly in the uterine wall. This can cause problems, such as depriving the fetus of needed oxygen and nutrients and vaginal bleeding.
Women who have a cesarean delivery may be given pain medication with an epidural block, a spinal block, or general anesthesia. An epidural block numbs the lower part of the body through an injection in the spine. A spinal block also numbs the lower part of the body but through an injection directly into the spinal fluid. Women who receive general anesthesia, often used for emergency cesarean deliveries, will not be awake during the surgery.
During the procedure, the infant is delivered through cuts in the mother's abdomen and uterus. The uterus is then closed with stitches that later dissolve. Stitches or staples also close the skin on the belly.
Cesarean delivery is safe, but it is still surgery, with risks and complications to consider. Recovery from a cesarean also often takes longer than from a vaginal delivery. Some women may request a cesarean birth even if vaginal delivery is an option. However, cesarean births can raise the risk of medical problems and having difficulties with future pregnancies. Also, infants delivered by cesarean delivery may experience more breathing problems than infants born by vaginal delivery.