Cesarean delivery, sometimes referred to as a “C-Section’, is one of the most frequent surgical procedures performed today in the United States.
Between 1970 and 1995, the rate of deliveries by cesarean section was reportedly between 20 and 25 percent on a national basis. Consequently, more and more pregnant mothers who previously delivered a child by cesarean section are now confronted with the question whether it is reasonably safe to attempt a vaginal delivery, referred to as a “VBAC”, or have another cesarean delivery in their subsequent pregnancies.
Because of the potential risks associated with “VBAC” deliveries, many obstetricians are guided by the principle of “once a cesarean, always a cesarean” for their patients.
One of the primary indications for the delivery of a baby via cesarean section is in utero fetal distress.
During labor, most patients obtain fetal monitoring through the application of an external electronic fetal heart monitor.
By analyzing the pattern of the fetal heart rate, safe and careful obstetricians and obstetrical nurses can assess the status of the baby while inside the mother’s womb.
Fetal distress is often associated with hypoxia, that is, a reduction or loss of oxygen to the baby. Fetal hypoxia, in turn, is often evidenced by abnormal drops or decelerations in the baby’s heart rate or by other well recognized changes in the fetal heart rate pattern.
Safe and careful obstetricians and obstetrical nurses will quickly respond to evidence of fetal distress which, in many instances, will require the prompt delivery of the baby by cesarean section.
Unfortunately, in many cases, prolonged fetal distress can lead to permanent and irreversible brain injury, also known as hypoxic-ischemic encephalopathy. Thus, prompt delivery by cesarean section in many cases is the only way to prevent a baby from suffering potentially devastating injuries such as brain damage and cerebral palsy.
Some hospitals, especially those in rural communities, may not have adequate staffing or personnel to permit a cesarean section to be quickly performed in the event of fetal distress.
If the necessary personnel to safely and expeditiously perform a cesarean delivery are not readily available at a hospital, the delay in delivery can itself cause permanent neurologic injury to the baby.