Understanding Your Doctor’s Reasoning: Why a C-Section Might Be Necessary

Dr. Ayita Verna, MD in Obstetrics and Gynecology and mother of Maya-Lou and Eloise, shares her knowledge on Vaginal Births and C-Sections.

As an OBGYN, mother, and friend, I am aware that many women feel a strong desire to maintain control over one of the most transformative experiences of their lives: childbirth. While I prioritize helping my patients have the most positive and empowering birth experience, it’s essential to recognize that despite the powerful forces of science and modern medicine advancements, many aspects still lie beyond our ability to change or influence.

Though a vaginal birth is, most of the time, considered the most natural and safest way to bring a baby into the world, this may not be the case for every patient. Sometimes, even if it’s difficult to accept, a Cesarean section may be the safer or more appropriate option, depending on the situation.

What I can assure you is that no doctor ever wants to tell a patient that their baby is in distress or that an emergency C-section is necessary. While sharing your birth plan is important, and we will do our best to honor it, our ultimate priority is always the same: ensuring the best possible outcome for both you and your baby.

The purpose of this article isn’t to advocate for or against C-sections. Instead, it’s to provide you, future moms, with essential information to start meaningful discussions with your doctors. Hopefully, this article will provide the right tools, empowering you to ask the right questions to make well-informed decisions.

Keeping it simple and concise, let’s explore some of the reasons why your doctor might recommend a C-section:

Let’s start with Mom and her health:

There are specific health conditions for which a C-section is strongly recommended. This information is based on population-level statistics:

• Placenta previa (where the placenta covers the cervix)
• Pre-eclampsia with worsening maternal conditions
• Certain heart conditions
• Active infection with HIV or Herpes

In all these cases, a vaginal birth could increase the risk of complications and negatively affect the baby during delivery.

Now, let’s discuss the fetus:

• The most common reason for an unplanned C-Section is fetal distress, which occurs when the fetal (baby’s) heart rate drops — a change that can be detected on the tracing/monitor you’re connected to in the hospital.
• We assess the whole tracing based on specific criteria. If the tracing looks concerning, we first try a method called intrauterine resuscitation to try to raise the heartbeat. If that doesn’t work, we may need to perform a C-section to prevent potential injury or stillbirth.
• If the fetus (baby) is not in the cephalic (head down) position, it is often an indication for a C-section, as the risks associated with vaginal delivery increase significantly.
• If the mother is having twins and one of the babies is not in the head-down position, a C-section would also be recommended for that reason.

Next, let’s look at a failed induction

It may happen that the mother doesn’t go into labor naturally or has a health condition that requires induction — using medications that mimic the hormones your body naturally produces to start labor.

• In case the mother undergoes induction and the cervix stops dilating, or the baby stops descending through the birth canal, it is often the safest option to proceed with a C-section; especially after a certain amount of time. Prolonged labor can increase risks for both mother and baby, including infection, hemorrhage, and fetal Distress.

Pelvic Structure and Large Baby

• Anatomically, some mothers may have a pelvic structure that is too narrow to allow a safe vaginal birth, particularly if the baby is large — this is known as cephalopelvic disproportion or CPD. This can not only make vaginal birth risky but also result in prolonged labor, arrest of descent, or injury to the baby.

Let’s talk about previous surgeries:

• Having two or more prior C-sections would increase the mother’s risk of uterine rupture, which is why a planned C-section is typically recommended in such cases.
• Having had a previous C-section and not being a suitable candidate for TOLAC (Trial of Labor After C-section). Please note TOLAC is when you haven’t yet delivered through a vaginal birth. VBAC (Vaginal Birth After C-section) is when you’ve had a successful vaginal delivery after a C-section.
• If the mother had a previous C-section with a vertical incision, the risk of uterine rupture is significantly increased.
• If the mother had an abdominal myomectomy, a C-section is typically recommended to prevent the risk of uterine rupture.

Planning a repeat C-section helps reduce the risk of scar rupture and provides a more controlled and predictable delivery environment for mothers.

Patient preference

Believe it or not, while we as doctors prioritize medical needs, we also understand the importance of maternal preferences and recognize that mental health is as important.

For example, many patients choose not to attempt a TOLAC (trial of labor after C-section) because their first C-section was a traumatizing experience. While we don’t typically recommend an elective primary C-section, we strive to respect a patient’s or mother’s autonomy when it’s their preferred option, as it may lead to improved mental and emotional outcomes.

Finally, while vaginal birth is often prioritized for its natural progression, shorter recovery time, lower risk of surgical complications, and significant health and psychological benefits, C-sections remain life-saving procedures in many situations. As a healthcare provider, I believe the professionals in the field are equipped with many tools to assess and determine when a C-section is the safest option. We also try our best to ensure our patients understand the reasoning behind these decisions.

Ultimately, the important thing is finding a healthcare provider you trust and feel connected to. It’s essential for you, as a mother, to feel informed, respected, and empowered to make the decisions that are best for you and your baby.