Pregnancy and Birth Sourcebook Part 41

* Be her guide through her contractions.

* Affirm what a great job she has done and is doing.

* Don't feel bad if she becomes angry or emotional with you.

524.

v.a.g.i.n.al and Cesarean Childbirth What Your Baby Is Doing While you are in labor your baby is taking steps to enter this world.

Your baby's head will turn to one side and the chin will automatically rest on the chest so the back of the head can lead the way.

Once you are fully dilated, your baby's head leads the way and the head and torso begin to turn to face your back as they enter your v.a.g.i.n.a.

Next your baby's head will begin to emerge or "crown" through the v.a.g.i.n.al opening.

Once your baby's head is out, the head and shoulders again turn to face your side. This position allows your baby to easily slip out.

Delivery and What to Expect Keep in mind your baby has been soaking in a sac full of amniotic fluid for nine months. He/she has been through contractions, and your very narrow birth ca.n.a.l.

The results of this journey include: * cone-shaped head; * vernix coating (cheesy substance that coats the fetus in the uterus); * puffy eyes; * lanugo (fine downy hair that cover the shoulders, back, forehead, and temple); * enlarged genitals.

Stages of Childbirth: Stage 3 The third stage is the delivery of the placenta and is the shortest stage. The time it takes to deliver your placenta is anywhere from 5 to 30 minutes.

What to Expect and What to Do After the delivery of your baby, your health care provider will be waiting for small contractions to begin again. This is the signal that your placenta is separating from the uterine wall and ready to be 525 Pregnancy and Birth Sourcebook, Third Edition delivered. Pressure may be applied by ma.s.sage to your uterus; and the umbilical cord may be gently pulled.

The result will be the delivery of your placenta, also known as afterbirth. You may experience some severe shaking and s.h.i.+vering after your placenta is delivered. This is common and nothing to be alarmed about.

You have now completed all the stages of childbirth and will be monitored for the next few hours to make sure that the uterus continues to contract and bleeding is not excessive.

Now you can relax and enjoy your little bundle of joy. Congratula-tions!

Section 66.2 v.a.g.i.n.al Birth after a Previous Cesarean Delivery or Repeat Cesarean Section "v.a.g.i.n.al Birth after a Previous Cesarean Delivery or Repeat Cesarean Delivery," 2009 Childbirth Connection. Accessed May 6, 2009 at www.childbirthconnection.org and reproduced with permission.

This text presents results of recent systematic reviews that can help women compare risks of planned v.a.g.i.n.al birth after cesarean (VBAC) and of planned C-section. While more high-quality studies are needed, a large body of research already exists and sheds light on these questions for those who need guidance now.

When deciding whether to plan a VBAC or a repeat cesarean, it is important to understand the full range of risks to you and your baby.

This means comparing the short- and long-term risks of cesarean surgery and risks of acc.u.mulating cesarean surgery scars to mothers and babies on the one hand, to the risk that the uterine scar will give way (uterine rupture) and lead to problems and a few risks that are worse for v.a.g.i.n.al birth generally.

Even if you do not plan to have more children, you should be aware of risks of multiple cesarean scars to future pregnancies and babies.

Many women change their mind and decide to become pregnant again or continue with unplanned pregnancies.

526.

v.a.g.i.n.al and Cesarean Childbirth What is the bottom line?

If you do not have a clear and compelling need for a cesarean in the present pregnancy, having a VBAC rather than a repeat C-section is likely to be: * safer for you in this pregnancy; * far safer for you and your babies in any future pregnancies.

When thinking about the welfare of your baby in the present pregnancy, there are trade-offs to consider: VBAC has some advantages, and a repeat C-section has others. You can learn more in the following text.

What are key messages about VBAC vs. repeat cesarean section?

Despite limitations of the best available research, the following conclusions seem clear: * Scar giving way: Scar giving way: The scar is more likely to give way during a VBAC labor than in a repeat C-section; for most women (exceptions noted below), the added risk of the scar giving way is about 27 in every 10,000 VBAC labors. In other words, nearly 400 women would need to experience the risks involved with repeat C-section to prevent one uterine rupture during a VBAC The scar is more likely to give way during a VBAC labor than in a repeat C-section; for most women (exceptions noted below), the added risk of the scar giving way is about 27 in every 10,000 VBAC labors. In other words, nearly 400 women would need to experience the risks involved with repeat C-section to prevent one uterine rupture during a VBAC labor.

