In preparation to deliver your first child, you might enroll in lamaze classes, seek out a midwife, and have regular consultations with your obstetrician. From conversations with experienced mothers, you prepare yourself mentally for many hours of labor.
You anxiously await the vaginal delivery of your baby, followed by suction to clear the infants airways. Gentle massaging—or as a last resort, spanking—can initiate a crying gasp for first breaths. 
You may not expect the doctor to cut open your belly to remove your bundle of joy. Historically performed when complications arise, cesarean births (c-sections) are becoming the norm in many delivery rooms. Nearly a third of births in the United States are cesarean. [2,3] Other countries, like Brazil, have cesarean birth rates between 80 and 90%.  Are there that many delivery complications or is something else motivating this trend?
Cesarean Births Without Complications
A birth is considered low-risk or NTSV—Nulliparous, or first-time moms; Term pregnancy; Singleton (not twins, triplets or more); Vertex, meaning the baby was head-down)—when there is only one full-term fetus in the head-down position.  Based on 2019 data from the Centers for Disease Control and Prevention (CDC), 31.7% of all U.S. births were cesarean, and 25.6% of NTSV pregnancies were cesarean.
Rates vary dramatically among hospitals—some performing 1500% more c-sections as others with low rates.  Therefore, as an alert mother-to-be do not simply assume that the closest hospital is the best option. Research and compare local hospital NTSV cesarean rates.
According to the March of Dimes vice president of global programs, such high rates are mainly due to an increase of elective c-sections. Doctors must weigh the risks of each cesarean versus vaginal delivery. [6,7]
Complications May Necessitate Cesarean
A doctor rules out vaginal delivery for in any of the following pregnancy complications:
- A prior c-section or other uterine surgeries. Some women can safely have a vaginal birth after cesarean (VBAC).
- Problems with the placenta, such as placenta previa, which can cause dangerous bleeding during vaginal birth.
- An existing infection, like HIV or genital herpes that can pass to your baby during vaginal birth.
- A medical condition that may make vaginal birth risky, like diabetes or high blood pressure.
- You’re having multiples (twins, triplets or more).
Other complications can occur during labor and birth. But many times your doctor schedules a c-section in advance. If your provider recommends scheduling a c-section, ask these questions:
- Why do I need to have a c-section?
- Is there a problem with my health or the health of my baby makes it necessary to have my baby before 39 weeks?
- Can I wait to have my baby closer to 39 weeks?
- What problems can a c-section cause for me and my baby?
- What will my recovery be like?
- Can I have a vaginal birth in future pregnancies?
Full-Term Whenever Possible
Doctors recommend full-term births whenever possible. At 35 weeks, a baby’s brain is only two-thirds its weight at 39 weeks. In preparation for life outside the womb, other internal organs also undergo significant development during the last month.
Do not consider an early c-section merely to relieve pregnancy discomfort. Obstetricians recommend that some pregnant mothers remain in bed during the last 4 to 5 weeks leading up to labor.
Cesarean delivery results in a longer hospital stay at a higher cost. Hospitals with higher rates of VBAC have lower rates of NTSV cesarean delivery. By implementing quality improvement interventions, hospitals can reduce the number of cesarean births.  Along with your breathing exercises and other preparations, plan who will deliver the baby and where the delivery will take place.
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