Does a diagnosis of preeclampsia automatically mean I need a c-section?
No, preeclampsia by itself should not automatically mean a c-section. In fact, women with preeclampsia are at higher risk for surgical complications. A c-section is a major surgery, and it puts a lot of strain on already struggling bodies. ACOG (US pregnancy guidelines) says vaginal delivery is preferred for women with gestational hypertension or preeclampsia without severe features, and that attempting induction is reasonable even for severe features, preterm deliveries, or fetuses with low birth weight.
Of course, many of us end up needing a c-section anyway, either from the start or after complications emerging during labor. There are many reasons why surgery could be the better choice in an individual case. Common reasons include:
fetal distress
poor fetal positioning (breech or transverse)
placenta previa or vasa previa
prolapsed cord
previous c-section making induction riskier
mother’s condition worsening too quickly to wait
being very far from term (the earlier you are, the lower the chances of successful induction)
and more
You can ask your doctor what is recommended in your case and why. You can discuss the benefits and risks of choosing a c-section or attempting labor. You can ask what circumstances might come up during labor that would lead to a change of plans, and what an unplanned/emergency c-section would be like. Then you will have the information to make the best choice for yourself and your baby.
Some studies:
Labor induction for the preterm severe pre-eclamptic patient: is it worth the effort? (2001)
Evaluation and management of severe preeclampsia before 34 weeks' gestation (2011)
And a screenshot from ACOG’s Practice Bulletin 202, page 13:
