There are many reason for needing to have a c-section that range from choosing to have it, baby being breech, placenta covering the cervix, or something that occurs during labor that requires expediting delivery.
When the c-section is done during labor, it is considered an unplanned c-section and can fall into two categories, a Low-risk C-section or Primary C-section, or both.
Low Risk C-section is done on someone who’s nulliparous (first birth), term (37 weeks or more), one baby, and head down.
Primary C-section is when someone who has never had a c-section prior has one, regardless of the number of previous births.
WHO Recommendations
The World Health Organization believes that a C-section can prevent maternal and newborn mortality when it is medically necessary.
They have also has recommended that the ideal rate of c-section is between 10-15% since 1985. This recommendation is based on research supporting that when the c-section rate is 10% this decreases the rate of maternal and newborn death rate. When the rate goes above 10%, the rate does not improve.
C-section statistics in 2020
According to CDC reports in 2020:
- C-section delivery rate: 31.8% (increase from 31.7% in 2019)
- Low-risk C-section: 25.9% (increase from 25.6% in 2019)
- Primary C-section: 21.9% (increase from 21.6% in 2019)
Health People 2030
This is a 10-year national goal with the purpose of identify health priorities to improve the our health. It tries to shift the focus from treating diseases to preventing them.
One of the indicators they look at are the Low-Risk C-section rate. Their goal is to decrease this rate to 23.6% using different strategies.
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C-section Reasons
Understanding the reasons for having a c-section is how we work to lower the number of c-sections done in a year!
What are the top reasons for an unplanned c-section during labor?
- Labor Arrest
- Abnormal or Indeterminate Fetal Heart Rate Tracing
- Fetal Malposition
1. Labor Arrest
This is #1 reason for an unplanned c-section. This is when labor stops or slows down for some reason. There are 3 main reasons for a labor stall:
- Passage (birth canal)
- Passenger (baby’s position)
- Power (birthing person)
Read more on reasons for a labor stall here
There are guidelines for providers before they will recommend a c-section for labor arrest that the governing bodies of OBGYNs developed for different stages of labor.
- Induction
- Early Labor
- Active Labor
- Pushing
2. Abnormal/Indeterminate Fetal Heart Rate Tracing
Previously called “Non-reassuring Fetal Heart Rate Tracing”
Fetal Heart Rate Tracings are categorizes into 3 categories, Category 1 being the best and Category 3 being the worst.
A majority of fetal tracing are Category 1 throughout labor, and this is a sign that baby is doing well at that time.
Category 3 is a sign that interventions or expedited delivery needs to occur promptly for the safety of baby!
Category 2 though is this gray area. It covers such a large gradient of babies that are tolerating labor but just giving us small signs that something may be going on, to babies that are about to become category 3 tracings. Category 2 tracings that persist, despite all our interventions, are the majority of tracings that end up delivering via C-section for fetal heart rate tracings.
There is an algorithm that was created on how to manage and communicate about Category 2 tracings as a team that includes the nurse, provider, and any other person that is involved in the care. This algorithm can help identify those persistent Category 2 tracings and develop a plan before baby starts to deteriorate more.
3. Fetal Malposition
Baby being in a non-optimal position where they are not able to navigate through the pelvis can cause labor to stop or slow down, but it can also prevent it from starting at all.
This is one of the things that can cause a labor arrest, which is reason #1. The baby’s position at birth is documented in the medical chart so we can know if the position is what lead to the arrest.
Similar to when a toddler tries to jam the square peg into the square hole without lining it up. When baby is not in the optimal position it could be presenting to the pelvis in a way that it is too large.
This reason is why it is so important for birth workers to understand how to tell what position baby is in and how to help baby reposition during labor to help reduce the number of c-sections done for baby’s position.
There are many other reasons for a c-section to occur during labor other than what is listed above. In order to lower the number of c-sections, we need to understand why they are being done to help prevent those things from happening.
If we can understand pelvic biomechanics and the birthing person’s anatomy and physiology, this can help prevent labor stalls. If we can educate ourselves on different birthing and laboring positions to help reposition baby’s positions to being more optimally.
Learn more in our Birth Workers Education Course and Childbirth Education Course