What is a Cesarean section?

Cesarean section, C-section, or Cesarean birth is the surgical delivery of a baby through a cut (incision) made in the mother's abdomen and uterus. Health care providers use it when they believe it is safer for the mother, the baby, or both.

The incision made in the skin may be :

Up-and-down (vertical) : This incision extends from the belly button to the pubic hairline.

Across from side-to-side (horizontal) : This incision extends across the pubic hairline. It is used most often, because it heals well and there is less bleeding.

The type of incision used depends on the health of the mother and the fetus. The incision in the uterus may also be either vertical or horizontal.

Why might I need a C-section?

If you can't deliver vaginally, C-section allows the fetus to be delivered surgically. You may be able to plan and schedule your Cesarean. Or, you may have it done because of problems during labor.

Several conditions make a Cesarean delivery more likely. These include :

• Abnormal fetal heart rate : The fetal heart rate during labor is a good sign of how well the fetus is doing. Your provider will monitor the fetal heart rate during labor. The normal rate varies between 120 to 160 beats per minute. If the fetal heart rate shows there may be a problem, your provider will take immediate action. This may be giving the mother oxygen, increasing fluids, and changing the mother's position. If the heart rate doesn’t improve, he or she may do a Cesarean delivery.

• Abnormal position of the fetus during birth : The normal position for the fetus during birth is head-down, facing the mother's back. Sometimes a fetus is not in the right position. This makes delivery more difficult through the birth canal.

• Problems with labor : Labor that fails to progress or does not progress the way it should.

• Size of the fetus : The baby is too large for your provider to deliver vaginally.

• Placenta problems : This includes placenta previa, in which the placenta blocks the cervix. (Premature detachment from the fetus is known as abruption.)

• Certain conditions in the mother, such as diabetes, high blood pressure, or HIV infection

• Active herpes sores in the mother’s vagina or cervix

• Twins or other multiples

• Previous C-section

Your healthcare provider may have other reasons to recommend a Cesarean delivery.

What are the risks of a C-section?

Some possible complications of a C-section may include :

• Reactions to the medicines used during surgery

• Bleeding

• Abnormal separation of the placenta, especially in women with previous Cesarean delivery

• Injury to the bladder or bowel

• Infection in the uterus

• Wound infection

• Trouble urinating or urinary tract infection

• Delayed return of bowel function

• Blood clots

After a C-section, a woman may not be able to have a vaginal birth in a future pregnancy. It will depend on the type of uterine incision used. Vertical scars are not strong enough to hold together during labor contractions, so a repeat C-section is necessary.

You may have other risks that are unique to you. Be sure to discuss any concerns with your healthcare provider before the procedure, if possible.

How do I get ready for a C-section?

Some possible complications of a C-section may include :

• Your healthcare provider will explain the procedure to you and you can ask question.

• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is unclear.

• You will be asked when you last had anything to eat or drink. If your C-section is planned and requires general, spinal, or epidural anesthesia, you will be asked to not eat or drink anything for 8 hours before the procedure.

• Tell your healthcare provider if you are sensitive to or are allergic to any medicine, latex, iodine, tape, or anesthesia.

• Tell your healthcare provider of all medicine (prescription and over-the-counter), vitamins, herbs, and supplements that you are taking.

• Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. You may be told to stop these medicines before the procedure.

• You may be given medicine to decrease the acid in your stomach. These also help dry the secretions in your mouth and breathing passages.

• Plan to have someone stay with you after a C-section. You may have pain in the first few days and will need help with the baby.

• Follow any other instructions your provider gives you to get ready.

What happens during a C-section?

A C-section will be done in an operating room or a special delivery room. Procedures may vary depending on your condition and your healthcare provider's practices.

In most cases, you will be awake for a C-section. Only in rare cases will a mother need medicine that puts you into a deep sleep (general anesthesia). Most C-sections are done with a regional anesthesia such as an epidural or spinal. With these, you will have no feeling from your waist down, but you will be awake and able to hear and see your baby as soon as he or she is born.

Generally, a C-section follows this process :

1. You will be asked to undress and put on a hospital gown.

2. You will be positioned on an operating or exam table.

3. A urinary catheter may be put in if it was not done before coming to the operating room.

4. An intravenous (IV) line will be started in your arm or hand.

5. For safety reasons, straps will be placed over your legs to hold you on the table.

6. Hair around the surgical site may be shaved. The skin will be cleaned with an antiseptic solution.

7. Your abdomen (belly) will be draped with sterile material. A drape will also be placed above your chest to screen the surgical site.

8. The anesthesiologist will continuously watch your heart rate, blood pressure, breathing, and blood oxygen level during the procedure.

9. Once the anesthesia has taken effect, your provider will make an incision above the pubic bone, either transverse or vertical. You may hear the sounds of an electrocautery machine that seals off bleeding.

10. Your provider will make deeper incisions through the tissues and separate the muscles until the uterine wall is reached. He or she will make a final incision in the uterus. This incision is also either horizontal or vertical.

11. Your provider will open the amniotic sac, and deliver the baby through the opening. You may feel some pressure or a pulling sensation.

12. He or she will cut the umbilical cord.

13. You will get medicine to help the uterus contract and expel the placenta in your IV.

14. Your provider will remove your placenta and examine the uterus for tears or pieces of placenta.

15. He or she will use sutures to close the incision in the uterine muscle and reposition the uterus in the pelvic cavity.

16. Your provider will close the muscle and tissue layers with sutures. He or she will close the skin incision with sutures or surgical staples.

17. Finally, your provider will apply a sterile bandage.

At home

You will need to wear a sanitary pad for bleeding. It is normal to have cramps and vaginal bleeding for several days after birth. You may have discharge that changes from dark red or brown to a lighter color over several weeks.

Do not douche, use tampons, or have sex until your healthcare provider tells you it’s OK. You may also have other limits on your activity, including no strenuous activity, driving, or heavy lifting.

Take a pain reliever as recommended by your healthcare provider. Aspirin or certain other pain medicines may increase bleeding. So, be sure to take only recommended medicines.

Arrange for a follow-up visit with your healthcare provider. This is usually 2 to 3 weeks after the surgery.

Call your healthcare provider right away if any of these occur :

• Heavy vaginal bleeding

• Foul-smelling drainage from your vagina

• Fever or chills

• Severe abdominal (belly) pain

• Increased pain, redness, swelling, or bleeding or other drainage from the incision

• Leg pain

• Trouble breathing, chest pain, or heart palpitations

In the hospital

In the recovery room, nurses will watch your blood pressure, breathing, pulse, bleeding, and the firmness of your uterus.

Usually, you can be with your baby while you are in the recovery area. In some cases, babies born by Cesarean will first need to be monitored in the nursery for a short time. Breastfeeding can start in the recovery area, just as with a vaginal delivery.

After an hour or 2 in the recovery area, you will be moved to your room for the rest of your hospital stay.

As the anesthesia wears off, you may get pain medicine as needed. This can be either from the nurse or through a device connected to your intravenous (IV) line called a PCA (Patient Controlled Analgesia) pump. In some cases, pain medicine may be given through the epidural catheter until it is removed.

You may have gas pains as the intestinal tract starts working again after surgery. You will be encouraged to get out of bed. Moving around and walking helps ease gas pains. Your healthcare provider may also give you medicine for this. You may feel some uterine contractions called after-pains for a few days. The uterus continues to contract and get smaller over several weeks.

The urinary catheter is usually removed the day after surgery.

You may be given liquids to drink a few hours after surgery. You can gradually add more solid foods as you can handle them.

You may be given antibiotics in your IV while in the hospital and a prescription to keep taking the antibiotics at home.