Labor & Delivery: What to Expect in a C-Section
Many expectant moms look forward to a beautiful childbirth. But what happens if you need a c-section? Two things are for sure: Your birth experience will not be as warm and intimate as you may have imagined, and your body will need more time to recover than if you had a vaginal birth. But in the grand scheme of parenthood, these are minor things; the c-section has the desired effect of delivering your baby safely into your arms. Here's the lowdown on having a c-section.
The first order of business -- after consent forms are signed -- is anesthesia. If you already have an epidural in place, the anesthesiologist will increase the dosage. If not, your obstetrician and the anesthesiologist will most likely choose an intrathecal (spinal). Both involve an injection in your back (for which you'll be numbed), and both numb you from the rib cage down. Next, you'll drink some chalky stuff called Bicitra to neutralize your stomach acids, and you'll be given a catheter and IV. Then it's on to the operating room, where your partner suits up in scrubs and a mask.
In the operating room, a curtain will be pulled across your midsection so that in addition to not feeling the proceedings, you won't see them either. With so many of your senses out of commission, you may find yourself listening hard. You're likely to hear a fair amount of activity in the far half of the room: a scrub nurse, another nurse or two, the anesthesiologist, and perhaps a hospital pediatrician. In a teaching hospital, an extra doctor may be observing.
A nurse will shave just enough of your pubic hair to clear the way for the incision, which is usually about as long as your middle finger. When the surgery begins, you won't feel pain. According to Anne Wigglesworth, MD, an ob-gyn with 19 years of experience practicing in Manhattan, Kansas, many patients feel a bit of a pinch as the peritoneum -- the shiny, hard-to-anesthetize tissue that lines the abdomen -- is reached.
Soon you may feel a fair amount of painless prodding, which means the baby is being moved into position. This part is not all that different from a vaginal birth, at least for the doctor. "I have to reach my hand underneath the baby's head to form a cradle so I can pull the head out," explains Amy Moore, MD, an ob-gyn in New York City. Because the mother can't push, she says, "I push the top of the uterus and elevate the head out of the pelvis, getting the shoulders and body to follow."
Before you know it, there will be a baby in the room. From the time the incision is made, the baby can be delivered in as little as two minutes or as long as half an hour, depending on the circumstances. Usually you get to see your baby before he's whisked away for care. Now the spotlight moves off you as all those people across the room clean your baby, administer the APGAR test, and place him in the "warmer," which has radiant heat above it and keeps the baby's body temperature steady.
Once the baby has been given a clean bill of health, the obstetrician comes back to close you up -- the most complex part of the c-section. "It's like putting together a puzzle," says Dr. Wigglesworth. The uterus is stitched up, the outer layers are realigned, and the skin is closed, either with dissolving stitches (which take longer to put in) or staples (which require removal a few days later).
You'll have a few minutes with your partner to marvel or cry or settle on your baby's name. You may experience nausea or a bout of the shakes (for which medical science has no explanation). You'll spend the next hour or so in the recovery room. You'll have a heart monitor and an oxygen saturation monitor attached to your finger. You will feel your legs coming back to life, sometimes gradually, sometimes in spurts. As the anesthesia wears off, you may feel itchy all over for a while; if it gets bad, you'll be offered an antihistamine.
That first day, you'll likely have a pump to deliver a low dosage of a narcotic, such as morphine, as needed. Some doctors will let you eat solids, while others will have you wait 24 hours or until you pass gas, a sign that your intestines are functioning normally. You will need loads of rest, and you will still be bleeding and will need to wear pads for a few days.
On the second day, you'll be switched from the pump to an oral painkiller. The catheter will come out, and you'll be asked to walk to the bathroom, which will appear to be in North Dakota. If the nurses push you before you feel ready, they aren't being sadistic; it's always important to get your lungs and muscles working after surgery. Dr. Moore strongly recommends "as much pain medicine as you need so that you can move around as much as possible." The second day will also bring an unusual interest in your intestinal activity. You may even feel a sensation like a humming motor inside you, which means that your intestines are getting back into gear after pain medications, which slow down your bowels.
By the third or fourth day, again depending on whether you're also recovering from labor, you will be sent home. If you're dead tired, push for as long a hospital stay as possible to rest. You will probably go home with a pain prescription in hand; don't hesitate to fill it. If breastfeeding is difficult, you may find that a nursing pillow is a godsend.
After two weeks, you'll go back to the doctor for a wound check to make sure your incision is healing well. At six weeks, you'll have a postpartum visit. And by that point, you'll probably feel like a parenting pro.
The information on this Web site is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child's condition.