Caesarean Section

What to Think About

If you plan to deliver vaginally and have concerns about having an unnecessary caesarean delivery, talk to your doctor or midwife ahead of time. Ask in what types of situations caesarean section is usually used and what measures he or she takes to promote a vaginal birth.

Public health experts have urged the North American obstetric community to reduce the percentage of deliveries done by caesarean, identifying birth scenarios that may not necessarily require surgical delivery. These include:

• History of caesarean. Some women with a caesarean scar can deliver vaginally, although there are risks involved in a VBAC delivery. Some smaller hospitals no longer provide VBAC, reflecting a trend toward greater medical caution with VBAC. If you have had a previous caesarean, weigh the benefits and risks of vaginal delivery with your doctor or midwife. For more information, see the topic Vaginal Birth After Caesarean (VBAC).
• Fetal distress. Deciding whether and when a fetus with a slowing heart rate should be delivered by caesarean is a common judgment call during labour. Ultimately, a health professional will lean toward caution and deliver by caesarean to prevent harm to a newborn.
• Difficult, slow labour (dystocia). Dystocia can often be corrected with medication that restarts contractions (augmentation). For women with a caesarean scar, oxytocin must be used carefully to reduce the slight risk of the scar rupturing during labour.

Some doctors are more likely to see a need for a caesarean than others. For example, what one doctor considers a slow labour may be a normal labour to another. However, all doctors are guided by the common goal of a healthy labour and delivery for both the mother and her newborn.

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Author:	Kathe Gallagher, MSW Carrie Henley	Last Updated: June 16, 2006
Medical Review:	Adam Husney, MD - Family Medicine Joy Melnikow, MD, MPH - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
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