Editing Caesarean section (section)

===By characteristics of the mother===

====Caesarean delivery on maternal request====
{{main|Caesarean delivery on maternal request}}
Caesarean delivery on maternal request (CDMR) is a medically unnecessary caesarean section, where the conduct of a [[childbirth]] via a caesarean section is requested by the [[pregnancy|pregnant]] patient even though there is not a medical [[Indication (medicine)|indication]] to have the surgery.<ref name="NIH">{{cite journal | vauthors = NIH | title = National Institutes of Health state-of-the-science conference statement: Cesarean delivery on maternal request March 27-29, 2006 | journal = Obstetrics and Gynecology | volume = 107 | issue = 6 | pages = 1386–1397 | date = June 2006 | pmid = 16738168 | doi = 10.1097/00006250-200606000-00027 | url = http://consensus.nih.gov/2006/CesareanStatement_Final053106.pdf | url-status = dead | access-date = 30 December 2008 | archive-url = https://web.archive.org/web/20170118080344/https://consensus.nih.gov/2006/CesareanStatement_Final053106.pdf | archive-date = 18 January 2017 }}</ref> Systematic reviews have found no strong evidence about the impact of caesareans for nonmedical reasons.<ref name="NICE2011" /><ref name="Lavender&nbsp;— non-medical">{{cite journal | vauthors = Lavender T, Hofmeyr GJ, Neilson JP, Kingdon C, Gyte GM | title = Caesarean section for non-medical reasons at term | journal = The Cochrane Database of Systematic Reviews | volume = 2012 | issue = 3 | pages = CD004660 | date = March 2012 | pmid = 22419296 | pmc = 4171389 | doi = 10.1002/14651858.CD004660.pub3 }}</ref> Recommendations encourage counseling to identify the reasons for the request, addressing anxieties and information, and encouraging vaginal birth.<ref name="NICE2011" /><ref>{{cite web|url=http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Ethics/Elective-Surgery-and-Patient-Choice|title=Elective Surgery and Patient Choice – ACOG|archive-url=https://web.archive.org/web/20150925012637/https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Ethics/Elective-Surgery-and-Patient-Choice|archive-date=25 September 2015|url-status=live|access-date=4 October 2015}}</ref> Elective caesareans at 38 weeks in some studies showed increased health complications in the newborn. For this reason [[American Congress of Obstetricians and Gynecologists|ACOG]] and [[National Institute for Health and Care Excellence|NICE]] recommend that elective caesarean sections should not be scheduled before 39 weeks gestation unless there is a medical reason.<ref>{{cite journal | vauthors = Glavind J, Uldbjerg N | title = Elective cesarean delivery at 38 and 39 weeks: neonatal and maternal risks | journal = Current Opinion in Obstetrics & Gynecology | volume = 27 | issue = 2 | pages = 121–127 | date = April 2015 | pmid = 25689238 | doi = 10.1097/gco.0000000000000158 | s2cid = 32050828 }}</ref><ref name=":1">{{Cite web|url=https://www.nice.org.uk/guidance/CG132|title=Caesarean section {{!}} Guidance and guidelines {{!}} NICE|website=www.nice.org.uk|date=23 November 2011 |access-date=5 January 2019}}</ref><ref name="ACOG559"/> [[Caesarean section#By urgency|Planned caesarean section]]s may be scheduled earlier if there is a medical reason.<ref name=":1" />

====After previous caesarean====
{{See also|Delivery after previous caesarean section}}
Mothers who have previously had a caesarean section are more likely to have a caesarean section for future pregnancies than mothers who have never had a caesarean section. There is a discussion about the circumstances under which women should have a vaginal birth after a previous caesarean.

Vaginal birth after caesarean (VBAC) is the practice of [[Childbirth|birthing a baby]] vaginally after a previous baby has been delivered by caesarean section (surgically).<ref>{{cite web | vauthors = ((WebMD Editorial Contributors)) | veditors = Johnson TC | url = http://www.webmd.com/baby/tc/vaginal-birth-after-cesarean-vbac-overview | title = Vaginal Birth After Cesarean (VBAC) – Overview | archive-url = https://web.archive.org/web/20091230133854/http://www.webmd.com/baby/tc/vaginal-birth-after-cesarean-vbac-overview | archive-date=30 December 2009 | work = [[WebMD]] }}</ref> According to [[the American College of Obstetricians and Gynecologists]] (ACOG), successful VBAC is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies.<ref name="American Congress of Obstetricians and 450–63"/> According to the American Pregnancy Association, 90% of women who have undergone caesarean deliveries are candidates for VBAC.<ref name="americanpregnancy">{{cite web |url=http://www.americanpregnancy.org/labornbirth/vbac.html |title=Vaginal Birth after Cesarean (VBAC) |publisher=American Pregnancy Association |access-date=16 June 2012 |url-status=dead |archive-url=https://web.archive.org/web/20120621050450/http://www.americanpregnancy.org/labornbirth/vbac.html |archive-date=21 June 2012  }}</ref> Approximately 60–80% of women opting for VBAC will successfully give birth vaginally, which is comparable to the overall vaginal delivery rate in the United States in 2010.<ref name="americanpregnancy"/><ref name="mayoclinic">{{cite web | url = http://www.mayoclinic.com/health/vbac/VB99999 | title = Vaginal birth after C-section (VBAC) guide | archive-url = https://web.archive.org/web/20100312103525/http://www.mayoclinic.com/health/vbac/vb99999 | archive-date=12 March 2010 | work = [[Mayo Clinic]] }}</ref><ref>{{cite web |url=https://www.cdc.gov/nchs/data/databriefs/db35.htm#ref1 |title=NCHS Data Brief: Recent Trends in Cesarean Delivery in the United States Products |publisher=Centers for Disease Control and Prevention |date=March 2010 |access-date=16 June 2012 |url-status=live |archive-url=https://web.archive.org/web/20120517145002/http://www.cdc.gov/nchs/data/databriefs/db35.htm#ref1 |archive-date=17 May 2012  }}</ref>

