C-Sections 101

Every year, about 30 percent of babies born in the U.S. are delivered by cesarean section. Here's the lowdown on why c-sections happen and what you need to know to prepare yourself.
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Having a c-section means your baby will be lifted out directly from your belly, rather than pushed out from your you-know-what. A c-section is surgery, and you'll have two incisions -- one in your abdomen and one in your uterus -- while you're under anesthesia. C-sections have come a long way (and are much less invasive than they used to be), but the reasons they're sometimes necessary have not changed that much -- since the goal of every birth is to end up with a healthy mother and a healthy baby.

Why Are C-Sections Done After Labor Has Started?

Once labor has begun the ideal outcome is always a vaginal delivery. However, there are times when it becomes clear that this could be risky for mom's or baby's health -- and c-section becomes medically necessary. The main reasons this happens are:

  • Your labor's stalling, or your baby's head is too big to fit through your pelvis (this is called cephalopelvic disproportion): These are the two most common reasons for needing a c-section, and account for about 30 percent of all cesareans.
  • Your baby's distressed: A c-section often becomes necessary if there are issues with the baby's heart rate or if the baby's oxygen supply has been disrupted by a prolapsed cord (a condition in which the cord slips down through the cervix ahead of the baby and becomes compressed) or if your placenta starts to separate from the wall of your uterus (a condition called placental abruption).

Why Are C-Sections Scheduled in Advance?

Not all c-sections come as a surprise during labor. In many cases, your doctor may schedule you for a c-section in advance because of known factors or complications that would make a vaginal delivery too difficult. These can include:

  • You've had a cesarean before: While some women who've had cesareans previously can safely undergo a vaginal birth the next time around, nearly 80 percent of scheduled cesareans are repeats. And once you've delivered one baby by c-section, you'll always be offered the option to do so again.
  • Your baby's in the breech position: If your baby's feet first (instead of head first) and your doctor can't turn him around, a c-section is usually the safest way for you to deliver.
  • You have placenta previa or placental abruption: If your placenta is lying at the bottom of your uterus (instead of at the side or top), it can block your baby's exit from your womb or cause heavy bleeding during delivery. If your placenta has started to separate from the wall of your uterus (a condition called placental abruption), this can cause heavy bleeding and complications for your baby, so c-sections are necessary in both cases.
  • You're pregnant with twins or multiples. Though a vaginal birth is possible with twins, most are delivered by c-section, where both babies can be more closely monitored. Triplets or larger groups of multiples are always born via c-section.

Some women may think about scheduling a c-section in advance for other reasons -- like wanting to have an exact plan for when their baby will be born, or because they're worried about the pain of having a vaginal birth, but experts advise against having the procedure strictly for convenience's sake, especially before 39 weeks. For one thing, a c-section is major abdominal surgery, and there's always the risk of complications with anesthesia or post-procedure infections. There's also a long and painful recovery period, which can make you pretty uncomfortable and have a harder time breastfeeding in the first few weeks after your baby's born.

Though Sapna wanted to give birth vaginally, her daughter had different plans. Sapna delivered via an unplanned c-section after having contractions that day she was supposed to be induced.

How Is a C-Section Done?

A c-section is actually a pretty quick operation. It takes about 45 minutes from start to finish, but your baby will be born (get ready to hear those amazing first cries!) in the first 10 minutes. Before surgery you'll be given anesthesia. If you haven't already received an epidural, you'll probably get a spinal block, which will numb you from your chest to your toes. Your partner can generally stay by your side during the procedure (unless it's a real emergency and you need general anesthesia). General anesthesia -- where you're completely knocked out and unaware of what's happening -- is not used very often anymore. It's usually reserved for extreme situations because it can be administered very quickly.

You might also be given a catheter to keep your bladder empty during the operation and receive an IV in your arm, through which you will receive fluids and pain medication after surgery. The doctors will put up a screen so you won't see the surgery being performed, but you'll be able to hear your baby as soon as he's born and hold him soon afterward.

