A c-section can save the life of a mother or fetus. Reasons for performing a c-section include, but are not limited to, small maternal pelvis, chorioamnionitis requiring immediate delivery, maternal pelvic deformity, eclampsia, life-threatening complications of pregnancy, a woman with cardiac disease that may not tolerate the stress of labor, fetal asphyxia, or fetal acidosis, life-threatening situations for the fetus that can lead to fetal hypoxia, umbilical cord prolapse, placenta previa, abnormal lie or presentation of the fetus, or uterine rupture. A fetal heart tracing is most commonly used to assess fetal acidosis. It is not accurate, but there are no better options. A category III fetal heart rate requires a c-section if the woman is remote from delivery. A category II fetal heart rate is a larger, harder to interpret category that may also lead to a c-section. For cesarean birth, multiple gestation pregnancies and women with active herpes simplex virus are also recommended. One (or even two) c-sections does not mean that a woman must have a c-section delivery with her next pregnancy. The woman should be evaluated and have discussions with her provider. The risk of uterine rupture is slightly higher, but she can be monitored for signs of uterine rupture during labor. A vertical incision in the uterus would not make her a candidate for a trial of labor after cesarean (TOLAC).
Some reasons likely have increased the risk of a c-section over time. These include increased maternal age during pregnancy, increased obesity and incidences of gestational diabetes, and increased use of fertility treatments. Another factor that may increase the c-section rate is the medical-legal aspect of labor and delivery. Malpractice rates and no cap limits on birth injuries may influence a provider’s decision to perform a c-section.