* Death of baby: Death of baby: While the scar giving way poses a threat to the baby, the added risk that the baby will die from a problem with the scar during a VBAC labor, compared with women planning repeat C-sections, is about 1.4 in every 10,000 VBAC labors. In other words, over 7,100 women would need to experience the risks involved with repeat C-sections to prevent the death of one baby due to uterine rupture. While the scar giving way poses a threat to the baby, the added risk that the baby will die from a problem with the scar during a VBAC labor, compared with women planning repeat C-sections, is about 1.4 in every 10,000 VBAC labors. In other words, over 7,100 women would need to experience the risks involved with repeat C-sections to prevent the death of one baby due to uterine rupture.

* Hysterectomy in mother: Hysterectomy in mother: If the scar gives way, some women have a hysterectomy (removal of the uterus). The added risk of needing a hysterectomy from this cause is about 3.4 in every 10,000 VBAC labors, when compared with women planning repeat C-sections. However, considering risk for hysterectomy from all causes, women who plan a VBAC are not more likely to experience an unplanned hysterectomy than women planning If the scar gives way, some women have a hysterectomy (removal of the uterus). The added risk of needing a hysterectomy from this cause is about 3.4 in every 10,000 VBAC labors, when compared with women planning repeat C-sections. However, considering risk for hysterectomy from all causes, women who plan a VBAC are not more likely to experience an unplanned hysterectomy than women planning repeat C-section.

527.

Pregnancy and Birth Sourcebook, Third Edition * Concerns about specific risks: Concerns about specific risks: The following factors do not increase risk of the scar giving way during labor: The following factors do not increase risk of the scar giving way during labor: * Type of uterine scar not known * Low vertical uterine incision for prior C-section (may have been used if C-section was performed earlier in pregnancy before growth in lower part of the uterus) * Baby estimated to be large, and to weigh more than 4,000 grams (8 pounds, 13 ounces) * Pregnancy goes past 40 weeks * Concerns about other risks: Concerns about other risks: The following factors have not been shown to increase the risk of the scar giving way, but too few cases have been studied to be confident: The following factors have not been shown to increase the risk of the scar giving way, but too few cases have been studied to be confident: * Twin pregnancy * Use of external cephalic version: turning a baby who is positioned b.u.t.tocks- or feet-first (breech) to head-first position by manipulating the woman's belly * Infection: Infection: Women planning C-sections are more likely to develop infections than women planning VBACs. Women planning C-sections are more likely to develop infections than women planning VBACs.

* Multiple scars in uterus: Multiple scars in uterus: Acc.u.mulating C-section scars increase risk for experiencing a number of serious problems relating to future pregnancies and births. These include: Acc.u.mulating C-section scars increase risk for experiencing a number of serious problems relating to future pregnancies and births. These include: * scar rupture in a subsequent labor; * ectopic pregnancy: the embryo develops outside the uterus; * placenta previa: the placenta grows over the cervix, the opening to the uterus; * placental abruption: the placenta separates from the uterus before the baby is born; * placenta accreta: the placenta growing abnormally into or even through the uterus.

What are some concerns about risks of C-section compared with v.a.g.i.n.al birth?

When weighing planned VBAC versus planned C-section, the focus is often on potential problems with the uterine scar in labor or 528 v.a.g.i.n.al and Cesarean Childbirth on problems a.s.sociated with acc.u.mulating scars. But this results in an incomplete picture because it overlooks other risks that also differ between v.a.g.i.n.al birth and cesarean section. Summarized here are some of the many extra risks a.s.sociated with cesarean surgery as well as the few advantages.

Most of what we know about these risks comes from studies of cesarean in general, not planned C-section. Available research suggests that some of these risks may be lessened when the C-section is planned.

The next question: What are some ways that a planned C-section may differ from an unplanned C-section? points to adverse effects where research finds differences in risk.

As you consider these, keep in mind that on average, 3 out of 4 women who labor after a C-section will give birth v.a.g.i.n.ally with care that encourages and supports VBAC (and fewer than 1 in 100 will experience the scar giving way). Even in cases where women scored 0 to 2 on a scale where 10 indicated greatest likelihood of v.a.g.i.n.al birth, half gave birth v.a.g.i.n.ally.

