Understanding Cesarean Birth

Reviewed by James Brann, MD
Cesarean birth refers to the surgery used to deliver a baby. Incisions are made in the pregnant woman’s uterus and abdomen to get the baby out.
A cesarean birth, or C-section, is commonly performed for these reasons:
  • Labor fails to progress
  • Contractions aren’t opening the cervix enough for your baby to move into the vagina
  • Pregnancy with multiples - A C-section may be needed if a woman is having twins, if the babies are being born too early, if they’re not in a good position inside the uterus, or for other problems. The risk of needing a C-section will increase with the number of babies a woman is having.
  • Concerns for baby - Fetal monitoring may have detected an abnormal heart rate, or the umbilical cord may have become compressed or pinched.
  • Placenta problems
  • Baby is breech
  • Baby is too large
  • Medical conditions with the mom, including high blood pressure or diabetes
  • Medical infections with the mom, including herpes, or HIV


Previous cesarean births

If you’ve had a C-section in the past, you may still be able to have a vaginal delivery. This will depend on the type of incision used in your other C-section, the number of C-sections you’ve had, whether you are at high-risk of a vaginal delivery, where you are delivering and possibly other factors. Make sure you talk with your doctor.

Requesting a C-section

Some women may want to have a C-section even when they have the option of a vaginal delivery. You need to weigh the decision with your doctor. Any surgery has the possibility of complications and risks. A C-section usually requires a longer hospital stay than a vaginal birth. There are also increased risks of future pregnancy problems and medical problems. This may not be the best option for women wanting to have additional children.

Preparing for a C-section

Before a C-section begins, a nurse prepares you for the operation. They will put an IV in a vein in your hand or arm. This will get you the medications and fluids you need during the surgery. Your nurse will also wash your abdomen, and trim or clip your pubic hair. In addition, you’ll get an infection-preventing medication. After this, a tube, or catheter is put in your urethra to help drain your bladder. An empty bladder lowers the likelihood of having it injured during surgery.

Anesthesia for a C-section

You’ll get either general anesthesia, an epidural block, or spinal block. With general anesthesia, you won’t be awake for the delivery. An epidural block will numb the lower half of your body. This injection is made in your lower back, in a space in your spine. A small tube then goes into this space so that more of the drug can go into the tube if you need it later. A spinal block will also numb the lower half of your body. You get it the same as an epidural block, however the drug goes directly into your spinal fluid.

Performing a C-section

In a C-section, an incision is made through your skin, and through the abdomen’s wall. It may be either horizontal or vertical near your pubic hairline. Your abdomen muscles may not need to be cut, but they are separated. The wall of the uterus will also need an incision. This will be either horizontal or vertical.

Your doctor delivers your baby through the incisions, cuts the umbilical cord, and then removes the placenta. After this, the uterus is closed with stiches that will eventually dissolve in your body. Staples or stiches will be used to close the skin on your abdomen.

Complications

A small percentage of women do have complications, which can be easily treated. These include:
  • Loss of blood
  • Infection
  • Blood clots in lungs, pelvic organs and legs
  • Injury to bladder or bowel
  • Reactions to anesthesia or medications used


After the procedure

If you’re awake for your C-section, it’s likely you can hold your baby immediately. You’ll be transferred to a recovery room or to your hospital room. Your breathing rate, pulse rate, blood pressure, bleeding and abdomen will all be checked on continually. If you’re going to breastfeed, you can still breastfeed your baby right away.

You may need to stay in bed, for now. When you try to get up the first few times, you’ll want someone to help you.

Not long after surgery is complete, your doctor or nurses will remove the catheter from your bladder. You will probably be sore in the spot of your abdominal incision for the first few days, or so. It’s likely your doctor will give you a prescription for pain medication once the anesthesia wears off. You may also find a heating pad is useful. There are several ways of controlling pain. Make sure you talk to your doctor about all of your options.

Usually, a woman with a C-sections stays in the hospital for between two to four days. How long you stay depends on why you needed a C-section, and how your body is doing at recovering. When you do get to leave, you’ll need to take care of yourself and limit the amount of activities you do.

During recovery

Expect that these things may occur during recovery:
  • Discharge or bleeding for 4-6 weeks
  • Mild cramping, more so if you’re breastfeeding
  • Bleeding with cramps and clots
  • Pain where the incision was
To help prevent an infection, don’t have sex or place anything in your vagina for a few weeks after having a C-section. Make sure you’ve given yourself enough time to heal before taking on any strenuous activities. Call your doctor if you’re having heavy bleeding, the pain gets worse, or if you have a fever.


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