Hesperian Health Guides

Birth by operation (Cesarean section, c-section)

In this chapter:

When complications make it dangerous for a woman or her baby to go through normal labor and birth, a doctor may make a cut in the woman's belly and womb and bring the baby out. The doctor then sews the womb and belly closed (the womb is not removed). The operation leaves one scar on the womb and a second scar on the belly. This operation is called a Cesarean section, or c-section.

Most pregnant women with physical disabilities, especially those who are paralyzed, are told by doctors and health workers that they MUST give birth by c-section. This is not always true. With a little help, it is possible for most women who have a physical disability, or have no feeling in the belly, to give birth through the vagina. No matter what sort of disability a woman has, the muscles of the womb will still contract by themselves to push the baby out. See information on particular disabilities that may cause problems during childbirth.

Sometimes it is necessary for a woman to have a c-section, especially if:

a side-to-side scar on the lower belly.
an up-and-down scar on the belly.
A scar on the womb like this is more likely to open up in labor
A scar that goes one way on the outside... ...may be hiding a scar on the womb that goes another way.
  • the baby is big or in a difficult birth position.
  • the woman has a pelvic deformity.
  • she has a curve in her spine.
  • she is unable to move her legs apart.
  • her pelvis is small, and the baby is big.
  • she is not strong enough for labor.

Even though a c-section is sometimes
necessary, if possible it is best to avoid this
operation. It is most often done because it is
easier for the doctor. In addition, it is expensive, there is always a possibility that something will go wrong, and it takes longer to recover than from a regular birth.

Many women who have had a baby delivered by c-section are able to give birth the next time through the vagina. This is especially true if the cut from the c-section was made across the lower belly from side to side, and not up and down. An up- and-down scar is more likely to open up during labor.

Even with the scar across the belly, there is a very small chance that the scar on the womb will tear open during labor. If this happens, the woman can bleed inside and die. Although she may not need another operation to give birth, it is safest for a woman with a past c-section to give birth in a hospital, in case there are problems. If this is not possible, she should try to give birth near a hospital. And before the birth, try to arrange to have hospital care in case there are any problems during the labor.

Female genital cutting (FGC, female circumcision)

a health worker meeting with a pregnant woman who uses crutches.

In some communities—mostly in Africa, but also in parts of South Asia, the Middle East, and other parts of the world—girls and young women are cut on their genitals. Like many cultural practices, female genital cutting is a way that girls’ bodies are changed so they are considered beautiful, acceptable, or clean. But while this tradition may be meaningful for the community where it is practiced, female genital cutting has serious harmful effects on the health and well-being of the girls who are cut. In the long term, female genital cutting can lead to urinary infections, emotional damage, loss of sexual sensation or ability to have sex as an adult, and long, difficult labors which can lead to death of the baby or the mother. If you are a woman who has had your genitals cut and then sewn partially closed, talk with an experienced midwife or health worker. Your genitals will need to be cut open before you give birth.

This page was updated:30 Nov 2023