C-Section

What is a C-section?

A C-section, also called a cesarean section or cesarean delivery, is a surgical procedure in which your baby is delivered through incisions in your abdomen and uterus. They’re performed when a vaginal delivery isn’t possible or safe, or when the health of you or your baby is at risk.

When would I need a C-section?

You may need a C-section if you have certain medical conditions or if complications occur during labor in a vaginal delivery. A planned C-section happens when any of the following conditions exist:

• Cephalopelvic disproportion (CPD): CPD is a term that means that your baby’s head or body is too large to pass safely through your pelvis, or your pelvis is too small to deliver an average-sized baby.
• Previous C-section: Although it’s possible to have a vaginal birth after a previous C-section, it’s not an option for everyone. Factors that can affect this include the type of uterine incision used in the previous C-section and the risk of uterine rupture.
• Expecting multiples: Although twins can often be delivered vaginally, two or more babies might require a C-section.
• Placenta previa: In this condition, the placenta is attached too low in your uterus and blocks your baby’s exit through your cervix.
• Transverse lie: Your baby is in a horizontal, or sideways, position in your uterus.
• Breech presentation: In a breech presentation, your baby is feet- or bottom-first in your uterus. Some providers may attempt to turn your baby, but a C-section will be necessary if that’s unsuccessful.
• Health conditions: Conditions like heart disease could worsen with labor during a vaginal birth. A C-section is necessary if you have genital herpes at the time of delivery.
• Obstruction: A large uterine fibroid, a pelvic fracture or you’re expecting a baby with certain congenital anomalies may also be reasons for a C-section.

An unplanned C-section delivery might be necessary if any of the following conditions arise during your labor:

• Labor isn’t progressing: Also called prolonged labor, this means your cervix dilates and stops, doesn’t efface (or thin) or your baby stops moving down the birth canal.
• Umbilical cord compression: The umbilical cord is looped around your baby’s neck or body or caught between your baby’s head and your pelvis.
• Umbilical cord prolapse: The umbilical cord comes out of your cervix before your baby does.
• Placental abruption: The placenta separates from the wall of your uterus before your baby is born.
• Fetal distress: Your baby might develop problems that cause an irregular heart rate during labor. Your obstetrician might decide that the baby can no longer tolerate labor and that a C-section is necessary.

How common are C-sections?

According to the U.S. Centers for Disease Control and Prevention (CDC), C-sections account for about 30% of all deliveries in the United States.

What can I expect before a C-section?

If you have a planned C-section, the following procedures will take place:

• You'll sign consent forms for the procedure.
• The anesthesiologist will discuss options for anesthesia. Most often, it's an epidural (or spinal block) that numbs you from your breasts down to your feet.
• The hair in the area around the incision will be clipped or shaved.
• A catheter will be inserted to keep your bladder empty.
• You will have heart and blood pressure monitors applied.
• You'll get an IV in your hand or arm to give you medicine and fluid.
• You'll discuss the procedure and what to expect with your obstetrician (if you haven't already).

If you need an emergency C-section, your obstetrician delivers your baby quickly because either the health of you or your baby is at risk. However, there's typically not much time to prepare, and you may need general anesthesia because it works faster.

What actually happens during a C-section?

The first step in a C-section procedure is preparing you for anesthesia. Most planned C-sections use an epidural, so you are awake for the delivery. However, in some cases, you're asleep under general anesthesia.

Your abdomen will be cleaned with an antiseptic, and you might have an oxygen mask placed over your mouth and nose to increase oxygen to your baby. Next, your provider places a sterile drape around the incision site and over your legs and chest. Finally, your providers raise a sterile curtain or drape between your head and your lower body.

The obstetrician will then make an incision through your skin and into the wall of your abdomen. They might use either a vertical or transverse incision. A horizontal incision is also called a bikini incision.

Next, your provider cuts a 3- to 4-inch incision into the wall of your uterus. This incision can also be transverse or vertical. Finally, the obstetrician removes your baby through the incisions. The umbilical cord is cut, the placenta is removed and the incisions are closed with stitches and staples.

Emergency C-sections follow the same steps; however, the speed at which your baby is removed is different. During a planned C-section, the delivery takes about 10 to 15 minutes. Your provider removes your baby in only a few minutes in an emergency C-section.

If you're awake for your C-section surgery, you will be able to see and hold your baby shortly after it's born.

What does a C-section feel like?

You'll be under anesthesia, which should prevent you from feeling any pain. Most people report feeling a tug or pull when their baby is removed from their abdomen.

Are C-sections safe?

Vaginal births are usually preferred, but in some cases, a C-section is the only safe option. For example, a C-section is the safer option when your baby is breech or you have placenta previa (placenta covers part of the cervix). A C-section carries risks and benefits, which should be discussed with your pregnancy care provider.

How long does a C-section surgery take?

