A cesarean delivery (also called a C-section) is the delivery of a baby through a surgical cut in a woman’s abdomen and uterus rather than through the vagina. There are several reasons you might have a C-section, and they carry more risk and a longer recovery time than vaginal deliveries.
Having a baby is an exciting time in a woman’s life, but it can be stressful if you’re told you need to have a C-section and know nothing about it.
What Is a C-Section?
Babies have two ways of being delivered: via the vaginal birth canal or via a C-section. For the latter, a doctor makes an incision in the woman’s abdomen and then in the uterus to remove the baby from the womb. The incisions are closed with stitches after the baby is born.
Roughly 30 percent of babies are born via C-section. About 7 to 9 percent of them are emergencies. It is the most common surgery performed in the United States, with more than 1 million C-sections performed each year. C-sections are more common now than they used to be. The number of C-section deliveries increased 72 percent from 1996 to 2008.
Some critics believe they’re unnecessarily common now, and there’s increasing pressure to decrease C-section rates. The World Health Organization, for instance, has stated that only 10 to 15 percent of deliveries should be via C-section and that many performed today are avoidable and put both mother and baby at unnecessary risk. But often C-sections are performed when it’s been determined that this method of delivery is the best option for both mother and baby.
There are many different reasons for a C-section, including some that are known ahead of time so the surgery can be planned and some that arise unexpectedly during the labor process.
These are some reasons you may be scheduled for a planned C-section:
Cephalopelvic disproportion (CPD), which means the baby’s head is too large to fit through the mother’s pelvis
Delivering multiples, though twins are sometimes delivered vaginally
Placenta previa, a condition in which the placenta blocks the cervix so the baby cannot exit safely
Previous C-section, though it’s possible to have a vaginal birth after cesarean (VBAC)
Baby is transverse or breech, which means sideways or bottom down in the uterus
Health conditions that may worsen during delivery, such as heart disease, or the presence of genital herpes
Presence of an obstruction, such as a fibroid or pelvic fracture, or if the baby is expected to be born with certain birth defects
An unplanned C-section can come about during the labor process in the following scenarios:
Labor isn’t progressing, meaning it’s going too slow or stops
Umbilical cord is wrapped around the baby’s neck or stuck between the baby’s head and the mother’s pelvis
Umbilical cord prolapse, in which the umbilical cord is delivered before the baby
Placental abruption, when the placenta separates from the uterine wall before birth
Fetal distress, such as if they baby’s heart rate is irregular and the medical team is worried about the baby’s well-being
A C-section is performed in the operating room of a hospital. You’ll typically be awake for the procedure, and your body will be numbed with an epidural or spinal anesthesia from the chest down. Once in the operating room, a urinary catheter will be placed to ensure the bladder remains empty, the abdominal area will be cleaned with an antimicrobial agent, and hair around the surgical area may be clipped or shaved. You won’t be able to see the surgery — the surgical team will place a drape between you and your abdomen to keep the surgical area sterile. You’ll also be hooked up to heart and blood pressure monitors and an IV to deliver medicine and fluids.
A C-section is performed by the obstetrician or sometimes a family physician. The instruments used by the doctor can include scissors, clamps, forceps, and suture stitches.
To perform the C-section, the doctor will make an incision across the area on the belly just above the pubic bone. Then, he or she will make the uterine incision, which is three to four inches either transverse or vertical. The uterus and amniotic sac will then be opened, and the baby is delivered through the openings. Once the baby is born, the medical team will clean the baby’s mouth and nose of fluids and cut the umbilical cord. The doctor will then remove the placenta and close the incisions with sutures.
C-section preparation includes fasting for eight or more hours before the surgery (clear liquids are generally okay), showering with a soap designed to minimize risk of infection, and avoiding shaving your stomach or pubic area. On the morning of the C-section, don’t apply lotion, perfume, or deodorant.
There are emotional and psychological aspects to consider as well. Many women feel disappointed that their childbirth experience won’t be what they expected it to be. If you’re feeling anxious or angry about needing to have a C-section, talk it through with your provider and ask any questions you have. It can also help to practice relaxation techniques, such as mindful breathing or repeating a mantra, so you can remain calm leading up to and during your delivery.
The operating room can be crowded — you’ll likely be with a team of nurses, an obstetrician, an anesthesiologist, and a respiratory therapist. If you have a partner, they will also be with you. You will be in the operating room for approximately an hour, though the baby will be delivered in the first 10 minutes. Thanks to the anesthesia, you won’t feel pain, but you may feel a tug or pull when the baby is removed from the womb.
Once the baby is delivered, you’ll have a chance to hold him or her. Then the baby will be taken by a neonatal practitioner to be cleaned and given an Apgar score (which assesses the baby’s activity, pulse, reflexes, appearance, and respiration). The baby will be brought back to you once testing is complete, and you’ll have an opportunity for skin-to-skin contact, which involves holding your baby to your bare chest.
