Cesarean section is a surgical procedure in which an incision is made in the mother’s abdomen and uterus to remove the baby. It is indicated when it is believed that a vaginal delivery could pose a risk to the mother or the fetus.
In certain situations, cesarean delivery is the only solution for the birth of a healthy baby, and therefore it should only be performed when necessary, always assessing the risks and benefits in each case, and avoiding unnecessary cesarean sections.
Depending on the case, the decision to perform a cesarean section may be made before delivery based on known alterations, such as, for example, abnormal fetal presentation or maternal illnesses; during labor , due to lack of adequate progression; or in the event of an emergency situation that arises during childbirth, such as fetal distress.
Each hospital center has its own specific protocol in case of cesarean section, so it is important that you inform yourself before the moment arrives.
Indications for cesarean section before delivery:
This is what is known as elective cesarean section or scheduled cesarean section that is performed before the start of labor in pregnant women with maternal or fetal pathology that contraindicates or advises against vaginal delivery.
- Fetal presentation that makes vaginal delivery difficult : In general, a cesarean section is usually indicated when the baby comes from the breech (breech presentation) or in a transverse or oblique presentation, but there are hospitals that have a specific protocol that allows attempting a vaginal delivery in breech presentation if the right conditions exist. Before delivery, and if there is no contraindication, the pregnant woman can be offered the possibility of performing an external cephalic version (at week 37-38) to turn the baby to the cephalic position and have a vaginal delivery.
- Fetal macrosomia: when the estimated weight of the baby is greater than five kilos, the need for a cesarean section is considered. In the case of a diabetic mother, weighing more than 4.5 kilos.
- Previous cesarean sections: in general, it is usually re-indicated for women who have had two or more previous cesarean sections, due to a possible risk, although minimal – 1.4 percent – of uterine rupture. However, in certain cases a vaginal delivery (VBAC) can be attempted if there are no risk factors that contraindicate it.
- Having had a uterine rupture in a previous pregnancy : due to the risk of recurrence.
- Total or complete occlusive placenta previa: when the placenta completely obstructs the cervical os, preventing the baby from leaving the birth canal.
- Maternal diseases or infections : condylomata, HIV positive patients, active genital herpes lesions, or medical conditions of the mother that advise against vaginal delivery such as severe heart disease, risk of stroke, pre-eclampsia, eclampsia, etc.).
- In some cases of prematurity and multiple pregnancies : it depends on the individual circumstances of each case. In twin pregnancy, that the position of one of the babies is not cephalic.
Indications for cesarean section during labor:
Once labor has started, situations may arise that require a cesarean section during labor , such as:
- Failed induction of labor.
- Parking for labor due to lack of dilation or descent of the baby.
- Cephalopelvic disproportion (PCD) : the baby’s head is too large to fit through the mother’s pelvis and cannot be removed with instruments. This is very rare.
Indications for urgent cesarean section during delivery:
During the expulsion phase, unforeseen extreme urgencies may occur that require urgent surgical intervention , such as:
- Fetal distress: suspected loss of fetal well-being.
- Placental abruption: requires immediate removal of the baby to avoid damage caused by lack of oxygen.
- Umbilical cord prolapse: occurs when after the bag has been ruptured, the umbilical cord protrudes through the cervix before the baby’s head. It is rare that it happens, there is one case in 1,000, but it poses a serious risk.
- Suspicion of uterine rupture.
- Vaginal bleeding that compromises the maternal state.
In Babies and more | Learn about the new WHO recommendations for a positive birth experience, Cesarean section scar care: what you need to know
