Childbirth

C-sections (Cesarean Section)

C-sections: Giving Birth By Cesarean Section

A c-section, or cesarean section, is the delivery of a baby through a surgical incision in the mother’s abdomen and uterus. In some circumstances, a c-section is scheduled in advance. In others, the surgery is needed due to an unforeseen complication. If you or your baby is in imminent danger, you’ll have an emergency c-section. Otherwise, it’s called an unplanned section.

It is a common procedure that is used to deliver about 1 in 5 babies in the United States, according to the Centers for Disease Control and Prevention.

C-sections are generally avoided before 39 weeks of pregnancy so the child has proper time to develop in the womb. Sometimes, however, complications arise and a C-section must be performed prior to 39 weeks.

C-sections (Cesarean Section)

Before surgery

To prepare for the operation, an IV will be placed in a woman’s arm or hand to give her the fluids and medications she’ll need during surgery. Her abdomen will be washed and her pubic hair may be clipped or trimmed.

A catheter (tube) is placed into a woman’s bladder to remove urine, and it will remain there for a day after the surgery.

Women are usually given regional anesthesia, either an epidural block or a spinal block, which both numb the lower half of her body but will allow the mother to be awake when her baby is born. This tends to be safer than general anesthesia, where a woman would be totally asleep during the delivery, Bryant said.

How a C-section is done

The obstetrician will use a knife to make a horizontal incision in the skin and the abdominal wall, usually along the bikini line, meaning that it’s low enough down on the pelvis that it would be covered up by underwear or a bikini bottom, Bryant said. Some women may get a vertical, or up-and-down cut, she said.

After the abdomen is opened, an incision is made in the uterus. Typically, a side-to-side (horizontal) cut is made, which ruptures the amniotic sac surrounding the baby, Bryant said. Once this protective membrane is ruptured, the baby is removed from the uterus, the umbilical cord is cut, and the placenta is removed. The baby is examined then given back to the mother for skin-to-skin contact, Bryant said.

Bryant explained that the cut made to a woman’s uterine wall is an important one because the way this uterine scar heals can affect her ability to have a vaginal birth in the future.

Once the delivery and afterbirth are completed, the cuts made to the mother’s uterus are repaired with stitches, which will eventually dissolve under the skin. The abdominal skin is closed with stitches or with staples, which will be removed before a woman leaves the hospital.

A woman typically spends 60 to 120 minutes in the operating room for a C-section, depending upon whether any complications arise during the delivery, Bryant said.

After the surgery, a woman will be taken to the hospital’s maternity ward to recover.

Recovering from a C-section

After a C-section, a woman may spend between 2 to 4 days in the hospital, but it may take her up to 6 weeks to feel more like herself again, Bryant said.

Her abdomen will feel sore from the surgery and the skin and nerves in this area will need time to heal. Women will be given pain medications to take the edge off any post-surgical pain, and most women use these medications for about 2 weeks afterward, Bryant said.

A woman may also experience bleeding for about 4 to 6 weeks after a surgical birth. She is also advised to not have sex for a few weeks after her C-section and to also avoid strenuous activities, such as lifting heavy objects.

The Risks of a C-Section

A C-section is becoming a more common delivery type, but it is still a major surgery that carries risks for both mother and child. The risks of a C-section include:

  • bleeding
  • blood clots
  • breathing problems for the child, especially if done before 39 weeks of pregnancy
  • increased risks for future pregnancies
  • infection
  • injury to the child during surgery
  • longer recovery time compared with vaginal birth
  • surgical injury to other organs

You and your doctor will discuss your birthing options before your due date. Your doctor will also be able to determine if you or your baby are showing any signs of complications that would require a C-section delivery.

What happens right before a c-section?

First, your practitioner will explain why he believes a c-section is necessary, and you’ll be asked to sign a consent form. If your prenatal practitioner is a midwife, you’ll be assigned an obstetrician for the surgery who will make the final decision and get your consent.

