One thing is certain about C-sections—when it comes to having a baby, they are second choice. Women are designed with a natural way out, and normal vaginal deliveries make use of that route; however there are times when it is prudent to resort to second choice.
Obstetrics is very easy at a certain point, that point being delivery. Why? While expecting a vaginal delivery, time and the laws of physics will allow it to happen or not. It becomes quite obvious when there's a problem with the expected progress.
Years ago, Dr. Friedman described the expected labor progress of two variables over time: dilation of the cervix and descent of the baby. Today we know it as the Friedman's Curve. When there is a slow-down of the slope of these curves, the labor is called dysfunctional. There are two general types of dysfunction: The cervix can stop dilating, or the baby's head will descend no further—or both.
Generally, when there is a plateau (stopping of progress) of two hours in Friedman's curve while in a non-medicated active labor, or of three hours in active labor with an epidural, then "failure to progress" is the diagnosis and C-section is indicated. Of course, appraisal of the "3 Ps"—Power, Passenger, and Passageway (basically this means the force of labor, the size and position of the baby, and the size of the birth canal) must be made to see if there's a correctable measure. But when the facts are irrefutable, then there may be danger in forcing a baby's head against the mother's bones any longer.
What should the C-section rate be for a doctor? Well, if you need one, 100 percent. If you don't, zero percent. I'm not trying to be coy; in other words, each patient's experience is unique and must be taken case-by-case.
More Reasons for C-Sections
There are other reasons for doing a C-section.
- Herpes infection could expose the baby to serious illness.
- A previous C-section with a vertical scar on the uterus (womb) may pose a danger of uterine rupture with labor.
- Breech delivery is another problem addressed by C-section.
- Twins, in which one of the babies is breech is the same problem.
- Of course, fetal distress requires a C-section if a vaginal delivery is not imminent.
- Serious bleeding from an abnormally placed or separating placenta elevates C-section to a heroic, life-saving procedure.
- Maternal disease that may put the mother in danger with labor, e.g., heart disease, can make operative delivery a viable choice as well.