Cesarean Birth (C-Section)
What is a cesarean section?
A cesarean section, also called a C-section, is a surgical procedure performed when a vaginal delivery is not possible or safe, or when the health of the mother or the baby is at risk. During this procedure, the baby is delivered through surgical incisions made in the abdomen and the uterus.
When would I need a cesarean section?
A cesarean delivery might be planned in advance if a medical reason calls for it, or it might be unplanned and take place during your labor if certain problems arise.
You might need to have a planned cesarean delivery if any of the following conditions exist:
- Cephalopelvic disproportion (CPD): CPD is a term that means that the baby’s head or body is too large to pass safely through the mother’s pelvis, or the mother’s pelvis is too small to deliver a normal-sized baby.
- Previous cesarean birth: Although it is possible to have a vaginal birth after a previous Cesarean, it is not an option for all women. Factors that can affect whether a cesarean is needed include the type of uterine incision used in the previous cesarean and the risk of uterine rupture.
- Multiple pregnancy: Although twins can often be delivered vaginally, two or more babies might require a cesarean delivery.
- Placenta previa: In this condition, the placenta is attached too low in the uterine wall and blocks the baby’s exit through the cervix.
- Transverse lie: The baby is in a horizontal, or sideways, position in the uterus. In this condition, a cesarean delivery is always used.
- Breech presentation: In a breech presentation, or breech birth, the baby is positioned to deliver feet or bottom first. If your doctor determines that the baby cannot be turned through abdominal manipulation, you will need to have a cesarean delivery.
An unplanned cesarean delivery might be needed if any of the following conditions arise during your labor:
- Failure of labor to progress: In this condition, the cervix begins to dilate and stops before the woman is fully dilated, or the baby stops moving down the birth canal.
- Cord compression: The umbilical cord is looped around the baby’s neck or body, or caught between the baby’s head and the mother’s pelvis.
- Prolapsed cord: The umbilical cord comes out of the cervix before the baby does.
- Abruptio placentae: The placenta separates from the wall of the uterus before the baby is born.
- Fetal distress: During labor, the baby might begin to develop problems that cause an irregular heart rate. Your doctor might decide that the baby can no longer tolerate labor and that a cesarean delivery is necessary.
What can I expect before the cesarean section?
If the cesarean delivery is not an emergency, the following procedures will take place:
- You will be asked if you consent to the procedure, and in some hospitals, you might be asked to sign a consent form.
- The anesthesiologist will discuss the type of anesthesia to be used.
- Your blood pressure, pulse and temperature will be taken.
- The hair in the area around the incision will be clipped.
- A catheter will be inserted to keep your bladder empty.
- You will have heart and blood pressure monitors applied.
What is the procedure for a cesarean section?
At the start of the procedure, the anesthesia will be administered, and a screen or sterile drape will be used to protect the sterile environment of the incision site. Your abdomen will then be cleaned with an antiseptic, and you might have an oxygen mask placed over your mouth and nose to increase oxygen to the baby.
The doctor will then make an incision through your skin and into the wall of the abdomen. The doctor might use either a vertical or transverse incision. (A horizontal incision is also called a bikini incision, because it is placed beneath the belly button.) Next, a 3- to 4-inch incision is then made in the wall of the uterus, and the doctor removes the baby through the incisions. The umbilical cord is then cut, the placenta is removed and the incisions are closed.
How long does the cesarean section procedure take?
The typical C-section takes about 45 minutes. After the baby is delivered, your healthcare provider will stitch up the uterus and close the incision in your abdomen.
There are different types of emergency situations that can arise during a delivery. In some cases, the cesarean delivery will happen very quickly, with the baby being delivered in as little as 15 to 20 minutes. This is an emergency C-section. Afterwards, there will be additional time when the provider will stitch up the uterus and abdomen.
Risks / Benefits
What are some of the risks involved in a cesarean section delivery?
Like any surgery, a cesarean section involves some risks. These might include:
- Loss of blood.
- A blood clot that may break off and enter the bloodstream (embolism).
- Injury to the bowel or bladder.
- A cut that might weaken the uterine wall.
- Abnormalities of the placenta in subsequent pregnancies.
- Risks from general anesthesia.
- Fetal injury.
Recovery and Outlook
What happens after the delivery?
A cesarean section is a surgical procedure and may require a longer recovery than a vaginal delivery. However, women who have undergone a long, difficult labor — and delivered vaginally — may have a longer recovery than those undergoing a c-section. Depending on your condition, you will probably stay in the hospital from two to three days.
Once the anesthesia wears off, you will begin to feel the pain from the incisions. You might also experience gas pains and have trouble taking deep breaths. You will also have a vaginal discharge after the surgery due to the shedding of the 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.
Can I have a baby vaginally after a cesarean delivery?
The majority of women who have had a cesarean delivery may be able to deliver vaginally in a future pregnancy. If you meet the following criteria, your chances of vaginal birth after cesarean (VBAC) are greatly increased:
- A low transverse incision was made into your uterus during your cesarean.
- Your pelvis is not too small to accommodate a normal-sized baby.
- You are not having a multiple pregnancy.
- Your first cesarean was performed for breech presentation of the baby.