* Physical problems for mothers: Physical problems for mothers: Compared with v.a.g.i.n.al birth, cesarean section increases a woman's risk for a number of physical problems. These range from less common but potentially life-threatening problems, including hemorrhage (severe bleeding), blood clots, and bowel obstruction (due to scarring and adhesions from the surgery), to much more common problems Compared with v.a.g.i.n.al birth, cesarean section increases a woman's risk for a number of physical problems. These range from less common but potentially life-threatening problems, including hemorrhage (severe bleeding), blood clots, and bowel obstruction (due to scarring and adhesions from the surgery), to much more common problems such as longer-lasting and more severe pain and infection. Even after recovery from surgery, scarring and adhesion tissue increase risk for ongoing pelvic pain and for twisted bowel.

* Hospital stays: Hospital stays: If a woman has a C-section, she is more likely to stay in the hospital longer and to be re-hospitalized. If a woman has a C-section, she is more likely to stay in the hospital longer and to be re-hospitalized.

* Emotional well-being: Emotional well-being: A woman who has a C-section may be at greater risk for poorer overall mental health and some emotional problems. She is also more likely to rate her birth experience poorer than a woman who has had a v.a.g.i.n.al birth. A woman who has a C-section may be at greater risk for poorer overall mental health and some emotional problems. She is also more likely to rate her birth experience poorer than a woman who has had a v.a.g.i.n.al birth.

* Mother-baby relations.h.i.+p: Mother-baby relations.h.i.+p: A woman who has a C-section is more likely to have less early contact with her baby and initial negative feelings about her baby. A woman who has a C-section is more likely to have less early contact with her baby and initial negative feelings about her baby.

* Breastfeeding: Breastfeeding: Recovery from surgery poses challenges for getting breastfeeding under way, and a baby who was born by C-section is less likely to be breastfed and get the benefits of breastfeeding. Recovery from surgery poses challenges for getting breastfeeding under way, and a baby who was born by C-section is less likely to be breastfed and get the benefits of breastfeeding.

529.

Pregnancy and Birth Sourcebook, Third Edition * Impact on babies: Impact on babies: Babies born by C-section are more likely to: Babies born by C-section are more likely to: * be cut during the surgery (usually minor); * have breathing difficulties around the time of birth; * experience asthma in childhood and in adulthood.

* Impact on any future babies: Impact on any future babies: A cesarean section in this pregnancy increases risk for babies in future pregnancies. Some research finds that babies who develop in a scarred uterus are more likely to: A cesarean section in this pregnancy increases risk for babies in future pregnancies. Some research finds that babies who develop in a scarred uterus are more likely to: * be born too early (preterm); * weigh less than they should (low birth weight); * have a physical abnormality or injury to their brain or spinal cord; * die before or shortly after the birth.

What are some concerns about risks of v.a.g.i.n.al birth com- pared with C-section?

C-section offers advantages in a few areas, primarily during the recovery period after birth. (Some practices used with v.a.g.i.n.al birth, such as episiotomy, are a.s.sociated with pelvic floor problems. It is wrong to conclude at this time that v.a.g.i.n.al birth itself causes such problems.) A woman who has a v.a.g.i.n.al birth is more likely to: * have a painful v.a.g.i.n.al area in the weeks after birth; * leak urine (urinary incontinence) (about 3 women per hundred still have a problem 1 year after birth); * leak gas, or more rarely, feces (bowel incontinence) (about 3 women per hundred still have a problem 1 year after birth).

Babies born v.a.g.i.n.ally have been shown to be at higher risk for a nerve injury affecting the shoulder, arm, or hand (brachial plexus injury) (usually temporary).

What are some ways that a planned C-section may differ from an unplanned C-section?

A planned C-section offers some advantages over an unplanned C-section that occurs after labor is under way. For example, there is a lower risk of surgical injuries and of infections. The emotional impact 530 v.a.g.i.n.al and Cesarean Childbirth of a cesarean that is planned in advance appears to be similar to or somewhat worse than a v.a.g.i.n.al birth. By contrast, unplanned cesareans can take a greater emotional toll. In addition, a woman planning repeat cesarean surgery would almost certainly be less likely to experience difficulty breastfeeding if she had breastfed before or to have negative feelings for her baby compared with a first-time mother having an unplanned cesarean. Nonetheless, a planned cesarean still involves the risks a.s.sociated with major surgery. And both planned and unplanned cesareans result in a uterine scar, which increases risk for serious concerns for mothers and babies in future pregnancies, and for adhesion-relation problems in mothers at any time.

