• If you’ve had only one previous c-section with a horizontal uterine incision, you may be a good candidate for a vaginal birth after cesarean, or VBAC. (Note that the type of scar on your belly may not match the one on your uterus.)
  • You’ve had some other kind of invasive uterine surgery, such as a myomectomy (the surgical removal of fibroids).
  • You’re carrying more than one baby. (Some twins can be delivered vaginally, but most of the time higher-order multiples require a c-section.)
  • Your baby is expected to be very large (a condition known as Macrosomia). This is particularly true if you’re diabetic or you had a previous baby of the same size or smaller who suffered serious trauma during a vaginal birth.
  • Your baby is in a breech (bottom first) or transverse (sideways) position. (In some cases, such as a twin pregnancy in which the first baby is head down but the second baby is breech, the breech baby may be delivered vaginally.)
  • You have placenta preview (when the placenta is so low in the uterus that it covers the cervix).
  • You have an obstruction, such as a large fibroid, that would make a vaginal delivery difficult or impossible.
  • The baby has a known malformation or abnormality that would make a vaginal birth risky, such as some cases of open neural tube defects.
  • You’re HIV-positive, and blood tests done near the end of pregnancy show that you have a high viral load.

Note that your caregiver will schedule your surgery for no earlier than 39 weeks — unless there is a medical reason to do so – in order to make sure the baby is mature enough to be born healthy.

Why would I have an emergency c-section?

You may need to have an emergency c-section if problems arise that make continuing or inducing labor dangerous to you or your baby. These include the following:

  • Your cervix stops dilating or your baby stops moving down the birth canal, and attempts to stimulate contractions to get things moving again haven’t worked.
  • Your baby’s heart rate gives your practitioner cause for concern, and she decides that your baby can’t withstand continued labor or induction.
  • The umbilical cord slips through your cervix (a prolapsed cord). If that happens, your baby needs to be delivered immediately because a prolapsed cord can cut off his oxygen supply.
  • Your placenta starts to separate from your uterine wall (placental abruption), which means your baby won’t get enough oxygen unless he’s delivered right away.
  • You have a genital herpes outbreak when you go into labor or when your water breaks (whichever happens first). Delivering your baby by c-section will help him avoid infection.