Though some obstetricians tout the safety of cesareans and their value in preventing perineal damage, a systematic review of current research shows that vaginal birth is safer for mother and baby than a cesarean—unless there’s a clear, compelling health reason for having a cesarean.
The risk of perineal damage in vaginal birth is extremely small if forceps, vacuum extractor, and episiotomy aren’t used.
Cesarean surgery increases your short-term risk of blood clots, stroke, surgical injury, infection, pain, separation from your baby, psychological trauma, longer hospital stay, emergency hysterectomy, and death in the short term. In the long term, it increases your risk of pelvic pain, bowel obstruction, infertility, and future pregnancy problems like ectopic pregnancy (pregnancy outside the uterus), placenta previa (placenta over the cervix), and uterine rupture.
A cesarean raises your baby’s risk of surgical injury, respiratory problems, and breastfeeding difficulties. It increases you future babies’ risk of stillbirth, low birth weight, preterm birth, and central nervous system injury.
If you’ve had a previous cesarean, there’s a small chance your uterine scar could separate during labor and a small chance that the separation could endanger you or your baby. This is more likely if your labor is induced or if your scar is high and vertical.
You’ll Need a Cesarean if:
You are hemorrhaging.
Your baby’s oxygen supply is blocked.
You have placenta previa.
Your baby is in a transverse position (lying horizontally across your pelvis).
You have poorly controlled diabetes or severe pregnancy-induced hypertension.
You’ve had a previous cesarean and your caregiver is unwilling to attend a vaginal birth after cesarean (VBAC) or your hospital doesn’t have round-the-clock anesthesia services.
Your labor is not progressing at all, and either you or your baby is not doing well.
Your baby is in a breech position (head up, feet or buttocks down) and your caregiver isn’t skilled at assisting vaginal breech birth.
Your baby’s heart rate slows and doesn’t improve when you change position, drink more fluids, breathe some oxygen, or turn your Pitocin down or off.
You’re carrying more than one baby, and one of your babies is in a transverse position or your caregiver isn’t skilled at assisting vaginal multiple births.
How to Avoid Unnecessary Use:
Let your labor start and progress on its own unless there are clear, compelling health reasons to induce or speed up labor.
It’s a day you’ll mark with cake and candles in the coming years—the day that you finally get to meet your new baby! You’ve waited many months for this moment, and spent considerable time thinking about how it will unfold.