Typically, your husband or partner can be with you during most of the preparation and for the birth. In the rare instance that a c-section is such an emergency that there’s no time for your partner to change clothes – or you need general anesthesia, which would knock you out completely – your partner might not be allowed to stay in the operating room with you.

An anesthesiologist will then come by to review various pain-management options. It’s rare these days to be given general anesthesia, except in the most extreme emergency situations or if you can’t have regional pain relief (like an epidural or spinal block) for some reason.

More likely, you’ll be given an epidural or spinal block, which will numb the lower half of your body but leave you awake and alert for the birth of your baby.

If you’ve already had an epidural for pain relief during labor, it will likely be used for your c-section as well. Before the surgery, you’ll get extra medication to ensure that you’re completely numb. (You may still feel some pressure or a tugging sensation at some point during the surgery.)

A catheter is inserted into your urethra to drain urine during the procedure, and an IV is started (for fluids and medications) if you don’t have one already. The top section of your pubic hair may be shaved, and you’re moved into an operating room.

You may be given an antacid medication to drink before the surgery as a precautionary measure. If an emergency arises, you may need general anesthesia, which puts you at risk for vomiting while you’re unconscious and inhaling your stomach contents into your lungs. The antacid neutralizes your stomach acid so it won’t damage your lung tissue if you vomit and accidently inhale that material.

You’ll probably be given antibiotics through your IV to help prevent infection after the operation. (Some practitioners give antibiotics after the surgery, but the current recommendations require giving them before the surgery.)

Anesthesia will be administered, and a screen will be raised above your waist so you won’t have to see the incision being made. (If you’d like to witness the moment of birth, ask a nurse to lower the screen slightly so you can see the baby but not much else.) Your partner, freshly attired in operating room garb, may take a seat by your head.

How to Prepare for a C-Section

If you and your doctor decide that a C-section is the best option for delivery, your doctor will give you complete instructions about what you can do to lower your risk of complications and have a successful C-section.

As with any pregnancy, prenatal appointments will involve many checkups, which will include blood tests and other examinations to determine your health for the possibility of a C-section.

Your doctor will make sure to record your blood type in case you need a blood transfusion during the surgery. Blood transfusions are rarely needed during a C-section, but your doctor will be prepared for any complications during the surgery.

Even if you aren’t planning to have a C-section, you should always prepare for the unexpected. At prenatal appointments with your doctor, discuss your risk factors for a C-section and what you can do to lower them.

Make sure all of your questions are answered, and that you understand what could happen if you need to have an emergency C-section before your due date.

Because a C-section takes additional time to recover from than normal birth, arranging to have an extra set of hands around the house will be helpful. Not only will you be recovering from surgery, but your new baby will need some attention as well.

Following up After a C-Section

After your C-section, you and your newborn will stay in the hospital for about three days. Immediately after surgery, you will remain on an IV. This allows for adjusted levels of painkillers to be delivered into your bloodstream while the anesthesia wears off.

Your doctor will encourage you to get up and walk around. This can help prevent blood clots and constipation. A nurse or doctor can teach you how to position your child for breast-feeding so there’s no additional pain from the C-section incision area.

Your doctor will give you recommendations for home care after the surgery, but you should generally expect to:

  • take it easy and rest, especially for the first few weeks
  • use correct posture to support your abdomen
  • drink plenty of fluids to replace those lost during your C-section
  • avoid sex for four to six weeks
  • take pain medications as needed
  • seek help if you experience symptoms of postpartum depression, such as severe mood swings or overwhelming fatigue

Call your doctor if you experience the following symptoms:

  • breast pain accompanied with a fever
  • foul-smelling vaginal discharge or bleeding with large clots
  • pain when urinating
  • signs of infection — for example, fever over 100 degrees Fahrenheit, redness, swelling, or discharge from the incision.
Reviewed by the QSota Medical Advisory Board

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