A C-section delivery is performed when a vaginal birth is not possible or is not safe for the mother or child.

Surgery is usually done while the woman is awake but anesthetized from the chest to the legs by epidural or spinal anesthesia. An incision is made across the abdomen just above the pubic area. The uterus is opened, the amniotic fluid is drained off, and the baby is delivered.

The baby's mouth and nose are cleansed of fluids and the umbilical cord is clamped and cut. The baby is handed to the pediatrician or nurse who will make sure that he/she is breathing well. The mother is awake and she can hear and see her baby.

Due to a variety of medical and social factors, C-sections have become fairly common (about 24% of all births in the United States in 2001).

The decision to have a C-section delivery can depend on the obstetrician, the delivery location, and the woman's past deliveries or medical history. Some of the main reasons for C-section instead of vaginal delivery include the following.

Reasons related to the baby:

• Developmental abnormalities of the fetus, such as hydrocephalus or spina bifida
• Abnormal fetal heart rate pattern
• Abnormal position of the baby within the uterus, such as crosswise (transverse) or buttocks-first (breech)
• Multiple babies within the uterus (triplet and some twin pregnancies)

Reasons related to the mother:

• Extreme maternal illness, such as heart disease, toxemia, pre-eclampsia or eclampsia
• Active genital herpes infection
• Maternal HIV infection
• Previous surgery in the uterus, including myomectomy and previous C-sections

Problems with labor or delivery:

• Prolonged or arrested labor
• Very large baby (macrosomia)
• Baby's head is too large to pass through mother's pelvis (cephalopelvic disproportion)

Problems with the placenta or unbilical cord:

• Umbilical cord prolapse (the umbilical cord comes through the cervix)
• Placenta attached in abnormal location (placenta previa) or prematurely separated from uterine wall (placenta abruptio)