To learn more about these differences, see: * Best Evidence: C-Section [http://www.childbirthconnection.org/ article.asp?ck=10166] for a summary of research comparing cesarean and v.a.g.i.n.al birth; * Preventing Pelvic Floor Dysfunction [http://www.childbirth connection.org/article.asp?ck=10206] for in depth information about the relations.h.i.+p between giving birth and a woman's pelvic floor health; * details in the following text about effects of giving birth when a woman's uterus has a scar from a previous cesarean.

What is the added likelihood that the scar will give way (uterine rupture) during a VBAC labor?

Best research suggests that an extra 27 women experience a ruptured uterus in every 10,000 VBAC labors, compared with planned C-section deliveries. Thus, nearly 400 women would need to experience surgical birth to prevent one instance of uterine rupture during VBAC labors. While the scar giving way usually requires an urgent cesarean, loss of the baby is much less common. Added likelihood for a woman with a known low-transverse (horizontal) scar: moderate for scar rupture compared with planned repeat C-section.

What is the added likelihood that the baby will die as a re- sult of the scar giving way (uterine rupture) during a VBAC labor?

Best research suggests that about 1.4 extra babies die due to problems with the scar in every 10,000 VBAC labors, compared with planned C-section deliveries. Thus, over 7,000 women would need to 531 Pregnancy and Birth Sourcebook, Third Edition experience risks of surgical birth to prevent the death of one baby from scar problems during VBAC.

Added likelihood for a woman with a known low-transverse (horizontal) scar: low for death of the baby around the time of birth compared with repeat C-section.

What is the added likelihood of the scar giving way (uter- ine rupture) with any of these factors?

* Type of uterine scar not known * Low vertical uterine incision at prior C-section (may have been used if C-section took place earlier in pregnancy before growth in lower part of the uterus) * Baby estimated to be large, weighing over 4,000 grams (8 lb 13 oz) or pregnancy extends past 40 weeks Some caregivers recommend planned repeat C-section with these factors on the grounds that VBAC is riskier, but the research does not support that belief.

No added likelihood for scar rupture in a woman with unknown type of uterine scar, prior low vertical uterine incision, baby estimated to weigh more than 4,000 grams, or pregnancy extending past 40 weeks, in comparison with women planning VBAC without these factors.

What is the added likelihood of the scar giving way (uter- ine rupture) with twin pregnancy or the use of external cephalic version (turning a baby in a b.u.t.tocks- or feet-first (breech) position to a head-first position by manipulating the woman's belly)?

While studies have not found an excess incidence of scar rupture in these situations, not enough women have been studied to rule out an increase. No currently known added likelihood for scar rupture in a woman with a twin pregnancy or a woman experiencing external version, in comparison with women planning VBAC without these factors.

What is the added likelihood that a woman planning VBAC will require a hysterectomy compared with a woman planning repeat C-section?

Most studies find an excess of hysterectomies (surgical removal of the uterus) among women planning repeat C-section. However, this 532 v.a.g.i.n.al and Cesarean Childbirth could be because those studies may have included cases where the C-section was planned for reasons that could increase the risk of complications during surgery such as the placenta overlaying the cervix (placenta previa). A study that took care to exclude women having planned repeat cesareans for medical reasons found no difference in the percentages of women having hysterectomies.

No apparent added likelihood for hysterectomy for a woman planning VBAC compared with a woman planning repeat C-section.

What is the added likelihood that a woman will require a hysterectomy as a result of the scar giving way (uterine rupture) during a VBAC labor?

Best research suggests that about 3.4 extra women have a scar-related hysterectomy (surgical removal of uterus) occur in every 10,000 VBAC labors, compared with planned C-section deliveries. Thus, nearly 3,000 women would need to experience surgical birth to prevent one instance of hysterectomy due to scar problems during VBAC labors.

Added likelihood for a woman with a known low-transverse (horizontal) scar: low for hysterectomy as a result of uterine rupture compared with repeat cesarean.

What is the added likelihood that a woman will develop an infection after a planned cesarean?

Surgery always introduces the risk of infection. Even though some women who plan VBAC will have repeat C-sections, most will not. This puts women planning VBAC at lower risk of having an infection than women planning repeat C-sections.

Added likelihood for a woman planning repeat cesarean: moderate for developing a wound or internal infection compared with planned VBAC.

What are some concerns about effects of acc.u.mulating uterine scars on future pregnancies and births?

