In my 5 years as a midwife, I’ve lost count of how many amazing caesarean births I’ve been lucky enough to be a part of. To me, the energy in the room when a baby arrives is the same no matter what kind of birth you have – joy and pure relief, you did it!
For some people, caesarean birth is planned, either by choice or because something has been identified in pregnancy that means it is the safer option. For others, it can be a bit of a shock and the result of some unexpected complications.
We are SO lucky in settings such as Australia to have access to clean equipment, skilled surgeons and high-quality postpartum care, all of which make caesarean birth safe. However, it isn’t quite as simple as your babe popping out the sunroof. It is still major abdominal surgery and as such, generally means longer recovery times and additional considerations for subsequent pregnancies when compared to vaginal birth.
In Australia, ‘elective’ caesarean birth (choosing caesarean in the absence of clinical indication) tends to be more readily available in the private maternity system, while in the public system, caesarean birth is usually reserved for complex scenarios in which vaginal birth may not be the safest option for Mum or baby. The reasons for electing caesarean birth are personal and can include trauma relating to previous birth experiences, fear of the unknown or as a strategy to support mental health. With this in mind, if you are birthing in the public system and have a strong desire for elective caesarean birth, I encourage you to share your reasons openly with your chosen care provider so that you can chat about all your options and make a plan for a positive birth experience.
So when is caesarean birth used?
Pregnancy can be complex! And what is right for one may not be right for another. Therefore the reasons listed here are not exhaustive, rather they cover some of the more common reasons caesarean birth may be recommended.
Typically caesareans can be divided into ‘planned’ or ‘emergency’.
Planned / Elective Caesarean
Sometimes, there are pre-existing reasons identified in pregnancy (or even before) that indicate surgery is the safest way to birth a baby, in which case a caesarean can be scheduled ahead of time. This is referred to as a planned cesarean or elective caesarean.
A planned caesarean may be recommended to you if:
- The placenta is covering all or part of the cervical opening.
- Your babe is in a breech position, meaning their bottom or feet are pointing down (97 per cent of babies will move into a position with their head down by 37 weeks gestation, so please don’t read this and panic!) It should also be noted that breech vaginal birth is possible for some people and is an option you can discuss with your care provider.
- Your baby is in a side-lying position and cannot be turned.
- You have had multiple caesarean births before.
- You are having twins and the first baby is in a breech position.
- You are pregnant with three or more babies.
- You have significant psychological trauma relating to previous birth experience(s).
- You have a personal preference for caesarean birth and elective c-section is offered by your OB/GYN.
An emergency caesarean section takes place when unexpected complications develop either before or during labour, requiring the birth to be hastened. For example:
- There is reason to believe the baby’s head will not move or fit through the pelvis.
- Despite hours of labour, progress (cervical dilation) is slow or absent.
- There is concern for your health, such as severe bleeding or severe pre-eclampsia (a blood pressure complication of pregnancy).
- The baby is showing signs of distress such as sudden or ongoing changes to their heart rate pattern.
- The umbilical cord, which supplies nutrients and oxygen, has dropped through the cervix and into the vagina. This is a rare complication known as a ‘cord prolapse’.
Globally, caesarean birth rates are on the rise and continue to exceed the World Health Organisation estimation that population caesarean rates should be between 10-15% to ensure mortality rates are kept low for mothers and babies. In the US, data released in 2019 reports a caesarean rate of 31% (CDC, 2019). The most recent data from Australia reveals a caesarean birth rate of 36% (AIHW, 2021).
With what appears to be absurdly high rates, the conversation around caesarean birth can be a delicate one. It is so important that we balance open discussion about the potential risks associated with caesarean birth, without cultivating a culture of shame around the choice or need to have one. As described here, there are many scenarios in which access to safe caesarean birth can be life-saving for both mum and bub.
Regardless of how your baby arrives in the world, birth is birth and each Mama and baby deserve to be celebrated and supported during this transformational life experience.