====Twins====
For otherwise healthy twin pregnancies where both twins are head down a trial of vaginal delivery is recommended between 37 and 38 weeks.<ref name=NICE2011 /><ref name=Bis2013/> Vaginal delivery in this case does not worsen the outcome for either infant as compared with caesarean section.<ref name="Bis2013"/> There is controversy on the best method of delivery where the first twin is head first and the second is not.<ref name=Bis2013/> When the first twin is not head down at the point of labor starting, a caesarean section should be recommended.<ref name=Bis2013/> Although the second twin typically has a higher frequency of problems, it is unknown if a planned caesarean section affects this.<ref name=NICE2011 /> It is estimated that 75% of twin pregnancies in the United States were delivered by caesarean section in 2008.<ref name="pmid22015878">{{cite journal | vauthors = Lee HC, Gould JB, Boscardin WJ, El-Sayed YY, Blumenfeld YJ | title = Trends in cesarean delivery for twin births in the United States: 1995-2008 | journal = Obstetrics and Gynecology | volume = 118 | issue = 5 | pages = 1095–1101 | date = November 2011 | pmid = 22015878 | pmc = 3202294 | doi = 10.1097/AOG.0b013e3182318651 }}</ref>

====Breech birth====
{{main|Breech birth}}
A breech birth is the birth of a baby from a breech [[presentation (obstetrics)|presentation]], in which the baby exits the pelvis with the [[buttocks]] or [[foot|feet]] first as opposed to the normal [[cephalic presentation|head-first presentation]]. In breech presentation, fetal heart sounds are heard just above the umbilicus.

Babies are usually born head first. If the baby is in another position the birth may be complicated. In a 'breech presentation', the unborn baby is bottom-down instead of head-down. Babies born bottom-first are more likely to be harmed during a normal (vaginal) birth than those born head-first. For instance, the baby might not get enough oxygen during the birth. Having a planned caesarean may reduce these problems. A review looking at planned caesarean section for singleton breech presentation with planned vaginal birth, concludes that in the short term, births with a planned caesarean were safer for babies than vaginal births. Fewer babies died or were seriously hurt when they were born by caesarean. There was tentative evidence that children who were born by caesarean had more health problems at age two. Caesareans caused some short-term problems for mothers such as more abdominal pain. They also had some benefits, such as less urinary incontinence and less perineal pain.<ref>{{cite journal | vauthors = Hofmeyr GJ, Hannah M, Lawrie TA | title = Planned caesarean section for term breech delivery | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 7 | pages = CD000166 | date = July 2015 | pmid = 26196961 | pmc = 6505736 | doi = 10.1002/14651858.CD000166.pub2 }}</ref>

The bottom-down position presents some hazards to the baby during the process of birth, and the mode of delivery (vaginal versus caesarean) is controversial in the fields of [[obstetrics]] and [[midwifery]].

Though vaginal [[childbirth|birth]] is possible for the breech baby, certain fetal and maternal factors influence the safety of vaginal breech birth. The majority of breech babies born in the United States and the UK are delivered by caesarean section as studies have shown increased risks of morbidity and mortality for vaginal breech delivery, and most obstetricians counsel against planned vaginal breech birth for this reason.  As a result of reduced numbers of actual vaginal breech deliveries, obstetricians and midwives are at risk of de-skilling in this important skill. All those involved in delivery of obstetric and midwifery care in the UK undergo mandatory training in conducting breech deliveries in the simulation environment (using dummy pelvises and mannequins to allow the practice of this important skill) and this training is carried out regularly to keep skills up to date.

====Resuscitative hysterotomy====
{{main|Resuscitative hysterotomy}}
A resuscitative [[hysterotomy]], also known as a peri-mortem caesarean delivery, is an emergency caesarean delivery carried out where maternal [[cardiac arrest]] has occurred, to assist in [[resuscitation]] of the mother by removing the [[aortocaval compression syndrome|aortocaval compression]] generated by the gravid uterus. Unlike other forms of caesarean section, the welfare of the fetus is a secondary priority only, and the procedure may be performed even before the limit of [[fetal viability]] if it is judged to be of benefit to the mother.