From the Guidelines
A primary cesarean delivery is defined as a surgical procedure to deliver a baby through incisions in the mother's abdomen and uterus when it is the woman's first cesarean delivery. This procedure is performed when a vaginal birth would put the mother or baby at risk. According to the study by 1, the indications for a cesarean delivery have been summarized by the Maternal-Fetal Medicine Unit Network, with primary indications including dystocia, nonreassuring fetal heart rate, abnormal fetal presentation, and other factors.
Key Points to Consider
- The decision to perform a primary cesarean delivery is typically made based on the risk to the mother or baby, with common reasons including failure to progress in labor, fetal distress, and abnormal fetal positioning.
- The surgery typically involves regional anesthesia, allowing the mother to remain awake while feeling no pain, and takes about 45-60 minutes to complete.
- Recovery from a primary cesarean delivery involves hospital monitoring for 2-4 days, pain management with medications, and a gradual return to normal activities over 4-6 weeks.
Importance of Understanding Primary C-Sections
Understanding primary C-sections is crucial because they impact future pregnancies, with many providers recommending subsequent C-sections after the first one, although vaginal birth after cesarean (VBAC) may be an option for some women, as noted in the study by 1.
Reducing Morbidity and Mortality
Initiatives to reduce the frequency of cesarean delivery and enhance maternal safety have been initiated, with approaches to reducing complications in cesarean delivery being adopted and demonstrated to be impactful, as reported by 1.
From the Research
Definition of Primary Cesarean Delivery
- A primary cesarean delivery, also known as a primary C-section, is defined as a cesarean delivery performed for the first time on a pregnant woman 2.
- This type of delivery is typically considered when a woman has not had a previous cesarean section.
Indications for Primary Cesarean Delivery
- The most common indications for primary cesarean delivery include:
- Labor dystocia (difficulty progressing in labor) 3, 4
- Abnormal or indeterminate fetal heart rate tracing 3, 4
- Fetal malpresentation (the baby is not in the correct position for vaginal delivery) 3, 4
- Multiple gestation (carrying twins or other multiples) 3
- Suspected fetal macrosomia (the baby is larger than normal) 3
Characteristics of Primary Cesarean Delivery
- The primary cesarean delivery rate varies by parity, with a higher rate for primiparous women (30.8%) compared to multiparous women (11.5%) 4.
- Among women with failure to progress, a significant proportion (42.6% of primiparous women and 33.5% of multiparous women) never progressed beyond 5 cm of dilation before delivery 4.
- The use of oxytocin and other interventions can increase the risk of uterine rupture in women undergoing a trial of labor after a previous cesarean delivery 5.