In which cases is a cesarean section scheduled?

Scheduled Caesarean section: the different scenarios

A cesarean section is usually planned around the 39th week of amenorrhea, or 8 and a half months of pregnancy.

In the event of a scheduled cesarean section, you are hospitalized the day before the operation. In the evening, the anesthetist makes a final point with you and briefly explains the procedure for the operation. You dine lightly. The next day, no breakfast, you go to the operating room yourself. A urinary catheter is put in place by the nurse. Then the anesthetist installs you and sets up a spinal anesthesia, after having already locally numbed the area of ​​the bite. You are then lying on the operating table. Several reasons may explain the choice to schedule a cesarean: multiple pregnancy, baby’s position, premature birth, etc.

Scheduled cesarean section: for a multiple pregnancy

When there are not two but three babies (or even more), the choice of cesarean section is most often necessary and allows the entire obstetric team to be present to welcome newborns. It can be done for all babies or just one of them. On the other hand, when it comes to twins, a vaginal birth is quite possible. In general, it is the position of the first, verified by ultrasound, that decides the mode of delivery. Multiple pregnancies are considered high risk pregnancies. It is for this reason that they are the subject of a reinforced medical follow-up. To detect a possible anomaly and take care of it as quickly as possible, expectant mothers have more ultrasounds. Pregnant women are often advised to stop working around the 6th month to reduce the risk of premature birth.

A scheduled cesarean section due to illness during pregnancy

The reasons for deciding to perform a Caesarean section may be a maternal illness. This is the case when the expectant mother suffers from diabetes and the probable weight of the future baby is estimated at more than 4 g (or 250 g). It also happens if the mother-to-be has serious heart problems. and that expulsive efforts are prohibited. Likewise, when a first outbreak of genital herpes occurs the month before childbirth because a vaginal birth could contaminate the child.

Other times we fear a risk of bleeding such as when the placenta is inserted too low and covers the cervix (placenta previa). The gynecologist will immediately perform a Caesarean even if the birth must be premature. This may in particular be the case if the mother-to-be suffers from pre-eclampsia (arterial hypertension with the presence of proteins in the urine) which is resistant to treatment and worsens, or if an infection occurs after a premature rupture (before 34 weeks of amenorrhea) of the water bag. Last case: if the mother is infected with certain viruses, in particular HIV, it is preferable to give birth by cesarean section, in order to prevent contamination of the child during passage through the vaginal tract.

A cesarean is also planned if the mother’s pelvis is too small or has a deformity. In order to measure the pelvis, we make a radio, called pelvimétrie. It is carried out at the end of pregnancy, in particular when the baby presents by the breech, if the future mother is small, or if she has already given birth by cesarean section. The Scheduled cesarean section is recommended when the baby’s weight is 5 kg or more. But since this weight is difficult to assess, it is considered that the cesarean section is to be decided, case by case, if the baby weighs between 4,5g and 5kg. The mother’s physical constitution

Scheduled Caesarean: The Impact of Old Caesareans

If the mother has already had two cesarean sections, the medical team immediately suggests performing a third cesarean section.. Her uterus is weakened and a risk of rupture of the scar, even if it is rare, exists in the event of a natural delivery. The case of a single previous cesarean will be discussed with the mother depending on the cause of the intervention and the current obstetric conditions.

Note that we call iterative cesarean section a cesarean section undertaken after a first delivery by cesarean section.

Baby’s position can lead to a scheduled cesarean section

Sometimes, it is the position of the fetus which imposes the cesarean section. If 95% of babies are born upside down, others choose unusual positions that do not always make it easy for doctors. For example, if he is crosswise or his head instead of being flexed on the thorax is completely deflected. Likewise, it is difficult to escape a cesarean section if the baby has settled horizontally in the womb. The siege case (3 to 5% of deliveries) he decides on a case-by-case basis.

In general, we can first try to tip the baby by practicing a version by external maneuvers (VME). But this technique does not always work. However, a scheduled cesarean is not systematic.

The High Authority for Health has recently re-specified the indications for a scheduled Caesarean section, when the baby presents by the breech: unfavorable confrontation between pelvimetry and the estimation of the measurements of the fetus or persistent deflection of the head. She also recalled that it is necessary to monitor the persistence of the presentation by ultrasound, just before entering the operating room to perform the cesarean section. However, some obstetricians still prefer to avoid the slightest risk and opt for a cesarean section.

Cesarean section scheduled to cope with a premature birth

In a very premature birth, a Caesarean prevents the baby from excessive fatigue and allows him to be taken care of quickly. It is also desirable when the baby is stunted and if there is severe fetal distress. Today, in France, 8% of babies are born before 37 weeks of gestation. The reasons for premature labor are many and different in nature. The maternal infections are the most common cause.  Mom’s high blood pressure and diabetes are also risk factors. Premature birth can also occur when the mother has a uterine abnormality. When the cervix opens too easily or if the uterus is malformed (bicornuate or septate uterus). A mother-to-be who is expecting several babies also has a one in two risk of giving birth early. Sometimes it is the excess amniotic fluid or the position of the placenta that can be the cause of a premature birth.

A cesarean section of convenience

A cesarean section on demand corresponds to a cesarean section desired by the pregnant woman in the absence of medical or obstetric indications. Officially, in France, obstetricians refuse caesarean sections without medical indication. However, a number of expectant mothers are pushing to give birth using this procedure. The reasons are often practical (childcare to organize, presence of the father, choice of the day…), but they are sometimes based on false ideas such as reduced suffering, greater safety for the child or better protection of the perineum. Cesarean section is a frequent gesture in obstetrics, well codified and safe, but remains a surgical intervention associated with an increased risk for the health of the mother compared to childbirth by natural means. There is in particular a risk of phlebitis (formation of a clot in a blood vessel). A cesarean section can also be the cause of complications in future pregnancies (poor positioning of the placenta).

The Haute Autorité de santé recommends that doctors find the specific reasons for this request, discuss them and mention them in the medical file. When a woman wants a cesarean for fear of vaginal birth, it is advisable to offer her personalized support. Pain management information can help mothers-to-be overcome their fears. In general, the principle of cesarean section, as well as the risks that arise from it, must be explained to the woman. This discussion should take place as soon as possible. If the doctor refuses to perform a cesarean section on request, he must then refer the mother-to-be to one of her colleagues.