What to Expect in a C-Section

Optional and elective C-sections

Possible But Not Absolute Indicators for a C-Section
Then there are conditions that occur where the doctor has the option for a C-section, but may or may not decide to perform one. These are the cases where it helps to trust your doctors and have confidence in their decisions. Remember, these conditions can go either way – meaning, the doctor may or may not decide to perform a C-section, but one could be warranted. Make sure your doctor discusses it with you or your partner first. (However, if the condition is life threatening, there may not be enough time.) These conditions include the following:

• Bleeding from the placenta
• Delivery is advisable immediately, but the mother is not in labor (reasons could include infection or severe preeclampsia)
• Water breaks but no indication of labor and 24 hours have passed
• Shoulder or breech presentation of the baby (the baby's buttocks or feet enter the canal first, instead of the head)
• More than one baby (many women having twins are able to deliver vaginally, but the risk for problems increases with the number of babies)
• Failure of labor to progress in a timely fashion
• Abnormal pelvic structure in the mother (for example, if the mother has had an injury to the pelvis or was born with a pelvic defect)
• If the mother has had a prior low-transverse C-section in a previous birth

Elective C-Sections (for the Convenience of the Patient)
Having a C-section just because it's more convenient (meaning you can schedule your child's birth) is a very controversial issue today, especially for first-time mothers. It's especially controversial if there are no known maternal or fetal issues indicating that the C-section is necessary. Traditionally, the thought process was that C-sections were riskier for both mother and baby compared to vaginal deliveries. Traditionalists say that C-sections put the mother at risk unnecessarily, and doctors and patients alike have to deal with the problems of repeat C-sections, which are not a trivial matter.

Proponents of voluntary C-sections argue that it is a woman's right to choose her type of delivery option and that even though the risk is increased, the overall risk is low. According to Dr. John, this is not a settled issue in the OB field, but it is being addressed in various forms, both from the patient safety standpoint and also from an ethical, moral standpoint.

Dr. John feels that it is helpful to address the reasons why the patient might want a C-section when discussing elective surgery. He's found that often the reason might be related to the patient's fears – the fear of unknown pain that might be experienced in labor being the most common. In counseling the patient and addressing the pain issue, Dr. John's patients have usually reconsidered having an elective C-section and opted for a vaginal delivery instead. "I've never had to do an elective primary C-section after I talked to my patient and relieved her concerns," he said.