Cesarean delivery — also known as a C-section — is a surgical procedure used to deliver a baby through an incision in the mother’s abdomen and a second incision in the mother’s uterus.
A C-section might be planned ahead of time if you develop pregnancy complications or you’ve had a previous C-section and aren’t considering vaginal birth after cesarean (VBAC). Often, however, the need for a first-time C-section doesn’t become obvious until labor is under way.
If you’re pregnant, knowing what to expect during a C-section — both during the procedure and afterward — can help you prepare.
What is the procedure for a cesarean?
At the start of the procedure, the anesthesia will be administered, and a screen or sterile drape will be used to prevent you from watching the surgery. 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.
Why it’s done
Sometimes a C-section is safer for you or your baby than is a vaginal delivery. Your health care provider might recommend a C-section if:
- Your labor isn’t progressing. Stalled labor is one of the most common reasons for a C-section. Perhaps your cervix isn’t opening enough despite strong contractions over several hours — or the baby’s head is simply too big to pass through your birth canal.
- Your baby isn’t getting enough oxygen. If your health care provider is concerned about your baby’s oxygen supply or changes in your baby’s heartbeat, a C-section might be the best option.
- Your baby is in an abnormal position. A C-section might be the safest way to deliver the baby if his or her feet or buttocks enter the birth canal first (breech) or the baby is positioned side or shoulder first (transverse).
- You’re carrying twins, triplets or other multiples. When you’re carrying multiple babies, it’s common for one or more of the babies to be in an abnormal position. In this case, a C-section is often safer.
- There’s a problem with your placenta. If the placenta detaches from your uterus before labor begins (placental abruption) or the placenta covers the opening of your cervix (placenta previa), C-section might be the safest way to deliver the baby.
- There’s a problem with the umbilical cord. A C-section might be recommended if a loop of umbilical cord slips through your cervix ahead of your baby or if the cord is compressed by the uterus during contractions.
- You have a health concern. Your health care provider might suggest a C-section if you have a medical condition that could make labor dangerous, such as unstable heart disease or high blood pressure. In other cases, a C-section might be recommended if you have an infection that could be passed to your baby during vaginal delivery — such as genital herpes or HIV.
- Your baby has a health concern. A C-section is sometimes safer for babies who have certain developmental conditions, such as excess fluid in the brain (hydrocephalus).
- You’ve had a previous C-section. Depending on the type of uterine incision and other factors, it’s often possible to attempt a vaginal delivery after a previous C-section. In some cases, however, your health care provider might recommend a repeat C-section.
- In addition, some women request C-sections with their first babies — sometimes to avoid labor or the possible complications of vaginal birth, or to take advantage of the convenience of a planned delivery. If you’re considering a planned C-section for your first delivery, work with your health care provider to make the best decision for you and your baby.
Recovery from a C-section takes longer than does recovery from a vaginal birth. And like other types of major surgery, C-sections also carry a higher risk of complications.
Risks to your baby include:
- Breathing problems. Babies born by C-section are more likely to develop transient tachypnea — a breathing problem marked by abnormally fast breathing during the first few days after birth. C-sections done before 39 weeks of pregnancy or without proof of the baby’s lung maturity might increase the risk of other breathing problems, including respiratory distress syndrome — a condition that makes it difficult for the baby to breathe.
- Surgical injury. Although rare, accidental nicks to the baby’s skin can occur during surgery.
Risks to you include:
- Inflammation and infection of the membrane lining the uterus. This condition — known as endometritis — can cause fever, foul-smelling vaginal discharge and uterine pain.
- Increased bleeding. You’re likely to lose more blood with a C-section than with a vaginal birth. Transfusions are rarely needed, however.
- Reactions to anesthesia. Adverse reactions to any type of anesthesia are possible. After an epidural or spinal block — common types of anesthesia for C-sections — it’s rare, but possible, to experience a severe headache when you’re upright in the days after delivery.
- Blood clots. The risk of developing a blood clot inside a vein — especially in the legs or pelvic organs — is greater after a C-section than after a vaginal delivery. If a blood clot travels to your lungs (pulmonary embolism), the damage can be life-threatening. Your health care team will take steps to prevent blood clots. You can help, too, by walking frequently soon after surgery.
- Wound infection. An infection at or around the incision site is possible.
- Surgical injury. Although rare, surgical injuries to nearby organs — such as the bladder — can occur during a C-section. If this happens, additional surgery might be needed.
- Increased risks during future pregnancies. After a C-section, you face a higher risk of potentially serious complications in a subsequent pregnancy — including bleeding and problems with the placenta — than you would after a vaginal delivery. The risk of uterine rupture is also higher. With uterine rupture, the uterus tears open along the scar line from the prior C-section. Uterine rupture is a life-threatening emergency.
What happens after the delivery?
Because the cesarean is major surgery, it will take you longer to recover from this type of delivery than it would from a vaginal delivery. Depending on your condition, you will probably stay in the hospital from 3 to 4 days.
Once the anesthesia wears off, you will begin to feel the pain from the incisions, so be sure to ask for pain medicine. 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 wall. The discharge will be red at first and then gradually change to yellow. Be sure to call your health care provider if you experience heavy bleeding or a foul odor from the vaginal discharge.