Typically, you’ll then move together to a recovery area, unless you’ve been placed under general anesthesia, which requires up to three hours of additional recovery time near the operating room.
A C-section is surgery, so it does involve some risks and the potential for complications. C-section risks are greater than those associated with a vaginal delivery.
The potential risks of a C-section include:
Infection
Blood loss
Blood clot
Injury to the bowel or bladder
Weakened uterine wall
Placental abnormalities in future pregnancies
Harm to the fetus
Anesthesia risks
Some people may see benefits of vaginal birth over C-section, such as a lower recovery time, lower risk of infection and blood loss, and lower risk of complications to the baby. But there are many medical reasons that may make a C-section the best option for an individual. And the important thing is that both you and your newborn baby are healthy.
Recovery after C-section is about four to six weeks longer than it is for a vaginal delivery. The procedure may also lead to breathing issues for the baby, and it can cause pelvic pain for the mother. C-sections may also lead to breastfeeding issues for several reasons, such as if the mother is experiencing pain and has trouble getting in the best feeding position, if mom or baby are drowsy from surgery medications, if they were unable to have skin-to-skin contact shortly after birth, and if breastfeeding hormones haven’t been activated due to not going into labor.
You’ll likely be in the hospital for two to three days as you begin healing after cesarean. Your baby will be with you, and you can start your breastfeeding journey if you plan to feed that way. You’ll be able to drink fluids and walk around during this time, which can help prevent common issues like constipation and blood clots. As you recover, a nurse will monitor your vital signs and the site of incision and aid with pain management.
Recovery takes time and continues once you’re home from the hospital. In the weeks following your C-section, avoid strenuous activities like climbing stairs, lifting more than 25 pounds, and exercise. Sometimes your doctor may limit your driving until you’re in a state that allows you to turn easily and use the pedals properly.
You may deal with cramping, bleeding, discharge that starts red and turns to yellow, and pain at the incision site for up to six weeks after the C-section. Over-the-counter pain relievers and heating pads can offer relief, and pads should be used for the bleeding because you shouldn’t insert a tampon at this time. Sex also is off limits for the first six weeks of recovery to minimize your risk of infection.
You’ll see your healthcare provider within 12 weeks of delivery for a follow-up visit to make sure your body is healing properly.
You may also need to recover emotionally. A C-section can be particularly distressing if it was an emergency. You may have negative feelings and resentment about having had a C-section rather than a vaginal delivery and be scared about what this means for future deliveries. Be sure to talk things through with your partner or your doctor.
During your recovery, keep an eye on the incision site. If you notice redness, swelling, or discharge, or if you have a fever, pain that gets worse, or heavy bleeding, contact your doctor. Up to 7 percent of mothers who deliver via C-section will develop C-section scar infections.
Just like with vaginal delivery, there’s a risk of postpartum depression (PPD) after C-section. PPD includes feeling hopeless, severe anxiety, excessive crying, and trouble eating, sleeping, and making decisions. It tends to begin a couple of days after delivery. PPD is indirectly associated with emergency C-sections because those women are more likely to develop post-traumatic stress disorder, which leads to PPD symptoms, according to a review.
There are also some risks associated with having a C-section for subsequent births because each surgery becomes more complicated than the one before it. Having multiple C-sections increases the risk of placental problems, which can lead to preterm birth, excessive bleeding, blood transfusion, or need for hysterectomy. You can also develop issues with the incision itself (such as a hernia) and the scar surrounding the adhesion, which can make the next surgery more difficult, increase the risk of injury to the bowel or bladder, or lead to excessive bleeding.
You may have concerns about bonding with your baby after cesarean, but research has shown that the mode of delivery has little effect on the mother-baby bond. This finding stands no matter if the C-section was planned or if it was an emergency.
Other than the potential complications and risks stated above, a C-section may have some long-term effects on the mother. One study found that having had a C-section increased the need for a hysterectomy (removal of the uterus) later in life. Those women were also found to be at increased risk for developing complications after the hysterectomy. On the plus side, C-sections are associated with reduced urinary incontinence and pelvic organ prolapse, according to one review. That review found that children born via C-section are at higher risk of some health issues, however, including asthma and obesity. C-sections can also lead to subfertility, making it harder for a woman to get pregnant again; and once pregnant, they have greater pregnancy risks, such as placenta previa, uterine rupture, and stillbirth.
Many women worry that once they’ve had a C-section they’ll need to have the surgery to deliver any future babies. And while having a C-section does increase the chances of having another one with future pregnancies, a VBAC is not only possible, it is common. Research shows 60 to 80 percent of women who’ve had a C-section go on to have a vaginal birth later.
A C-section is when a baby is delivered surgically through incisions in the abdomen and uterus. C-sections are common, accounting for roughly one-third of all deliveries in the United States. There are some risks associated with C-sections, but the procedure is often chosen as the best delivery method in order to keep the baby and mother healthy.
