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Often the fetus will indicate that the pelvis may not be a "comfortable fit" by assuming a position other than the normal head-first position for birth. A woman in labor whose baby is in a transverse lie will need a cesarean since neither head nor buttocks are in the pelvis. Multiple births are more likely to require a cesarean since the babies can assume different positions in the uterus.
Then there's the breech birth. When a baby is born breech through the vaginal route, the buttocks emerge before the head. The head has a larger diameter than the buttocks and may not fit well through the passage since it has not had the opportunity to mold and nestle into the pelvis throughout the labor process. Today, cesareans are usually, though not always, performed for breech births.
Unusual birth positions often can be diagnosed in late pregnancy, allowing you and your doctor to assess various options, such as turning a breech baby.
Once in a great while the pelvic passage will be obstructed. This can be caused by a fibroid or even by the placenta, in a situation called placenta previa.
Herpes is another reason a woman may need to have a cesarean. This can cause major problems for the newborn if the mother has active lesions in the birth passage. The cesarean route bypasses the lesions.
Occasionally, other conditions may warrant a cesarean. If you have pregnancy-induced hypertension, your provider will make every effort to deliver your baby vaginally, but a cesarean is sometimes necessary. Another common reason for cesareans is dystocia, although sometimes this diagnosis can be avoided.
Again, keep in mind that these conditions are rare and that a cesarean can be avoided most of the time. If a cesarean cannot be avoided in your case, remember that it is a form of birth that helps deliver the healthiest baby possible. Also remember that just as with a vaginal birth, a cesarean birth marks the beginning of a new life and a wonderful new family.