Cesarean Sections (C-Sections)

What Is a C-Section?

A cesarean section (C-section) is the surgical delivery of a baby through incisions in the mother's abdominal wall and uterus.

C-sections can help women who are at risk for problems avoid dangerous delivery-room situations and can be a lifesaver in an emergency.

C-sections are done by obstetricians (doctors who care for pregnant women before, during, and after birth) and some family physicians. Midwives cannot perform C-sections.

Why Are C-Sections Needed?

Scheduled C-Sections

Some C-sections are scheduled if the doctor knows that a vaginal birth would be risky. A doctor may schedule one if:

• the baby is in breech (feet- or bottom-first) or transverse (sideways) position in the womb (although some babies can be turned before labor begins or delivered vaginally using special techniques)
• the baby has certain birth defects (such as severe hydrocephalus)
• the mother has problems with the placenta, such as placenta previa (when the placenta sits too low in the uterus and covers the cervix)
• the mother has a medical condition that could make a vaginal delivery risky for herself or the baby (such as HIV with a high viral load or an active case of genital herpes)
• some multiple pregnancies
• the mother previously had surgery on her uterus or an earlier C-section (although many such women can safely have a vaginal birth after a C-section, called a VBAC)

Emergency C-Sections

Some C-sections are unexpected emergency deliveries done when problems arise with the mother and/or baby during pregnancy or labor. An emergency C-section might be done if:

• labor stops or isn't moving as it should (and medicines aren't helping)
• the placenta separates from the uterine wall too soon (called placental abruption)
• the umbilical cord becomes pinched (which could affect the baby's oxygen supply) or enters the birth canal before the baby (called umbilical cord prolapse)
• the baby is in fetal distress — certain changes in the baby's heart rate may mean that the baby is not getting enough oxygen
• the baby's head or entire body is too big to fit through the birth canal

If your doctor has recommended a C-section and it's not an emergency, you can ask for a second opinion. In the end, though, it's best to rely on the judgment of the doctors.

How Is a C-Section Done?

Here's a quick look at what usually happens during a scheduled C-section.

Your labor coach or partner, wearing a surgical mask and gown, can stay by your side during the entire delivery (although they might not be allowed to stay for an emergency C-section). Before the procedure begins, an anesthesiologist will discuss what will be done to make sure you don't feel pain. Regional anesthesia blocks the feeling from specific regions of the body, and is used for pain relief in both vaginal and cesarean section deliveries.

To prepare for the delivery, you'll probably have:

• various monitors in place to keep an eye on your heart rate, breathing, and blood pressure
• your mouth and nose covered with an oxygen mask or a tube placed in your nostrils to give you oxygen
• a catheter (a thin tube) inserted into your bladder through your urethra (which may be uncomfortable when it's placed, but should not be painful)
• an IV in your arm or hand
• your belly washed and any hair between the bellybutton and pubic bone shaved
• a privacy screen put around your belly

After you get anesthesia, the doctor makes an incision on the skin of the abdomen — usually horizontally (1–2 inches above the pubic hairline, sometimes called "the bikini cut").

The doctor then gently parts the abdominal muscles to get to the uterus, where they will make another incision in the uterus itself. This incision can be vertical or horizontal. Doctors usually use a horizontal incision in the uterus, also called transverse, which makes a VBAC much more possible.

After the uterine incision is made, the baby is gently pulled out. The doctor suctions the baby's mouth and nose, then clamps and cuts the umbilical cord. As with a vaginal birth, you should be able to see your baby right away. Then, your newborn is handed over to be cared for by a nurse or doctor for a few minutes.

The obstetrician then removes the placenta from your uterus, closes the uterus with dissolvable stitches, and closes the abdominal incision with stitches or surgical staples that are usually removed, painlessly, a few days later.

If the baby is doing OK, you can hold and/or nurse your newborn in the recovery room. You may need help holding the baby on the breast if you have to stay lying down flat.

Will I Feel Anything?

You won't feel any pain during the C-section, although you may feel sensations like pulling and pressure. Most women are awake and simply numbed from the waist down using regional anesthesia (an epidural and/or a spinal block) during a C-section.

