Harvard Women's Health Watch

Ask the doctors: What determines whether a woman needs a cesarean section?

Ask the doctors

Q: I'm expecting and want to have a vaginal delivery, but many of my friends have had cesarean sections lately. Is this a preference, or are there medical reasons to have a cesarean?

A: The health of the mother and baby, the family's personal preferences, and the hospital in which a woman delivers her baby play a role in determining whether she has a cesarean. Common medical reasons for cesareans include fetal malpresentation (when the baby is turned so that its feet or buttocks will come out first), pelvic disproportion (a birth canal that is unusually shaped or too small in relation to the size of the baby), and a past cesarean. A study published in the Journal of the American Medical Association in December 2015 suggests that such commonly cited medical issues may account only partly for high cesarean rates.

Research by one of the study's authors, Dr. Neel Shah, our colleague at Beth Israel Deaconess Medical Center, suggests that time pressures in some hospitals may lead to more cesareans, especially since vaginal deliveries can take a great deal of time and staff resources. If you are healthy and have a low-risk pregnancy, the hospital where you plan to deliver may determine your odds of cesarean more than any other factor. Find out the caesarean rate of hospitals in your area. (The study indicated that a cesarean rate around 19% is optimal). If you are early in your pregnancy, you might opt to choose your doctor based on where he or she delivers.

A woman who has a strong preference for vaginal delivery but ends up with a cesarean may feel a sense of loss for the childbirth she hoped to experience. But it's important to remember that there are times when a cesarean is the best and safest option for delivery. Doing your homework about quality of care may reassure you that your delivery method is determined for the right reasons.

— Hope Ricciotti, M.D., and Hye-Chun Hur, M.D., M.P.H.
Editors in Chief, Harvard Women's Health Watch