The likelihood of the following problems grows as the number of previous cesareans (and C-section scars) grows: * Placenta previa: Placenta previa: A woman whose uterus has a cesarean scar is more likely than a woman with an unscarred uterus to have a future placenta attach near or over the opening to her cervix; this increases her risk for serious bleeding, shock, blood transfusion, 533 A woman whose uterus has a cesarean scar is more likely than a woman with an unscarred uterus to have a future placenta attach near or over the opening to her cervix; this increases her risk for serious bleeding, shock, blood transfusion, 533 Pregnancy and Birth Sourcebook, Third Edition blood clots, planned or emergency delivery, emergency removal of her uterus (hysterectomy), placenta accreta, and other complications. Added likelihood for a woman with a previous cesarean: moderate for placenta previa in a future pregnancy after having one cesarean; high for placenta previa in a future pregnancy after having more than one cesarean.

* Placenta accreta: Placenta accreta: A woman whose uterus has a cesarean scar is more likely than a woman with an unscarred uterus to have a future placenta grow through the uterine lining and into or through the muscle of the uterus; this increases her risk for uterine rupture, serious bleeding, shock, blood transfusion, emergency surgery, emergency removal of her uterus (hysterectomy), and other complications. Added likelihood for a woman with at least one previous cesarean: moderate for placenta accreta in a future pregnancy, with increasing risk as the number of previous cesareans grows. A woman whose uterus has a cesarean scar is more likely than a woman with an unscarred uterus to have a future placenta grow through the uterine lining and into or through the muscle of the uterus; this increases her risk for uterine rupture, serious bleeding, shock, blood transfusion, emergency surgery, emergency removal of her uterus (hysterectomy), and other complications. Added likelihood for a woman with at least one previous cesarean: moderate for placenta accreta in a future pregnancy, with increasing risk as the number of previous cesareans grows.

* Rupture of the uterus: Rupture of the uterus: A woman whose uterus has a cesarean scar is more likely than a woman with an unscarred uterus to have the uterine wall give way in a future pregnancy or labor, especially at the site of the scar; this increases her risk for severe bleeding, shock, blood transfusion, blood clots, planned or emergency cesarean delivery, emergency removal of the uterus (hysterectomy), and other complications; whether a woman plans a repeat cesarean or a VBAC (v.a.g.i.n.al birth after cesarean), she is at greater risk for a ruptured uterus than a woman with no previous cesarean. Added likelihood for a woman with a previous cesarean: moderate for rupture of the uterus, with increasing risk for two or more cesareans. A woman whose uterus has a cesarean scar is more likely than a woman with an unscarred uterus to have the uterine wall give way in a future pregnancy or labor, especially at the site of the scar; this increases her risk for severe bleeding, shock, blood transfusion, blood clots, planned or emergency cesarean delivery, emergency removal of the uterus (hysterectomy), and other complications; whether a woman plans a repeat cesarean or a VBAC (v.a.g.i.n.al birth after cesarean), she is at greater risk for a ruptured uterus than a woman with no previous cesarean. Added likelihood for a woman with a previous cesarean: moderate for rupture of the uterus, with increasing risk for two or more cesareans.

Questions about Impact of Repeated Cesareans We did not find research to clarify whether some scar-related risks in future pregnancies increase as the number of previous cesareans increases. The following risks for mothers are worse after one cesarean and may or may not grow as the number of C-section scars grow: fertility problems, ectopic pregnancy (not within the uterus), and placental abruption (placenta detaches before birth). The following risks for babies are worse after one cesarean and may or may not grow as the number of C-section scars grows: being born too early (preterm), being born too small (low birthweight), having a physical abnormality or injury to the brain or spinal cord, and dying before birth (stillbirth) or shortly after birth.

534.

v.a.g.i.n.al and Cesarean Childbirth Scarring and adhesion tissue often increase as the number of cesareans increases, creating greater and greater challenges for any future surgical procedures in the area. We did not find information to clarify whether the likelihood of the following adhesion-related problems grows as the number of cesareans grows: ongoing pelvic pain and risk for twisted and blocked bowel in women.

References Guise J-M, Berlin M, McDonagh M, Osterweil P, Chan B, Helfand M.

Safety of v.a.g.i.n.al birth after cesarean: a systematic review. Obstet Obstet Gynecol Gynecol 2004;103:4209. 2004;103:4209.