Once the anesthesiologist is certain that you're numb, your doctor will make the first incision in your abdomen, which will be about 6 inches long (usually horizontal, toward your pubic bone). A second incision is then made in your uterus, through which your baby is delivered. You may feel a slight tugging sensation as your baby emerges. A pediatrician will immediately check out your baby, and if all is well, he'll be given to either you or your partner to hold. While your new family gets acquainted, your doctor will remove the placenta and begin to close both incisions.

What's Recovery from a C-Section Like?

Right after surgery, you'll go to a recovery room for about an hour, where your vital signs will be monitored and you'll receive pain medication. If your baby's healthy, he can stay with you during this time (it's a great opportunity to hold him and try to breastfeed if you haven't already).

The first day or so after your c-section, you may feel a little nauseated and weak. It may be uncomfortable to cough, sneeze, or even laugh. After a day or so, you'll be encouraged to get up and start moving around, which is important to prevent fluid from building up in your lungs, boost circulation, and help with digestion. It'll be hard at first, but the more you move, the better you'll feel.

After about three or four days, you'll probably be able to go home, after your doctor removes your stitches. You'll get a prescription for pain medication to help you through the next week (if you plan to nurse, make sure your doctor knows so he can prescribe medications that are safe). Once you're home, resist the temptation to busy yourself with stuff around the house -- just focus on resting, making sure not to lift anything heavier than your baby. Although many c-section mothers report feeling better rather quickly, it's still important to take it easy -- remember, you just had major surgery. You'll probably be back to your old self in about a month to six weeks.

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. 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.

Will Having a C-Section Affect My Sex Life?

Intercourse will be off limits for the first six weeks (trust us, it'll be the last thing on your mind anyway!) after you deliver, which gives your incision time to heal and your cervix time to close and return to normal. When your doctor gives you the green light to get started, know that your first time back in the saddle will actually be much more comfortable than it would have been after having a vaginal delivery.

Having a c-section should not affect your sex drive, but many new moms aren't exactly dying to jump back into bed so quickly -- and that's totally normal. For one thing, you're probably exhausted from your newborn's round-the-clock eating-crying-pooping schedule. And the hormones you release while breastfeeding have also been known to temporarily lower libido too.

Is There Any Way I Can Avoid a C-Section?

Most women don't want to have a c-section, but if you or your baby develops a complication before or during labor, there's usually nothing you can do to avoid it.

Some women may be more likely to need a c-section than others, though, so there are things that you can do throughout pregnancy that may lower your chances of needing one. Eating well, staying active, and maintaining a healthy weight gain can minimize your chances of developing the types of complications that often lead to cesareans, like preterm birth, a too-large baby, and conditions like diabetes and high blood pressure, for example.

You should also talk to your doctor about his philosophy on cesareans, and make sure it matches yours. Some physicians are more likely to recommend c-sections than others, or have varying definition of what's really medically necessary. And if your doctor says you need a c-section, don't hesitate to ask why. In certain cases (like if your baby is large) you may be allowed to try a vaginal birth for a period of time to see if surgery can be avoided, but you'll only be offered this opportunity if your doctor considers it safe for both you and your baby.

Try to avoid being induced for labor unless your doctor says you need to be. Research shows that women who are induced are more likely to need c-sections than those who go into labor on their own (usually because labor is more likely to stall, which can cause distress for the baby).

And if you end up having a c-section don't feel guilty -- you didn't do anything to cause it. Some women report feeling cheated out of the experience of childbirth and that's natural, but your best defense against these feelings is to focus on the positive result: a healthy baby and a healthy mom to care for him!

Sources: The Mayo Clinic Guide to a Healthy Pregnancy; The American College of Obstetricians and Gynecologists educational pamphlet Cesarean Birth

All content on this Web site, including medical opinion and any other health-related information, is for informational purposes only and should not be considered to be a specific diagnosis or treatment plan for any individual situation. Use of this site and the information contained herein does not create a doctor-patient relationship. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.

Updated 2010

American Baby


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