A Caesarean section is often performed when a vaginal delivery would put the baby's or

mother's life or health at risk. Some are also performed upon request without a medical
reason to do so, which is a practice health authorities would like to reduce.[1][2][3]

C-sections result in a small overall increase in bad outcomes in low risk pregnancies.[4] The
bad outcomes that occur with C-section differ from those that occur with vaginal delivery.
Established guidelines recommend that caesarean sections not be used before 39 weeks
without a medical indication to perform the surgery.[5]

Some medical indications are below. Not all of the listed conditions represent a mandatory
indication, and in many cases the obstetrician must use discretion to decide whether a
Caesarean is necessary.

Complications of labor and factors impeding vaginal delivery, such as:

 abnormal presentation (breech or transverse positions)

 prolonged labour or a failure to progress (dystocia)
 fetal distress
 cord prolapse
 uterine rupture or an elevated risk thereof
 increased blood pressure (hypertension) in the mother or baby after amniotic rupture
 increased heart rate (tachycardia) in the mother or baby after amniotic rupture
 placental problems (placenta praevia, placental abruption or placenta accreta)
 failed labour induction
 failed instrumental delivery (by forceps or ventouse (Sometimes a trial of
forceps/ventouse delivery is attempted, and if unsuccessful, it will be switched to a
Caesarean section.)
 large baby weighing >4000g (macrosomia)
 umbilical cord abnormalities (vasa previa, multilobate including bilobate and
succenturiate-lobed placentas, velamentous insertion)

Other complications of pregnancy, pre-existing conditions and concomitant disease, such as:

 pre-eclampsia[6]
 previous (high risk) fetus
 HIV infection of the mother
 Sexually transmitted diseases, such as genital herpes (which can be fatal to the baby if
the baby is born vaginally)
 previous classical (longitudinal) Caesarean section
 previous uterine rupture
 prior problems with the healing of the perineum (from previous childbirth or Crohn's
disease)
 Bicornuate uterus
 Rare cases of posthumous birth after the death of the mother

Other

 Lack of obstetric skill—obstetricians not being skilled in performing breech births,

multiple births, etc. (In most situations women can birth vaginally under these
circumstances, although planned C-section has a lower risk of infant death for breech
 births than vaginal delivery.[7] Obstetricians are not always trained in proper
procedures for such deliveries, increasing the risk still further.)[8]
 Improper Use of Technology (Electric Fetal Monitoring [EFM])[8][9]

Prevention

 It is generally agreed that the prevalence of C-section is higher than needed in many
countries and physicians are encouraged to actively lower the rate. Some of these
efforts include: emphasizing that a long latent phase of labor is not abnormal and thus
not a justification for C-section; changing the start of active labor from a cervical
dilation of 4 cm to a dilation of 6 cm; and allowing at least 2 hours of pushing for
women who have previously given birth and 3 hours of pushing for women who have
not previously given birth before labor arrest is considered.[4] Physical exercise during
pregnancy also decreases the risk.[10]
 Risks
 Adverse outcomes in low risk pregnancies occur in 8.6% of vaginal deliveries and
9.2% of C-section deliveries.[4]
 Risks to the mother
 In those who are low risk the risk of death for Caesarian sections is 13 per 100,000
and for vaginal birth 3.5 per 100,000 in the developed world.[4] The UK National
Health Service gives the risk of death for the mother as three times that of a vaginal
birth.[11]
 In Canada the difference in bad outcome in the mother (e.g. cardiac arrest, wound
hematoma, or hysterectomy) was 1.8 additional cases per 100 or three times the
risk.[12]