Guise J-M, McDonagh MS, Osterweil P, Nygren P, Chan BKS, Helfand M. Systematic review of the incidence and consequences of uterine rupture in women with previous caesarean section. BMJ BMJ 2004;329: 15965. 2004;329: 15965.

Has.h.i.+ma JN, Eden KB, Osterweil P, Nygren P, Guise J-M. Predicting v.a.g.i.n.al birth after cesarean delivery: a review of prognostic factors and screening tools. Am J Obstet Gynecol Am J Obstet Gynecol 2004;190:54755. 2004;190:54755.

Lieberman E. Risk factors for uterine rupture during a trial of labor after cesarean. Clin Obstet Gynecol Clin Obstet Gynecol 2001;44:60921. [Alone among references, this article is not a systematic review; it is included, however, as a well done review that addresses important questions for women facing the VBAC/repeat c-section decision.] 2001;44:60921. [Alone among references, this article is not a systematic review; it is included, however, as a well done review that addresses important questions for women facing the VBAC/repeat c-section decision.]

Childbirth Connection. Comparing risks of cesarean and v.a.g.i.n.al birth to mothers, babies, and future reproductive capacity: a systematic review. New York: Childbirth Connection, April 2004.

535.

Pregnancy and Birth Sourcebook, Third Edition Section 66.3 Cesarean Sections "Should I Have a Cesarean Section?" Journal of Midwifery and Women's Journal of Midwifery and Women's Health, Health, March/April 2004. 2004 American College of Nurse-Midwives (www.midwife.org). Reprinted with permission. Reviewed by David A. March/April 2004. 2004 American College of Nurse-Midwives (www.midwife.org). Reprinted with permission. Reviewed by David A.

Cooke, MD, FACP, April 12, 2009. Dr. Cooke is not affiliated with the American College of Nurse-Midwives.

What is a cesarean section?

A cesarean section, or C-section, is major surgery that is done to deliver a baby through the abdomen. A doctor makes a 6- to 7-inch-long cut through the skin and muscle of the abdomen. Then the doctor makes a 5- to 6-inch cut in the uterus. The doctor puts his or her hand into the uterus through the cut and pulls the baby out. Usually the cut is made across the lower abdomen between the hip bones. This is called a low-transverse C-section. If the cut goes up and down, it is called a cla.s.sic C-section.

Why are C-sections done?

Most of the time, C-sections are done when labor is not proceeding normally. If you or your baby has severe trouble during labor, your health care provider will talk with you and your family about the possibility of a C-section. Then, together, you will decide on the best plan: continue labor or have a C-section. Sometimes, problems develop so quickly a C-section needs to be done as an emergency operation. In that case, there will not be time to allow labor to continue, and a C-section will be done immediately. Occasionally, a C-section is planned ahead and done before you go into labor. Most women do not need a C-section.

Will I need a C-section?

If you have had a C-section before, you should talk with your health care provider during your pregnancy about the safest way to give birth this time. Your health care provider may offer you the choice of a C-section or v.a.g.i.n.al birth (v.a.g.i.n.al birth after C-section, or VBAC).

536.

v.a.g.i.n.al and Cesarean Childbirth Can I choose to have a C-section?

Unless you have one of the problems listed on the flip side of this page, v.a.g.i.n.al birth is safer than a C-section for both you and your baby.

Isn't a C-section safe?

C-sections are often considered a "safe surgery" because women having babies are usually healthy and able to recover easily. However, any surgery has some risk. Women who have C-sections have a higher risk of heavy bleeding and infection after the birth of the baby. There is also some added risk from having anesthesia. The major risk to you from having a C-section occurs the next time you are pregnant. In the next pregnancy, there is a higher chance of placenta previa (a placenta that partly or completely covers the cervix, which is the mouth of the uterus) or placenta accreta (a placenta that grows too deeply into the wall of the uterus). Either of these placenta problems can cause severe bleeding that is very dangerous for you and your baby. New studies also show a higher chance of stillbirth in women who are pregnant again after having a C-section. If you need a C-section, your health care provider will talk to you about the risks in more detail.

I've heard that some women have a C-section to avoid problems with leaking urine later in life. Is this a good reason to have a C-section?

There have been many studies trying to find out which is the safest way to have a baby. At this time, there is no proof that having a C-section is safer or protects against future problems with leaking urine or stool, or uterine prolapse. Because there are more medical risks for women who have a C-section compared to women who have a v.a.g.i.n.al birth, v.a.g.i.n.al birth is safer.