No matter what type of birth you're planning (and hoping) for, you shouldn't rule out the possibility of a Cesarean section. In fact, the number of women delivering via C-section in the United states is nearly 1 in 3, and about 61 percent of those are first-time surgeries (mainly when problems arise during labor.)
Unexpected or not, there's no reason a C-section has to be a totally negative experience, says Dana Sullivan, a three-time C-section veteran and co-author of The Essential C-Section Guide (Broadway Books). Knowing how to prepare for and "personalize" a C-section can make the surgery less traumatic and help speed recovery.
Whether you want to avoid a Cesarean or make the surgery as uncomplicated as possible, you need to pay attention to your weight early on. Researchers at Seattle's Swedish Medical Center found that women who were overweight when they got pregnant were twice as likely as lean women to have C-sections. Obese women had three times the risk. "They have more surgical complications as well—from anesthesia and with healing," says perinatologist and study co-author Tanya Sorensen, M.D. Other research has shown that overweight women labor longer (which can lead to a C-section) and have lower success rates when attempting a vaginal birth after delivery (VBAC).
When you're packing your hospital bag, adding a few extra items can improve your stay in case you have a C-section. Some women pack cranberry juice, which is believed to reduce the risk of a post-catheterization urinary tract infection; others bring chewing gum or molasses to hasten notoriously balky post-surgery bowel function.
Once you’re ready for 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.
Knowing in advance what to request from hospital staff can help minimize the emotionally upsetting aspects of having a C-section. Many women worry that the surgery will require them to be separated from their newborns. Yet unless the baby or mother needs immediate medical treatment, most hospitals will accommodate parents' expressed wishes for early bonding opportunities, says OB-GYN Bruce Flamm, M.D., a partner physician at Kaiser Permanente Medical Center in Riverside, Calif.
For instance, a screen blocks off the sterile surgical area during a Cesarean. "A lot of times, if you ask, the doctor will either drop that screen a bit or hold the baby up over it so you can see him as soon as he comes out," Flamm explains.
After the birth, ask if your partner can hold the baby while you are being stitched up, if the baby can accompany you to the recovery room and if you can breastfeed immediately.
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. 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.
To speed recovery, eating healing foods can also help. Lisa Kimmel, M.S., R.D., C.S.S.D., sports nutritionist at Yale University in New Haven, Conn., recommends protein sources, such as lean meats, eggs, nuts, beans and legumes and low-fat dairy products, as well as specific nutrients, including zinc (found in seafood, meats and whole grains), vitamin C (citrus fruits, strawberries, red bell peppers) and vitamin A (carrots, sweet potatoes, mangoes).
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.