• Rosie Das

Medical indications for having a Caesarean

Updated: Jun 29, 2020

There is no doubt that Caesareans can save lives. What are the medical indications that a Caesarean might be needed?

Malpresentation or breech baby.

Not all care providers are experienced or trained in delivering babies who are breech (bottom first), so it may be recommended to have a Caesarean. It is entirely possible to give birth to a breech baby vaginally but it does depend on having an experienced practitioner supporting you. Your baby can turn and change position throughout your pregnancy, right up to when you are in labour, so being breech in the third trimester does not always automatically mean they will be breech when it is time to give birth. The position of the baby's head, neck and jaw can also mean a Caesarean is needed, for example if the baby has their head tilted up or to the side as they enter the birth canal.

Big baby (macrosomia)/small pelvis.

This one is a little trickier, as late pregnancy ultrasounds weight estimates are just that; estimates. It is also generally possible to birth a big baby vaginally - there are often stories in the news of people giving birth to 10 or 11 pound babies! Sometimes though, a baby just isn't going to fit, usually for a combination of reasons.

Fetal distress / heart problems.

If you are already in labour, it is likely that your midwife or doctor will ask to monitor your baby by placing straps and monitors over your bump. This can be continuous, i.e. the monitors stay on, or intermittent, where they check every half an hour or so. These monitors are checking your baby's heart rate, and the strength of your contractions. This produces a graph showing how your baby's heart rate is affected by contractions. It is normal for the heart rate to dip down during contractions - after all, they're being squashed and squeezed in there! But it is not normal for the heart rate to drop down very low, and take a longer time to recover (come back up) after the contraction has ended. If the midwives or doctor spot this pattern it can indicate your baby is in distress and needs to come out sooner rather than later.

Failure to progress in labour.

This is often the reason given to move to a Caesarean during a labour that is taking a long time. This means that over a period of at least 6 hours there has been no cervical change (position change or thinning), your waters have broken either on their own or have been broken, and you are not dilating further, and baby is not moving down with each contraction. However it is important to recognise that each person's labour is unique to them, and does not always follow a typical pattern. There are lots of reasons why a labour might be taking a longer period of time, and a long labour can be very tiring. Failure to progress is often described as failure to wait, so it is important to try different ways of moving labour along before going to a Caesarean (e.g. change of position, sleep, epidural to get some rest, eat something, go to the toilet).

✅ Placenta previa.

Placenta previa is where the placenta covers the cervix, therefore covering baby's exit route! The placenta does tend to change position through pregnancy, so an early diagnosis does not mean that it won't later move as the uterus grows. However if the placenta is covering the cervix as you approach your due date, this is a very real reason to have a Caesarean.

Known medical risk to parent or baby.

You may have a known medical condition that means it would be dangerous for you to give birth vaginally. Scans may have shown that your baby needs to be born by Caesarean for a medical reason.

DID YOU KNOW? You can hire me to support you for your Caesarean! Yes, it's true, as your doula I can support you before, during (sometimes, depending on hospital policy) and after your Caesarean. As someone who's had a Caesarean myself I totally get that there are lots of emotions involved, and recovery can be tough! Here's some more info:

Caesarean recovery tips

Doula support for your Caesarean

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