A cesarean section (C-section) is a surgical procedure used to deliver a baby through incisions made in the mother’s abdomen and uterus. C-sections can be lifesaving in emergencies and help prevent complications during delivery. C-sections are performed by obstetricians, who specialize in care for pregnant women, and some family physicians. Midwives do not perform C-sections.
Why Are C-Sections Needed?
Scheduled C-Sections:
A C-section may be scheduled if a vaginal birth is deemed risky. Common reasons include:
- The baby is in a breech (feet-first) or transverse (sideways) position.
- The baby has certain birth defects, like severe hydrocephalus.
- Placental issues, such as placenta previa (where the placenta covers the cervix).
- The mother has a medical condition that makes vaginal delivery risky, such as HIV or active genital herpes.
- Multiple pregnancies.
- Previous uterine surgery or C-section, although many women can still have a vaginal birth after a C-section (VBAC).
Emergency C-Sections:
In some cases, an unexpected emergency C-section is necessary due to issues during pregnancy or labor, such as:
- Labor stops progressing despite medication.
- Placental abruption, where the placenta separates from the uterine wall prematurely.
- Umbilical cord complications, like pinching or prolapse.
- Fetal distress, indicating the baby might not be getting enough oxygen.
- The baby is too large to fit through the birth canal.
If a C-section is recommended and it’s not an emergency, seeking a second opinion can be helpful. However, trusting the medical team’s judgment is crucial in making the safest decision.
How Is a C-Section Done?
Here’s what usually happens during a scheduled C-section:
Your partner or labor coach can stay with you during the procedure (except in emergencies). An anesthesiologist will ensure you don’t feel pain, typically using regional anesthesia to block sensation from the waist down.
Preparation includes:
- Monitors to check your heart rate, breathing, and blood pressure.
- Oxygen through a mask or nasal tube.
- A catheter in the bladder.
- An IV in your arm or hand.
- Cleaning the belly and shaving the area if necessary.
- A privacy screen around your belly.
After administering anesthesia, the doctor makes a horizontal incision (the «bikini cut») on the abdomen. The abdominal muscles are gently parted to access the uterus, where another incision is made, usually horizontal, making future VBACs more possible.
The baby is then gently delivered. The doctor suctions the baby’s mouth and nose and clamps and cuts the umbilical cord. You should be able to see your baby right away. The placenta is removed, and the uterus and abdominal incisions are closed with stitches or surgical staples.
In the recovery room, you can hold and nurse your newborn if they are doing well. You may need help holding the baby if you need to remain lying flat.
Will I Feel Anything?
You won’t feel pain during the C-section, but you may feel pulling and pressure. Most women are awake, numbed from the waist down using an epidural or spinal block. A curtain will cover your abdomen, but you might be able to peek when the baby is delivered.
In an emergency C-section, general anesthesia might be necessary, meaning you will be unconscious and won’t feel or remember anything.
What Are the Risks?
C-sections are generally safe for both mother and baby, but as with any surgery, there are risks, including:
- Increased bleeding (rarely requiring a blood transfusion).
- Infection (antibiotics are given to prevent this).
- Bladder or bowel injury.
- Reactions to medications.
- Blood clots.
- Rarely, death.
- Possible injury to the baby.
Regional and general anesthesia are safe but can cause nausea and low blood pressure in the mother. Babies delivered by C-section may experience transient tachypnea due to fluid in the lungs, usually resolving within a day or two.
A C-section can impact future pregnancies, potentially requiring another C-section, especially if the initial uterine incision was vertical. It may also increase the risk of placental issues in future pregnancies.
In emergencies, the benefits of a C-section usually far outweigh the risks.
What Is the Recovery Like?
Recovery after a C-section is longer than after a vaginal birth. Hospital stays usually last 3-4 days. You may feel itchy, nauseous, and sore due to anesthesia and surgery.
Common post-surgery symptoms include:
- Tiredness.
- Soreness around the incision (pain relief can be prescribed).
- Constipation and gas.
- Difficulty moving around or lifting the baby.
Supporting your abdomen when sneezing, coughing, or laughing can reduce pain. Avoid heavy lifting and driving. Check with your healthcare provider about when to resume normal activities, typically after 6-8 weeks.
Early, gentle walking can ease pain and prevent blood clots. Take it easy and seek help with housework and other children.
Breastfeeding might be painful initially; try nursing positions like lying on your side or the clutch hold to relieve abdominal pressure. Drink plenty of water to support milk supply and prevent constipation.
C-section scars fade over time, often becoming less noticeable.
What If I Don’t Feel Better?
Contact your healthcare provider if you experience:
- Fever.
- Signs of infection around the incision.
- Sudden or worsening abdominal pain.
- Foul-smelling vaginal discharge.
- Pain when urinating.
- Difficulty with bowel movements.
- Heavy vaginal bleeding.
- Leg pain, swelling, or redness.
- Difficulty breathing or chest pain.
- Breast pain.
- Feelings of depression or thoughts of self-harm.
Emotionally, you may feel disappointed if you were hoping for a vaginal birth. Remember, having a C-section does not make your baby’s birth any less special. You underwent major surgery to safely bring your baby into the world.