We hope not! But some women do, of course.

Cesarean delivery is definitely over-used in the United States. There are some good reasons why a woman might need one:

  • If she has had a prior “classical” Cesarean delivery (where the incision on the uterus is made higher than normal)
  • If she has had more than two prior regular (“low transverse” incision) Cesareans
  • If she has placenta previa, where the placenta covers (or is very close to) the cervix or vasa previa (where placental blood vessels cover the cervix)
  • If her baby is breech or sideways (and the doctor is unable to turn the baby to be head down)
  • If her baby does not tolerate labor (this should be relatively rare and there are some specific criteria that can indicate this)
  • If her baby is too big, which is more than 5,000 grams (or about 11 lbs) for a nondiabetic mother or more than 4,500 grams (or just under 9 lbs 15 oz) for a diabetic mother
  • If her labor doesn’t progress or she is unable to push the baby out after sufficient time (many doctors don’t give women enough time for these things; however, we have criteria that we follow to determine if this is happening)
  • If she has triplets or quadruplets, or monochorionic-monoamniotic twins
  • If she has active genital herpes or uncontrolled HIV

Those are just about all of the reasons, aside from the more emergent ones we won’t go into here. We don’t know for sure, but as many as half of all Cesareans performed are unnecessary. Most of the unnecessary Cesareans are related to impatience. Guidelines from the American College of Obstetricians and Gynecologists (ACOG) will, if followed, result in significantly fewer Cesareans if doctors follow them.