244 chapter 11: Labor and birth
Birth by operation
(Cesarean section, c‑section)
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. For information on
particular disabilities that may cause problems during childbirth, see page 213.
Sometimes it is necessary for a woman to have a c-section, especially if:
• 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.
A scar on the
womb like this
is more likely
• she is not strong enough for labor.
to open up in
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
A scar that
...may be hiding a scar
goes one way on on the womb that goes
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.
A Health Handbook for Women with Disabilities 2007