Why abdominal births (also known as Caesareans or C-sections) take place

Abdominal births (also known as Caesareans or C-sections) can be suggested or take place for many reasons. It's important for any Mum-to-be to understand the reasons, benefits and risks of how and why these may occur.

TMM Expert Laura Berkeley explains some of the reasons abdominal birth might be suggested or take place are:

  • Raised BMI – although there isn’t good evidence to back this up to be a reason you should have/need an abdominal birth. Each individual person is different so if this is the sole reason a c section has been suggested you might want explore all of your options or seek some additional support
  • Breech presentation – this does not automatically mean abdominal birth. You can have a vaginal breech birth if you choose. The risks & benefits of both can be weighed up before you make a final decision.
  • Transverse/oblique lie position – a baby in the transverse position cannot be born vaginally. Something called an ECV (external cephalic version) might be offered to turn your baby. ECV success rates depend on many factors such as who carries out the procedure, at what point in pregnancy you are etc. it’s worth doing some research & asking questions before accepting or declining.
  • Maternal age – again ‘risk’ factors increase with age but again – personal choice. Is the risk increased by 1% within your age bracket or 40%? You get to weigh up the risks & benefits
  • Concern for parent – if there is a concern due to mother’s health such as a heart condition, severe pre-eclampsia/eclampsia, fibroids etc. Or, if there is a decline in a parent’s health over time where bringing baby earth side abdominally truly is the safest option.
  • Concern for baby – Baby’s heart rate, mother’s health, infection etc
  • Multiple pregnancies – if there are complications with parent or babies that suggest abdominal birth would be safest. Be sure to do your research as multiple birth doesn’t automatically mean abdominal birth. You may wish to weigh up the risks vs benefits that feel right for you
  • Multiple pregnancy – if you have triplets or more, the more babies you are pregnant with the more risks can increase which is why if you are expecting 3 or more babies more support & abdominal birth might be suggested
  • Suspected ‘large’ or ‘small’ baby – ultrasound scans are not 100% accurate at determining a baby’s size or weight. They can be up to 1.9lb incorrect. However, if there are indications or strong evidence that your baby is either growing too slowly or is large, a C-section might be recommended. This is very individual so an area that would need to e explored in detail to help you make a decision dependent on circumstances
  • Preterm birth – if you go into labour between 26 & 36 weeks
  • Placenta praevia – when the placenta partially or completely covers the cervix so the baby cannot be born vaginally
  • Herpes simplex virus – if a vaginal herpes outbreak is present at the time labour starts then abdominal birth might be suggested to avoid contact for the baby. This is a personal decision & antiviral medications can be used to prevent/reduce outbreaks
  • Previous C-section – You may have been advised to have another C-section if you have had one previously, especially if you have had two or more. There isn’t a lot of clear evidence of improved outcomes compared with outcomes for vaginal birth. Unless your previous section/s have encountered complications, or you would be happier to have another section
  • Maternal choice – previous trauma, fear of childbirth (tokophobia), anxiety, need/want for medication so needing baby/babies to be born as soon as possible. Previous c section & not wanting a VBAC, previous sexual abuse or physical abuse, mental health reasons. The NICE guidelines recommend that if you have requested a c section that you have some counselling beforehand to address the reasons why – however it is YOUR choice & your care providers have a duty to provide you with the care that you request & desire


How are abdominal births classified?

Category 1 – Immediate threat to life of the woman or baby/babies. Usually within 30 minutes of a decision being made (2011, amended 2021)

Category 2 – Maternal or foetal compromise which is not immediately life threatening. In most situations within 75 minutes of making the decision (2011, amended 2021)

Category 3 – No maternal or foetal compromise but needs early birth

Category 4 – Birth timed to suit woman or healthcare provider

(Ref 1.4.2 NICE guideline www.nice.org.uk/guidance/ng192)

 For information on how to have a gentle C-section, read this blog post next.

p.s don't forget you got this mama!

Love Sophia x