Delivery by Caesarean Section

A caesarean section involves delivering a baby by making an incision in the abdomen and uterus of a pregnant woman through which a baby can be delivered. In some cases, a caesarean section is planned (elective). The reasons for an elective caesarean section include:

• The baby is in a breech position (feet first);
• The placenta is low-lying;
• Multiple gestation;
• Pregnancy-related high blood pressure;
• Infections which may affect the baby if born vaginally;
• Previous caesarean sections or surgery on the uterus;
• The baby appears large relative to the size of the pelvis of the pregnant woman;
• The pregnant woman chooses to have a caesarean section for personal reasons.

In some circumstances a caesarean section is non-elective. The reasons for a non-elective caesarean section include:

• Fetal distress;
• Ineffective uterine contractions;
• Failure to progress;
• Obstructed labour (i.e. due to cephalopelvic disproportion).

In Canada, approximately 28% of all births are by caesarean section. This rate is increasing every year.

Like any surgical procedure, there are risks to the pregnant woman, which include:

• Infection of the wound;
• Bleeding from the incisions;
• Blood clots developing in the legs; and
• Injury to the organs or tissue near the surgical incisions.

There are also risks to the baby including:

• Breathing difficulties in the minutes and sometimes hours following delivery;
• Injury from the incision was made.

The decision as to whether to proceed with a caesarean section should balance the risks of a caesarean section and the benefits of delivering in this way. A caesarean section may reduce the risk to a baby and/or a pregnant woman from continuing in labour or through delivering vaginally. If a baby is showing early warning signs of potential fetal distress, delivering urgently may help to avoid a significant brain injury to the baby.

This discussion should occur again during labour if there are any early warning signs of potential fetal distress, so that the pregnant woman can reassess her risk tolerance and her decision on how she wished to deliver her baby. It is important to remember that a woman does not have to “qualify” for a caesarean section and the health care provider does not have to agree with her decision to have a caesarean section.

Broadly speaking there are two scenarios that need to be considered – the planned elective caesarean section and the emergent caesarean section due to potential fetal distress. An emergency caesarean section is higher risk because it is often done in response to fetal distress and also because the surgery is more complicated with greater risks to the pregnant woman and her baby the farther the baby progresses down the birth canal. For this reason, planned caesarean sections are scheduled to take place a week or two before the expected delivery date to avoid these additional risks.

The primary risk associated with emergency caesarean section when it is done in response to potential fetal distress relates to delay in delivering the baby. The delay can be in:

• making the decision to proceed with a caesarean section; and/or
• performing the caesarean section once the decision is made.

During labour, a baby may signal that he or she is not getting enough oxygen and his or her heart rate may reveal that he or she is being affected.  Or, during labour, a baby may not move down the birth canal as expected. Health care providers are required to carefully monitor the baby during labour and watch for warning signs of potential problems. These warning signs include changes in the fetal heart rate such as repetitive or complicated decelerations or an increasing heart rate, an abnormal contractions pattern, or failure to progress in the expected manner. It is important that these early warning signs are detected and responded to before they progress to an obstetrical emergency. Timely and clear communication amongst all members of the team, including the specialists required to intervene if an emergency arises, is critical.  Health care providers are required to anticipate potential emergencies that may arise for their patient and plan accordingly. A scramble at the last minute, once the baby is clearly in distress, creates unnecessary risks to both the pregnant woman and her baby.

The pregnant woman has a right to be informed of all warning signs that her baby may be in distress or if her labour is not proceeding normally and has a right to participate in the decision-making process.

A planned caesarean section may be the safest option in response to risk factors in the pregnancy or in response to the pregnant woman’s choice. An emergency caesarean section may be the safest option for delivery if there are concerns about the health and wellbeing of a pregnant woman or her baby. If you have concerns about how you were cared for in your pregnancy or labour then please contact us – we would like to help. We have a team of experienced lawyers and medical specialists who can review the medical care you received and help answer your questions. We will provide you with the information and advice you need to make informed decisions about your child’s future and ensure your child’s rights are protected. Rest assured – the consultation is confidential and free of charge.