Which of the following circumstances necessitate a caesarean delivery over attempting a vaginal delivery?
- The baby is in the breech position – presenting bottom down rather than head down
- Mum is carrying twins – both twins are presenting head down
- Mum has HIV – with a viral load of less than 400 copies per ml
- Mum has had a caesarean previously
- Mum’s labour is failing to progress
- The baby is in the transverse position – lying across mum’s body
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Only No. 6. and even then, only after attempts to manipulate baby into a head down (or breech) position have not worked.
In all other instances, a caesarean may well be recommended, but it is not required.
That said, it is worth listening to the fine detail of why a caesarean may be being recommended. For example, over the last few decades the number of breech babies delivered vaginally at home has significantly decreased, so if your baby is breach and you are planning a home birth and your midwifery team are recommending a hospital birth, this could be because they feel less experienced in home breech births. Investigating the possibility of an experienced, independent midwife may mean this is still possible, or moving the birth to a birthing centre within your local hospital may help move towards a birth plan which supports both parties.
Similarly, twins do not have to be delivered vaginally, but where one twin is lying in a more complex position i.e. not head down, then a caesarean may be preferrable to mitigate against situations where cords become entangled or prolapse as the first twin is delivered.
At the end of the day, it is about being informed and checking you have all the facts. If you are at all unsure that the advice you are being given is the whole picture, it is your right (in the UK at least) to ask for a second opinion.