“Plan B!! When Labor Turns Into a Cesarean” – with Dr. Lis Shlansky

Dr. Lisabeth Shlansky joins host Dr. Nathan Fox to discuss cesarean sections after a woman has been laboring. While this can be a stressful and uncertain situation for patients, Dr. Shlansky discusses what doctors can do to help them feel more informed as well as common signs that a cesarean delivery may be necessary.  

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Many patients are fearful of a cesarean delivery, especially if they’re having their first baby. Dr. Shlansky explains the likelihood that a patient will require a cesarean delivery after labor, and that making this decision is not always simple or clear.  

Generally, there are two reasons why a c-section may be necessary. Either the baby is not tolerating labor, such as a situation in which low oxygen levels can cause brain injury, or there is an indication that labor is not progressing normally to the point it can be dangerous to either the mother or the baby. While fetal monitoring is not always precise, and a baby may be perfectly healthy despite concerns during labor, c-sections are sometimes performed to ensure that the baby does not suffer negative health effects through labor. Very long labors can be dangerous for both the mother and baby, with risks such as infection, hemorrhaging, or organ damage. Dr. Shlansky also notes that if the mother has a fever, she considers this a “significant event” that may indicate a cesarean is necessary. Other factors that are considered include the baby’s position and whether the cervix is continuing to dilate. However, she stresses that during labor, there are no clear-cut decisions regarding cesarian delivery outside of extreme scenarios. 

Before a patient goes into labor, there are some risk factors that indicate a cesarean is more likely. These include genetic factors such as pelvic issues (which can be indicated through a family history of cesarean delivery), a higher starting BMI or amount of weight gain during pregnancy, and the age of the patient. Drs. Fox and Shlansky explain that as patients get older, the uterus muscle declines in strength, increasing the risk of a cesarean delivery. Despite these common risk factors, it’s still difficult for doctors to predict whether a cesarean will be necessary after a patient goes into labor.  

Drs. Fox and Shlansky emphasize the importance of trust between a patient and their obstetrician. Dr. Fox notes that “if you don’t trust the person who is taking care of you, that is a set up for disaster.” Obstetricians can help establish trust by getting to know their patient as a person and having multiple appointments with them before they go into labor. They should also help them understand their decision process, explain their risk factors, and allow patients to ask questions throughout the process. Dr. Shlansky notes that cesarean rates have stayed relatively constant in the past 15 years, which is information that usually helps patients feel more comfortable. After the birth, obstetricians can meet with patients and explain the decision-making process to their patients again outside of the stress of labor, so that patients may feel more confident if they decide to become pregnant again in the future.  

Dr. Lisabeth Shlansky is a board certified Obstetrician/Gynecologist with Maternal Fetal Medicine Associates in New York City. She holds 20 years of clinical experience, and was a full-time faculty member at Saint Francis Hospital in Hartford, CT before joining the practice in 2018. Dr. Shlansky completed medical school at New York Medical College and a residency at Danbury Hospital in Danbury, CT.