What is a cesarean section?
A cesarean section, or c-section, is the delivery of a baby through a surgical incision in the mother's abdomen and uterus. In certain circumstances, a c-section is scheduled in advance. In others, it's done in response to an unforeseen complication.
According to the Centers for Disease Control and Prevention, about 30 percent of American women who gave birth in 2005 had a cesarean delivery, up from 6 percent in 1970, 17 percent in 1980, and 23 percent in 1990.
A c-section is major abdominal surgery, so it is riskier than a vaginal delivery. Moms who have c-sections are more likely to have an infection, excessive bleeding, blood clots, more postpartum pain, a longer hospital stay, and a significantly longer recovery. Injuries to the bladder or bowel, although very rare, are also more common.
In addition, if you plan to have more children, each c-section you have increases your future risk of these complications as well as placenta previa and placenta accreta. That said, not all c-sections can — or should — be prevented. In some situations, a c-section is necessary for the well-being of the mother, the baby, or both.
Why would I have a planned c-section?
Sometimes it's clear that a woman will need a cesarean even before she goes into labor. Conditions that may require a planned c-section include:
• You've had a previous cesarean with a "classical" vertical uterine incision or more than one previous c-section. (If you've had only one previous c-section with a horizontal incision, you may be a good candidate for a vaginal birth after cesarean, or VBAC.)
• You've had some other kind of invasive uterine surgery, such as a myomectomy (the surgical removal of fibroids).
• You're carrying more than one baby. (Some twins can be delivered vaginally, but all higher-order multiples require a c-section.)
• Your baby is expected to be very large (a condition known as macrosomia). This is particularly true if you're diabetic or you had a previous baby of the same size or smaller who suffered serious trauma during a vaginal birth.
• Your baby is in a breech (bottom first) or transverse (sideways) position. (In some cases, such as a twin pregnancy in which the first baby is head down but the second baby is breech, the breech baby may be delivered vaginally.)
• You have placenta previa (when the placenta is so low in the uterus that it covers the cervix).
• The baby has a known illness or abnormality that would make a vaginal birth risky.
• You're HIV-positive, and blood tests done near the end of pregnancy show that you have a high viral load.
Why would I have an unplanned cesarean delivery?
You may need to have a c-section if problems arise that make continuing or inducing labor risky. These include the following:
• Your cervix stops dilating or your baby stops moving down the birth canal, and attempts to stimulate contractions to get things moving again haven't worked.
• Your baby's heart rate gives your practitioner cause for concern, and she decides that your baby can't withstand continued labor or induction.
• The umbilical cord slips through your cervix (a prolapsed cord). If that happens, your baby needs to be delivered immediately because a prolapsed cord can cut off his oxygen supply.
• Your placenta starts to separate from your uterine wall (placental abruption), which means your baby won't get enough oxygen unless he's delivered right away.
• You have a genital herpes outbreak when you go into labor or when your water breaks (whichever happens first). Delivering your baby by c-section will help him avoid infection.
What happens right before a c-section?
First, your practitioner will explain why she believes a c-section is necessary, and you'll be asked to sign a consent form. If your prenatal practitioner is a midwife, you'll be assigned an obstetrician for the surgery who will make the final decision and get your consent.
Typically, your husband or partner can be with you during most of the preparation and for the birth. In the rare instance that a c-section is such an emergency that there's no time for your partner to change clothes — or you need general anesthesia, which would knock you out completely — your partner might not be allowed to stay in the operating room with you.
An anesthesiologist will then come by to review various pain-management options. It's rare these days to be given general anesthesia, except in the most extreme emergency situations or if you can't have regional pain relief for some reason.
More likely, you'll be given an epidural or spinal block, which will numb the lower half of your body but leave you awake and alert for the birth of your baby.
If you've already had an epidural for pain relief during labor, it'll be used for your c-section as well. Before the surgery, you'll get extra medication to ensure that you're completely numb. (You may still feel some pressure or a tugging sensation at some point during the surgery.)
A catheter is then inserted into your urethra to drain urine during the procedure, and an IV is started if you don't have one already. The top section of your pubic hair is shaved, and you're moved into an operating room.
Anesthesia will be administered, and a screen will be raised above your waist so you won't have to see the incision being made. (If you'd like to witness the moment of birth, ask a nurse to lower the screen slightly so you can see the baby but not much else.) Your partner or husband, freshly attired in operating room garb, may take a seat by your head.
How is a c-section done?
Once the anesthesia has taken effect, your belly will be swabbed with an antiseptic, and the doctor will most likely make a small, horizontal incision in the skin above your pubic bone (sometimes called a "bikini cut").
The doctor will cut through the underlying tissue, slowly working her way down to your uterus. When she reaches your abdominal muscles, she'll separate them (usually manually rather than cutting through them) and spread them to expose what's underneath.
When the doctor reaches your uterus, she'll probably make a horizontal cut in the lower section of it. This is called a low transverse incision.
In rare circumstances, the doctor will opt for a vertical or "classical" uterine incision. This might be the case if your baby is very premature and the lower part of your uterus is not yet thinned out enough to cut. (If you have a classical incision, it's much less likely that you'll be allowed to attempt a vaginal delivery with your next pregnancy.)
Then the doctor will reach in and pull out your baby. You'll have a chance to see the baby briefly before he's handed off to a pediatrician or nurse. While the staff is examining your newborn, the doctor will deliver your placenta and then begin the process of closing you up.
After your baby has been examined, the pediatrician or nurse may hand him to your partner, who can hold him right next to you so you can admire, nuzzle, and kiss him while you're being stitched up, layer by layer. The final layer — the skin — may be closed with stitches or staples, which are usually removed three days to a week later. Closing your uterus and belly will take a lot longer than opening you up, usually about 30 minutes.
After the surgery is complete, you'll be wheeled into a recovery room, where you'll be closely monitored for a few hours. If your baby is fine, he'll be with you in the recovery room and you can finally hold him.
If you plan to breastfeed, give it a try now. You may find nursing more comfortable if you and your newborn lie on your sides facing each other.
You can expect to stay in the hospital for three or four days before going home. For the full scoop on what happens after a cesarean, see our article on recovering from c-section.
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