To caesarean or not to caesarean? As an obstetrician of 35 years, I have been asked this question countless times. For women considering a c-section, it
is important to understand the different types of c-section as well as risks to and benefits for you and your unborn child. In this short article I
aim to address these important points, however it is crucial that expecting mums talk to their doctor, obstetrician or health care provider to talk
through your birth options and make the decision that is right for you.

Elective c-sections

An elective c-section means a planned c-section, and there are two types.

The first is the most common form – when your doctor, obstetrician or health care provider recommends you have a planned c-section because it is the safest
way to deliver your baby. In most cases, there may be a medical issue at hand, namely that:

You previously had a caesarean section.

Your baby is breech, or positioned bottom or feet first, or is lying sideways/transverse and cannotbe turned.

Your cervix is blocked by the placenta (otherwise known as placenta previa).

Your baby is in fetal distress, without enough oxygen, or has a birth defect

You are carrying multiple babies, and/or one is positioned bottom or feet first.

You have a health problem, such as a heart problem, high blood pressure, or an infection that could be passed to your baby during a vaginal birth, such as genital herpes or HIV.

The second type of elective c-section is a c-section on maternal request – when a woman opts to have a planned c-section because it provides more control
in deciding when her baby is born. Only a small number of women choose this option and should discuss their decision with their doctor or midwife,
because, as like most surgeries, there are risks and benefits both for mother and baby.

For mum, this includes potential blood loss, organ damage, allergic reaction to anaesthesia, infections, and blood clots – and of course a slower recovery.

The most common problem affecting babies born by caesarean section is temporary breathing difficulty. There is also a small risk of your baby being cut
during the operation, which is usually small, and which usually heals without any further harm. Forceps or a vacuum may be used, which means a baby
may have bruising around their head or body after delivery.

All that said however, a mother’s decision for a c-section on maternal request must be respected, but your health care provider will talk you through the
pros and cons.

Emergency c-sections

Emergency c-sections usually occur when labour has already commenced, and complications arise. However, in rare instances, the urgency to deliver a baby
is due to a sudden and fast deterioration in the mother’s health, which then requires immediate action to give both the baby and mother the best chance
possible for a safe delivery.

What can I do to avoid having a c-section

If you are pregnant for the first time, there are a few things you can do both during and near the end of pregnancy to try to avoid the need for a c-section.
This includes eating a moderate, nutritious diet throughout pregnancy, as studies show that gaining too much weight can increase the need for a c-section.
Other preventative measures include getting plenty of exercise, taking childbirth classes, and if your baby is breech, talking to your health care provider about a procedure known as an external
cephalic version (ECV) to turn him or her. 

Towards the end of pregnancy, you can try and avoid labour induction, as women who undergo an induction usually have higher c-section
rates than those who wait for birth to begin naturally. Consider a doula or childbirth coach, or waiting for an epidural, and be prepared for the possibility of a long labour. Importantly, remember to relax – your doctor, obstetrician or healthcare provider will work with you to make the necessary decisions to ensure the health and safety or you and your baby.

About Dr Ian Hill

Dr Ian Hill is an experienced obstetrician and gynaecologist practicing in the eastern suburbs and inner west of Sydney.

He specialises in high-risk obstetrics, top level pre-, ante- and post-natal care, and routine gynaecology covering all aspects of women’s reproductive health.

He has practices at both Prince of Wales Private Hospital in Randwick and Royal Prince Alfred Hospital in Camperdown 

 02 9519 8929.