In the United States today, about 1/3 of all mothers have their first babies by cesearean section surgery. Of those women, only about 13% go on to birth vaginally in a subsequent pregnancy. Mainstream health authorities and holistic health guides alike, agree that a cesarean rate exceeding 10-15 percent indicates a misuse of resources and contributes unnecessary harm to women and children. Our current national cesarean rate is hovering near 30%, double to triple of what is deemed medically appropriate. This prevalence of high-intervention practice directly influences mothers' birth experiences, physical and mental health, and often impacts the options and perceptions in subsequent births.
So, how do you know if you really do need (or needed) a surgical birth?
Cesearans can be broken down into 3 general categories:
Planned Elective,
Elective Non-Emergent, and
Emergent.
We will explore the variations within these categories here, but if you want a deeper dive into specific indications and the reasons behind them, check out Did I Really Need a C-Section ebook, available here!
Keep in mind that each birth and person's health is unique, and this generalized resource can not substitute your intuition or accurately categorize your individual history. If you are looking for a thorough history and debrief of your birth, consider looking over a copy of your medical records, filling in informational gaps with your midwife or doctor, or working with your birth story outside of the allopathic system. Many doulas and birthkeepers, including myself, offer debrief and integration sessions, where you can share your birth story authentically, gain a clearer understanding of your birth timeline and your associated emotions, digest your experience, and release any constriction or limitation.
Planned Elective
URGENCY LEVEL: LOW
This is a planned c-section, usually before the onset of labor is expected with no plans of anticipating a vaginal birth. These planned cesareans are often scheduled closer to 37 weeks gestation to bypass the labor process altogether.
Reasons for a planned cesarean are very commonly associated with previous cesarean birth, breech baby, non-singleton pregnancy, advanced maternal age, history of primary or gestational diabetes, and presumed placenta abnormalities.
Medically indicated reasons for a planned elective cesarean include reasons that the benefits of a surgical birth outweigh the benefits of vaginal birth or continuing a pregnancy for the mother and/or the baby. This may be due to a serious medical condition that could become more dangerous by continuing pregnancy or by enduring the labor process. It may also be due to confirmed structural abnormalities that are incompatible with vaginal birth or that can be better cared for by opting for a surgical birth.
Elective Nonemergent
URGENCY LEVEL: LOW - MEDIUM
An elective nonemergent cesarean may be suggested for any number of reasons, ranging from an unfavorable fetal position during labor to avoiding an anticipated emergency situation on the horizon. These situations are not emergencies, so they are not incredibly rushed in nature, nor were they foreseen early enough to be planned weeks to months in advance.
Common reasons for an unplanned, elective non-emergent cesarean include a transverse-positioned baby that isn't a fan of moving into a vertical position, or a breech baby that isn't receptive to moving heads-down, advanced gestational age of 40+ weeks, a long labor (with or without maternal exhaustion) or labor without evidence of progressive cervical change, an active genital herpes outbreak, and persistent nonreassuring fetal heart patterns that are not yet emergent. Root causes of some of these concerns may be iatrogenic, meaning that that are due to other medical intervention, ie medications, nosocomial infection, etc.
Medically indicated reasons for an elective nonemergent cesarean often exist within a gray-zone: was it truly needed or was it not? For example, a transverse-positioned baby cannot be born vaginally, but a breech baby can . . . and not all hospitals or providers are willing to "allow" breech birth. Healthy pregnancies very often last between 40 and 42 weeks, followed by spontaneous vaginal birth. However, many providers begin to push for induction after 40 weeks, which can lead to complications that then lead into cesarean. Many women have long labors - lasting up to 3 days in some cases. . . and many hospitals and providers are uncomfortable allowing labor to last longer than 24 hours after the water bag releases due to risk of infection, and are also uncomfortable if the water bag does not release after so many hours of labor, deemed failure to progress.
It is a teetering topic, and ultimately the decision of whether or not to opt into a nonemergent, unplanned cesarean should lie with the birthing woman after having a conversation weighing the reasons one might be helpful or how one might create disproportiate risk.
Emergent
URGENCY LEVEL: HIGH
An emergent cesarean, also called an emergency cesearean or crash c-section is a nearly-nonnegotiable cirumstance. An emergency cesarean will always be fast-paced with little to no information being shared with a birthing woman and her support person; the only priority is to get the baby out as fast as possible.
An emergent cesarean may become necessary to aid the baby, such in the case of a placental abruption or any other scenerio that causes rapid hypoxia, consistently concerning or absense of fetal heart tones. An emergent cesarean may also become necessary to aid the mother, such in the case of an acute injury or medical condition where sustaining pregnancy creates additional risk or obstruction to treatment.
It is common for physicians and nurses to state that an emergency c-section is needed, but this may not be a true reflection of your birth story. If a birth team is not rushing around, calling codes, and assessing and preparing the mother baby for surgery, there is likely enough time to have a brief conversation with any member of your medical team about what is happening, then state your consent or refusal to the procedure. It's important to note that though every patient has the right to consent to or refuse suggested treatments - life saving ones included - not all providers are receptive to honoring that right or having the discussions necessary for true informed decision making to happen.
Closing Thoughts
Many cesareans performed in the United States are unnecessary or avoidable. Many are iatrogenic in nature, and directly related to other interventions that occured within the birth process. Still, some are medically indicated and life saving for a variety of reasons. It is fortunate that women have access to both surgical care and neonatal intensive care for these situations.
Often times, the largest concern with cesarean births is the way women are treated before, during and after the emergence of their babies. The presence or absense of validation of their feelings about their birth experience is often overlooked or deemed unimportant, deepening a sense of trauma. Many providers unnecessarily rush the birth process, with little to no explanations or options for informed decision making by the mother - leaving feelings of degradation, abandonment, and betrayal. Paired with awareness of unjustified high surgical rates, women are often curious about what was possible for their birth:
"Could my story have been written differently?"
You are the sole authority of your body, and the core wisdomkeeper of your birth.
Your Intuition is a Divine Compass. Trust It.
Ready for a Deeper Dive? We've Got You Covered.
Did I Really Need a C-Section Ebook
18 Pages of Exploration on:
Maternity Care in the United States
Prevalence of Cesareans and VBAC
A Breakdown of the 22 Most Common Reasons for Cesearean Sections &
Why These Reasons Are or Are Not Medical Indications for Surgical Intervention in Birth
Planning for Your VBAC | Digital Bundle
This digital workshop with Lynnea, Diana, and Dr. Sarah of Birth Uprising offers comprehensive insight to the essentials of planning for your vaginal birth after a cesarean (VBAC).
You Get:
The Recorded VBAC Planning Workshop
A Copy of Dr. Sarah's Birth Plan
Our Overcoming the Top 10 VBAC Obstacles Ebook.
Private Support with Lynnea
Sometimes Story Medicine is the Best Medicine.
You deserve a safe, compassionate space to get real about your birth story, your desires, and your experience. .
Choose which support best aligns with your needs:
30-Minute Consultation
Birth Story Integration (90 min)
Birth & Postpartum Planning (90 min)