Cesarean section is the most frequently performed major abdominal surgery in this country. There has been a lot of concern about the increasing frequency of C-sections over the last few years. Why is the number of these surgeries increasing? Let's look at the some of reasons this surgery is done.

The most common reason is elective repeat C/S in people that had them before, vaginal birth after C/S (VBAC) is looking more and more dangerous, and the vast majority of women are choosing repeat C/S. I will still care for a patient who wants a VBAC, if the setting is right.

The next most common reason is the baby being too large for the pelvis or the pelvis too small for the baby. In years passed, when C/S were more of a threat to the mother's life, more heroic measures were used to achieve a vaginal birth and avoid a cesarean section. As late as the 1940s C/S had a 5% mortality! Forceps were used with the baby still very high in the pelvis. The birth injuries that resulted are no longer acceptable because C/S are so safe now.

Occasionally, the baby will present breech (bottom first) or sideways in the pelvis. I would say 99.9% of breech babies are delivered via C/S. Back in the old days, many of these babies were delivered vaginally, but also with more frequent birth injuries. The problem is that the head coming last can get stuck after the body is delivered.

Fetal distress is diagnosed if the baby is compromised somehow and can not tolerate labor to the point of delivery. Obstetricians are well versed in interpreting heart monitor tracings and can determine if the baby is in jeopardy and needs a C/S to be done to protect the baby’s wellbeing.

In recent years there has also been a movement for elective primary cesarean sections for convenience, to avoid the duress of labor, to protect against future bladder and bowel problems and to avoid the risks of labor on the baby. This is still an evolving issue, but frankly, after going through labor with thousands of women, I can understand this new wave. In an informed patient, I personally would be OK with an elective cesarean.

The goal of pregnancy is a healthy baby; the general preference is by a vaginal delivery. A C/S is a safe option, be grateful it's there.