That way, they are awake to see and hear their baby being born. A curtain will be over your abdomen during the surgery, but you may be able to take a peek as your baby is being delivered from your belly.

Sometimes, a woman who needs an emergency C-section might require general anesthesia. This means she'll be unconscious (or "asleep") during the delivery and won't remember anything or feel any pain.

What Are the Risks?

C-sections today are, in general, safe for both mother and baby. However, there are risks with any kind of surgery. Potential C-section risks include:

• increased bleeding (that could, though rarely, require a blood transfusion)
• infection (antibiotics are usually given to help prevent this)
• bladder or bowel injury
• reactions to medicines
• blood clots
• death (very rare)
• possible injury to the baby

Regional anesthesia used during a C-section and general anesthesia both are considered safe for the baby, but can cause problems like nausea and low blood pressure in the mother.

Babies born by C-section sometimes have breathing problems (transient tachypnea of the newborn) because labor hasn't jump-started the clearance of fluid from their lungs. This usually gets better on its own within the first day or two of life.

Having a C-section may — or may not — affect future pregnancies and deliveries. Many women can have a successful and safe vaginal birth after cesarean. But in some cases, future births may have to be C-sections, especially if the incision on the uterus was vertical rather than horizontal. A C-section can also put a woman at increased risk of possible problems with the placenta in future pregnancies.

In the case of emergency C-sections, the benefits usually far outweigh the risks. A C-section could be lifesaving.

What Is the Recovery Like?

As with any surgery, there's usually some degree of pain and discomfort after a C-section. The recovery period is also a little longer than for vaginal births. Women who've had C-sections usually stay in the hospital for about 3 or 4 days.

Right after, you may feel itchy, sick to your stomach, and sore — these are all normal reactions to the anesthesia and surgery. If you needed general anesthesia for an emergency C-section, you may feel groggy, confused, chilly, scared, alarmed, or even sad. Your health care provider can give you medicines to ease any discomfort or pain.

For the first few days and even weeks, you might:

• feel tired
• have soreness around the incision (the doctor can prescribe medicines and/or recommend over-the-counter pain relievers that are safe to take if you're breastfeeding)
• be constipated and gassy
• have a hard time getting around and/or lifting your baby

It can help if you support your abdomen near the incision when you sneeze, cough, or laugh. These sudden movements can be painful. You'll need to avoid driving or lifting anything heavy so that you don't put any unnecessary pressure on your incision.

Check with your health care provider about when you can get back to your normal activities (typically after about 6 to 8 weeks, when the uterus has healed). As with a vaginal delivery, you shouldn't have sex until your doctor has given you the go-ahead, usually about 6 weeks after delivery.

Frequent and early walking may help ease some post-cesarean pains and discomfort. It also can help prevent blood clots and keep your bowels moving. But don't push yourself — take it easy and have someone help you get around, especially up and down stairs. Let friends, family, and neighbors lend a helping hand with meals and housework for a while, especially if you have other children.

Although breastfeeding might be a little painful at first, lying on your side to nurse or using the clutch (or football) hold can take the pressure off your abdomen. Drink plenty of water to help with your milk supply and to help avoid constipation.

C-sections scars fade over time. They'll get smaller and become a natural skin color in the weeks and months after delivery. And because incisions are often made in the "bikini" area, many C-section scars aren't even noticeable.

What If I Don't Feel Better?

Call your health care provider if you have:

• a fever
• signs of infection around your incision (swelling, redness, warmth, or pus)
• pain around your incision or in your abdomen that comes on suddenly or gets worse
• foul-smelling vaginal discharge
• pain when peeing
• trouble pooping
• heavy vaginal bleeding
• leg pains, or swelling or redness of your legs
• trouble breathing or chest pain
• pain in one or both breasts
• feelings of depression
• thoughts of hurting yourself or your baby

Emotionally, you may feel a little disappointed if you'd been hoping for a vaginal birth or had gone through labor that ended in a C-section. Remember that having a C-section does not make the birth of your baby any less special or your efforts any less amazing. After all, you went through major surgery to deliver your baby!