Chapter 7: Learning a pregnant woman’s health history
Did she have a cesarean surgery (birth by operation)?
In a cesarean surgery, a doctor cuts open the woman’s belly and womb to get the
baby out. After the baby is out, the doctor sews the womb and belly closed. This
leaves one scar on the womb and a second scar on the belly. Sometimes a cesarean
surgery is done because the baby does not fit through the mother’s pelvis.
Sometimes it is done because the baby is in danger and must be born very quickly.
Note: Cesarean surgeries save lives, but in many places they are used
too much — usually for the convenience of the doctor or because
women falsely believe that a cesarean will be easier. Cesareans should
only be used in emergencies.
Most women can have a safe vaginal birth even if they had a cesarean with a
previous baby. But there is a very small chance that the scar on the womb may tear
open during labor. If this happens, the woman could bleed inside and she or the
baby could die. For this reason, it is safest for a woman who has had a cesarean to
give birth in or near a medical center or hospital. If she is planning to give birth at
home, arrange for her to have medical care in case there are any problems during
If any of the following are true, this woman should definitely go to a
medical center for the birth:
• The cesarean was less than 2 years ago.
• This baby is big or in a difficult birth position.
• The woman had a cesarean because her pelvis was not formed well as a child.
This is usually caused by poor nutrition.
• The scar on the womb is up-and-down.
Unfortunately, you cannot
tell anything about the
scar on the womb by
looking at the belly.
The scar on the belly can
be one way, and the scar
on the womb inside can
be another. You can only
find out by checking the
medical records at the
hospital or by asking the
doctor who did the
A scar that
goes one way
on the outside...
A scar on the
womb that goes
this way is more
likely to open up
...may be hiding a scar
on the womb that
goes another way.
A Book for Midwives (2010)