All About C-Sections: Before, During, and After
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, nearly 32% of women deliver via C-section in the United states, and there's no reason it 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. Here’s everything you need to know about the C-section procedure.
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What is a C-Section?
A Cesarean section (C-section) is a procedure for delivering a baby through abdominal and uterine incisions. C-sections are sometimes scheduled in advance for various pregnancy complications, such as breech presentation or maternal high blood pressure. According to Michele Hakakha, M.D., a board-certified obstetrician and gynecologist in Los Angeles, C-sections are planned about one week before the due date. “This is done to try to prevent a woman from going into labor prior to her C-section date,” she says.
Emergency C-sections, which aren’t scheduled before labor begins, might occur as a life-saving measure for the mother or baby. They're often necessary if the baby is in distress, the labor isn’t progressing normally, or the doctor detects a placenta problem (such as placenta previa).
The entire C-section lasts about 25 to 60 minutes, and recovery takes longer than with vaginal delivery. You’ll likely stay in the hospital for two-four days afterwards. As with every surgery, complications are possible, including infection, blood clots, or excessive bleeding. However, most side effects are minor and resolve within a few weeks.
C-Section Risk Factors
Sometimes no amount of planning can prevent a C-section. However, certain risk factors might increase your odds of having a C-section, including pregnancy with multiples, sexually transmitted infections like herpes, and maternal medical conditions like heart disease, high blood pressure, or kidney disease.
What’s more, 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).
Preparing for a C-Section
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, 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.
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A curtain will be pulled across your midsection so you can’t see the procedure. With so many of your senses out of commission, you may find yourself listening hard to what’s going on behind the curtain. You're likely to hear a fair amount of activity: a scrub nurse, another nurse or two, the anesthesiologist, and perhaps a hospital pediatrician. In a teaching hospital, an extra doctor may be observing.
The C-Section Procedure: What to Expect
A nurse will shave just enough of your pubic hair to clear the way for the incision, which is usually about four to six inches long. You won’t feel pain when the surgery begins. But according to Anne Wigglesworth, M.D., 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. Most doctors do a horizontal cut through your abdomen and uterus, although vertical cuts may be done on rare occasions.
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, M.D., 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." Doctors will also cut the umbilical cord and remove the placenta.
Before you know it, there will be a baby in the room. "A lot of times, if you ask, the doctor will either drop the surgical screen a bit or hold the baby up over it so you can see him as soon as he comes out," explains says Bruce Flamm, M.D., a partner physician at Kaiser Permanente Medical Center in Riverside, California.
How long does a C-section take? 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. Your provider will stitch up the uterus, realign the outer layers, and close the skin with either dissolving stitches (which take longer to put in) or staples (which require removal a few days later).
It’s common to experience nausea or a bout of the shakes (although medical science has no explanation for this normal side effect). You’ll spend the next hour or so in the recovery room with a heart monitor and an oxygen saturation monitor attached to your finger. Your legs will start coming back to life—sometimes gradually and 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.
Afraid you won’t be able to bond with baby immediately? 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. Unless the baby or mother needs immediate medical treatment, most hospitals will accommodate parents' expressed wishes for early bonding opportunities, says Dr. Flamm.
C-Section Recovery Timeline
On the day of the C-section, 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'll need loads of rest, and you’ll wear pads for a few days for the bleeding.
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. This means that your intestines are getting back into gear after pain medications, which slow down your bowels.
By the third or fourth day, 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. Don’t hesitate to fill your painkiller prescription, and consider buying nursing pillow for breastfeeding.
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. By that point, you probably feel like a parenting pro!
C-Section Side Effects
Common C-section side effects include cramping, nausea, weakness, and fatigue. It may be uncomfortable to cough, sneeze, or even laugh. The area around your incision will be tender for the first few weeks and you should watch it closely. If it becomes very red or inflamed, or if you start running a fever, call your doctor, since this could be a sign of infection.
To speed recovery, eating healing foods can help. Lisa Kimmel, M.S., R.D., C.S.S.D., sports nutritionist at Yale University in New Haven, Connecticut, recommends protein sources (such as lean meats, eggs, nuts, beans, and legumes) and low-fat dairy products. She also advises to eat 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).
Most women notice that their actual scar is numb from the nerves being cut, but this numbness should go away over the next few months. Your scar will continue to get lighter and look better with time, and eventually it'll fade to almost the color of your skin. C-section incisions are made very low these days, so they're easy to conceal—even in bikinis and low-rise jeans.