Cesarean birth, also known as a C-section, is a surgical procedure to deliver a baby through incisions in the abdomen and uterus, a pathway to birth that can be both planned and unexpected.
What it is
A cesarean birth is a major abdominal surgery where your baby is delivered through incisions made in your abdomen and uterus. While some cesareans are planned in advance due to specific medical considerations, many become necessary during labor when unforeseen circumstances arise that make a vaginal birth less safe for parent or baby. This might include situations like labor not progressing, concerns about the baby's well-being, or the baby being in a breech position.
What the evidence says
The rate of cesarean births in the U.S. is around 32%, which is notably higher than the World Health Organization's estimated optimal range of 10–15% for population health. This suggests that for many, a cesarean might be occurring without a clear medical necessity, and research shows that primary cesarean rates can vary threefold across different U.S. hospitals. This highlights how much your choice of provider and birth location can matter. For those who have had a prior cesarean, a trial of labor after cesarean (TOLAC) is a safe option for most with one prior low transverse cesarean, with a VBAC (Vaginal Birth After Cesarean) success rate around 70% with appropriate selection. Evidence also suggests that immediate Skin-to-Skin at Birth in the operating room, often called a "gentle cesarean," can significantly improve breastfeeding initiation and parent satisfaction.
When it's recommended
Common reasons for a cesarean recommendation include a prior cesarean, labor dystocia (when labor isn't progressing effectively), fetal distress, breech presentation, placenta previa, or multiple gestation. While a cesarean might be recommended by your care provider, it's always an opportunity for an informed conversation about your options. "Maternal-request cesarean," where a cesarean is chosen without a medical indication, is a growing topic of discussion, though the American College of Obstetricians and Gynecologists (ACOG) generally recommends against it before 39 weeks of pregnancy.
