Reasons for caesarean birth

This article looks at why doctors might recommend an elective or emergency caesarean section, whether you can refuse to have one and how you might make a decision.

In some cases there is clear evidence that a caesarean is needed to save life or to safeguard the health of mother or baby. 

However, in other cases the best option isn’t clear. Doctors can read the same evidence in different ways and hold differing opinions on the need for a caesarean. There are occasions when the choice is left to the parents. This article covers:

When might I be told I need a caesarean?

Why might I need a caesarean section?

Can I choose not to have a caesarean section?

A strategy for decision making

Further information

When might I be told I need a caesarean?

A caesarean may be recommended at any time during pregnancy or labour.

Why might I need a caesarean section?

Sometimes a caesarean is definitely needed. You need a caesarean if you have:

  • Placenta praevia: when your placenta lies across your cervix, the opening into the vagina.
  • Placental abruption: when the placenta comes away from the wall of the uterus.
  • Pre-eclampsia, which can develop into a serious medical condition of pregnancy.
  • Umbilical cord prelapse: NICE guidelines state a caesarean section is needed in these cases ‘unless birth is imminent’.

You will also need one if your baby:

  • Is lying in the oblique or transverse position.
  • Has a particular medical condition that makes it necessary for her to be born by caesarean section.

In other cases:

  • your baby is breech (lying bottom down),
  • the progress of labour is considered to be too slow (failure to progress),
  • the baby is believed to be in difficulty (foetal distress),
  • you have a history of previous caesarean deliveries,
  • you are carrying more than one baby,

and the decision is less straightforward.

Can I choose not to have a caesarean section?

 As with all interventions in labour and pregnancy, you have to give your consent before you can have a caesarean. However, if you are uncertain about the need for a caesarean it can be very difficult to disagree with your medical professionals, particularly if you are in labour.

Not all ‘emergency’ caesareans are urgent. The urgency of a caesarean (elective or emergency) has been graded into four categories:

  1. There is an immediate threat to the life of the mother or baby.
  2. Mother or baby are in difficulty, but it’s not immediately life-threatening.
  3. Mother should be delivered shortly, but neither mother nor baby are in difficulty.
  4. Delivery is timed to suit the mother and the staff. 

Unless the circumstances of your caesarean fall into one of the first two categories, there should be time for you to seek more information to help you understand your situation and come to your own decisions.

A strategy for decision making

It may be helpful to have a strategy for making decisions when medical help is offered. A strategy which many women have found helpful is the ‘BRAIN’ analysis:

Benefits: What are the benefits of the intervention?

Risks: What are the risks both to the baby and to yourself?

Alternatives? What other options are there?

Instincts? What do your instincts tell you?

Nothing: What if you don’t do anything?

Asking yourself, your midwife, and/or your doctor these questions, and thinking through the answers, will help you make decisions that are right for you. 

See our article on Giving birth by caesarean for the main risks to mother and baby of having a caesarean.

Page last updated: 31 August 2012

Further information

NCT's helpline offers practical and emotional support in all areas of pregnancy, birth and early parenthood: 0300 330 0700. We also offer antenatal courses  which are a great way to find out more about birth, labour and life with a new baby.

NHS Choices offers a section on caesarean birth

NICE provides evidence-based guidelines on caesarean section.

The site www.caesarean.org.uk offers research-based information and support on all aspects of caesareans and vaginal birth following caesarean section.

The book Caesarean Birth – Your Questions Answered is available from NCT Sales.