What to Think About

If you plan to deliver vaginally and have concerns about having an unnecessary cesarean delivery, talk to your doctor or midwife ahead of time. Ask in what types of situations cesarean section is usually used and what steps 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 cesarean, identifying birth scenarios that may not necessarily require surgical delivery. These include:

• History of cesarean. Some women with a cesarean 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 cesarean, weigh the benefits and risks of vaginal delivery with your doctor or midwife. For more information, see the topic Vaginal Birth After Cesarean (VBAC).
• Fetal distress. Deciding whether and when a fetus with a slowing heart rate should be delivered by cesarean is a common judgment call during labor. Ultimately, a health professional will lean toward caution and deliver by cesarean to prevent harm to a newborn.
• Difficult, slow labor (dystocia). Dystocia can often be corrected with medicine that restarts contractions (augmentation). For women with a cesarean scar, oxytocin must be used carefully to reduce the slight risk of the scar rupturing during labor.

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