The typical C-section takes about 45 minutes from start to finish. After your provider delivers your baby, they'll stitch your uterus and close the incision in your abdomen. Different types of emergencies can arise during a delivery. In some cases, the delivery will happen very quickly, with your baby being delivered in as little as 15 minutes. This is an emergency C-section.

What happens after a C-section?

Like vaginal births, your obstetrician will deliver the placenta after your baby is born. Next, your provider will stitch your uterus and stitch or staple your abdominal muscles. Stitches should dissolve, but staples are removed at the hospital about one week later. Your abdomen will be sore for several days or weeks. In some cases, your provider may prescribe stronger pain medication.

You can expect to limit your activities, take it easy and rely on family and friends once you go home. A typical C-section surgery requires at least two to three days in the hospital.

What are the benefits of a C-section?

The advantages of a C-section depend on your pregnancy. In most cases, the biggest benefit of a C-section is that it's safer for both you and your baby. When a vaginal birth is risky or could hurt your baby, most providers will turn to a C-section to minimize risks. Sometimes C-sections are unplanned. For example, if your baby's heart rate drops to an unsafe level, an emergency C-section is safer than letting your baby's heart rate decline further.

What are the risks involved in a C-section?

Like any surgery, a C-section involves some risks. The risks of complications are slightly higher with C-sections than with vaginal delivery. These might include:

• Infection.
• Loss of blood (hemorrhage).
• A blood clot that may break off and enter your bloodstream (embolism).
• Injury to the bowel or bladder.
• A cut that might weaken the uterine wall.
• Abnormalities of the placenta in future pregnancies.
• Risks from general anesthesia.
• Fetal injury.

Other disadvantages of having a C-section are:

• Recovering from a C-section may be more difficult than a vaginal delivery.
• C-sections are more likely to cause chronic pelvic pain.
• You're more likely to have a C-section in future pregnancies.
• Your baby may have trouble breastfeeding.
• Your baby may be at greater risk for breathing problems.

How long does a C-section recovery take?

Once the anesthesia wears off, you’ll begin to feel the pain from the incisions. You might also experience gas pains and have trouble taking deep breaths. Make sure an adult is there to help you get up from bed the first several days following C-section surgery. Most people stay in the hospital between two and three days.

A full recovery can take between four and six weeks. Ask your healthcare provider what you can expect during recovery. Most providers recommend avoiding steps, lifting, exercise and other strenuous activities for several weeks. Ask your friends or partner for help with errands, cooking and cleaning so you can rest and recover. Your provider may put restrictions on driving until you're able to turn your body and apply pressure to the pedals with ease.

You can expect cramping and bleeding for up to six weeks, as well as some discomfort around the incision. Taking over-the-counter pain relievers such as acetaminophen or ibuprofen for pain may help. Avoid sex for at least six weeks or until your healthcare provider gives you the OK.

You will also have a vaginal discharge after the surgery due to the shedding of your uterine lining. The discharge, called lochia, will be red at first and then gradually change to yellow. Be sure to call your healthcare provider if you experience heavy bleeding or a foul odor from the vaginal discharge. Use sanitary pads, not tampons, until you're completely done bleeding.

Can I have a baby vaginally after a C-section?

The majority of people who had a C-section can consider a vaginal delivery in future pregnancies. If you meet the following criteria, your chances of vaginal birth after cesarean (VBAC) are significantly increased:

• Your provider used a low transverse incision.
• Your pelvis is not too small to accommodate an average-sized baby.
• You're not expecting multiples.
• Your first C-section was only performed because your baby was breech.

When should I see my healthcare provider?

If you have an infection at your C-section incision, contact your healthcare provider. Watch for signs of infection such as:

• Red or swollen incision.
• Pus or leaking discharge from the incision.
• Fever or worsening pain.

Other signs of a problem include heavy bleeding or severe pelvic pain and cramping.

What is more painful: a C-section or natural birth?

The level of pain you experience during childbirth is unique. For example, if you opt for an unmedicated vaginal birth, you can expect more pain than someone who had an epidural before a vaginal birth. During a C-section delivery, you won't feel much pain. However, recovering from a C-section may be more painful and take longer than recovering from a natural birth. There isn't a right or wrong answer as to what is more painful because every birth is different.

How many C-sections can you have?

The number of C-sections you can have is unique to your medical history and pregnancy. An exact number hasn't been agreed on. The surgery may be slightly more complicated each time due to prior incisions or scarring.

A note from Cleveland Clinic

C-sections are often necessary for the health of you and your baby. If you know you're having a C-section, your obstetrician can walk you through the procedure and discuss the recovery process with you in advance. In the cases where a C-section is unexpected, you may end up feeling upset that your birth plan didn't go as expected. Just know that most providers prefer a vaginal delivery and that the decision to proceed with a C-section was made for you or your baby's wellbeing. The best thing you can do after a C-section delivery is rest and allow others to help you recover.