What is the reason for giving birth

Caesarean section - reasons for the operation

Around every third child in Germany is born by caesarean section. This puts Germany well above the Caesarean section rate recommended by the World Health Organization (WHO). What are the reasons for a caesarean section?

If there are signs of complications for mother and / or child during pregnancy or childbirth, a caesarean section can be a saving way out of an unfavorable or even dangerous situation. Obstetrics differentiates between mandatory and non-mandatory medical reasons (absolute and relative indications) for performing the operation.

Compelling reasons (absolute indications)

Some of the compelling reasons that make a caesarean section inevitable include:

  • a child position that makes normal birth impossible or risky (for example, a lateral position)
  • when the child's head does not fit through the maternal pelvis
  • a (threatening) uterine tear
  • a placenta that lies in front of the cervix and blocks the birth path (placenta praevia)
  • a premature release of the placenta from the uterine wall
  • an infection of the egg cavity (amniotic infection syndrome)
  • a preeclampsia that has turned into severe convulsions (eclampsia)
  • the HELLP syndrome
  • an umbilical cord incident
  • an insufficient supply of oxygen to the child (fetal acidosis)

It can be established even before the birth that childbirth in a natural way is impossible or too dangerous. Or there may be complications during the birth which, in the interests of the mother and / or the child, require an immediate end to the birth process.

Absolute indications make up less than ten percent of caesarean sections in Germany. In most cases, the operation is performed on the basis of relative indications, that is, there is no compelling medical reason for the caesarean section.

Non-compelling reasons (relative indications)

Relative indications are risk factors that may, but not necessarily, lead to complications during vaginal birth. These include, for example:

  • a breech position of the child - it is not head, but bottom first in the uterus
  • the birth of multiples
  • a previous caesarean section
  • a suspicion of a mismatch between the size of the child and the maternal pelvis
  • a birth arrest
  • abnormal heartbeat of the child during childbirth
  • a greatly prolonged birth
  • maternal exhaustion

In these cases, the obstetricians and the pregnant woman weigh up which procedure - vaginal delivery or caesarean section - offers the greatest safety for mother and child.

Planned and unplanned caesarean section

In the case of a planned caesarean section ("primary Caesarean section"), the decision to have the operation is made during pregnancy. The procedure is usually performed on a predetermined date before labor begins.

An unplanned caesarean section - also known as a "secondary caesarean section" - is a caesarean section that is usually necessary due to a critical birth situation. The birth has already started, but can no longer be safely continued. This is the case, for example, in the event of a birth arrest, if the heartbeat of the child deteriorates or if the woman giving birth has dangerous high blood pressure.

Caesarean section on request

A caesarean section for which there are no medical reasons and which is only carried out at the personal request of the pregnant woman - for organizational reasons, for example - has to be paid for privately and is rare in Germany. Surveys carried out in recent years came to the conclusion that the proportion of desired caesarean sections is around two to three percent.