C-Section Indications: Reasons And Considerations For Cesarean Delivery
Explore the common indications for a C-section, including medical conditions, complications, and maternal/fetal factors. Understand when cesarean delivery is necessary for the safety of mother and baby.
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Last updated on 3rd Jul, 2025
C-section or Caesarean section was a dreaded surgery in earlier times. Today, it has become a safer and more reliable method of parturition or child delivery. It helps doctors to deliver the baby in emergencies safely or when the mother or the foetus is at high risk. However, this parturition method is chosen in certain circumstances only where doctors determine its feasibility based on specific indicators such as fatal positioning, number of foetuses, and placental structure.
Maternal Indications for C-Section
Doctors can recommend having a C-section delivery based on certain criteria related to the mother:
Previous C-Section Delivery
If a woman has undergone a C-section childbirth previously, doctors can opt for proceeding with another caesarean surgery for the current delivery plan. While vaginal birth after caesarean (VBAC) is common, your gynaecologist will be able to decide the safest and most reliable parturition.
Placenta Previa or Placental Abruption
Doctors can also choose to perform a C-section delivery if there is any problem with the placenta connecting the foetus with the inner lining of the uterus, like:
Placenta Previa: This is a medical condition in which the placenta partially or completely covers the opening of the uterus, known as the cervix.
Placental Abruption: In this condition, the placenta detaches completely or partially from the uterine wall before parturition and is often characterised by sudden abdominal pain, vaginal bleeding, and uterine tenderness.
Foetal Indications for C-Section
Sometimes, C-sections can be recommended due to certain foetal conditions that make vaginal birth a risk for both the baby and the mother. This includes –
Foetal Distress
Foetal distress is a medical condition when the foetal heart patterns are abnormal due to underlying issues like late deceleration, tachycardia, and bradycardia. It indicates reduced oxygen supply to the foetus, leading to an emergency C-section delivery.
Abnormal Foetal Positioning
The doctor can recommend C-section delivery based on the abnormal foetal position, like:
Breech Presentation: The baby’s feet or buttock is close to the cervix before delivery.
Face or Brow Presentation: The baby’s forehead or brow region is exposed rather than the head during delivery.
Transverse Lie: The foetal position is sideways in the uterus.
Combined Maternal and Foetal Indications
Combined foetal and maternal indicators for C-section are signs that both the baby and the mother have complications or are at risk for a vaginal birth. These indicators include –
Multiple Births (twins, triplets)
When multiple foetuses are present, like in cases of twins, triplets, or quadruplets, vaginal birth can be painful and riskier for both the mother and the babies. That’s why doctors recommend a C-section delivery to ensure safety for all.
Large Baby (macrosomia)
Macrosomia is a medical condition characterised by the abnormal size of the foetus based on clinical guidance. Due to the increased body weight and size, vaginal birth can become riskier for both the mother and the baby.
Risks and Benefits of C-Section
Although C-section delivery is a safer parturition method in emergencies like foetal distress, placental abruption, placenta stevia, and many more, it comes with risks for both the mother and foetus. Let’s understand these in detail –
Short-Term and Long-Term Maternal Risks
The short-term maternal risks associated with C-sections are –
Infection: Post-operative infections are common after C-section in the urinary tract or endometritis.
Complications with Anaesthesia: Drug reactions and respiratory distress may occur as a part of the body’s adverse reaction to anaesthesia.
Haemorrhage: If there is excessive blood loss during or after the C-section surgery, it can put the mother’s health at risk.
Thromboembolism: The potential risks of blood clots in the legs and lungs skyrocket after the C-section delivery.
The long-term maternal risks associated with C-sections are –
Uterine Rupture: There might be an increased risk of uterine scar rupture in subsequent pregnancies.
Ectopic Pregnancy: The chances of embryo implantation outside the uterus are slightly higher after a C-section delivery.
Adhesions: Scar tissue formation can increase adhesions in the uterine walls and other organs.
Short-Term and Long-Term Foetal Risks
The short-term foetal risks are:
Respiratory Issues: Breathing problems like respiratory distress syndrome and transient tachypnea are common in babies delivered via C-section before labour onset.
Altered Immunity: C-sections can potentially alter the baby’s immune system, leading to higher risks of developing asthma and allergies.
The long-term foetal risks are –
Obesity: Babies born via C-section are likelier to become obese during their adulthood.
Elective Vs Emergency C-Section
Although a C-section is done in emergencies to save both the mother and the baby, one can opt for an elective caesarean delivery after discussing it with the doctor.
Criteria for Elective C-Section
Medical indications like placental previa, breech presentation, and maternal infections are considered to be the most common criteria for elective C-section delivery.
Doctors also opt for C-section delivery upon the request of the mother due to anxiety about vaginal birth, past surgery trauma, or personal preferences.
Emergency C-Section Protocol
Once the doctors identify the need for an emergency C-section, they will activate the CODE-10 Crash Caesarean protocol to mobilise the team required for immediate action.
Informed consent will be taken from the patient, either in written form or through verbal response.
Both the mother and the baby will be rapidly evaluated to determine the safest anaesthesia procedure.
Preparing For a C-Section
C-sections are associated with a specific preparatory step, both before and after the surgery, as discussed below:
Pre-Operative Preparations
Consent will be taken from the patient for the C-section delivery.
Health evaluation needs to be performed to decide the best conditions for anaesthesia.
Blood tests, such as CBC and cross-match, will be done to assess the haemoglobin level and prepare for blood transfusion if needed.
A Foley catheter or enema is often administered to prepare the bladder and bowel.
Intravenous antibiotics will be administered 60 minutes before the incision.
Post-Operative Preparations
The doctor will continue to monitor the vitals and check uterine firmness for postpartum haemorrhage.
The incision site will be protected properly with regular changes of the bandages and covers.
The doctor may also keep an eye on the urination and bowel movement schedule.
Impact of C-Section on Future Pregnancies
Since the body undergoes surgical trauma during C-section, knowing its impact on future pregnancies is imperative.
Vaginal Birth after Caesarean (VBAC) Options
Women can opt for a vaginal birth even if they have a previous C-section. However, it’s better to discuss the risk factors and safety levels with their doctor.
Risks in Subsequent Pregnancies
C-section can create a few risk factors in subsequent pregnancies, like embryo implantation outside the uterus, uterine rupture, and complications due to adhesions around the previous surgical site.
Conclusion
Whether it’s due to foetal distress or placental abruption, C-section has proven to be one of the safest approaches for parturition when vaginal birth becomes complicated and riskier. The doctor will look for both maternal and foetal indications to determine if patients are suitable for an elective C-section procedure or not. In certain cases, emergency caesarean delivery can be performed to save both the mother and the baby.
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