One in four deliveries in the United States is a cesarean delivery (also called a "C-section"), which is the birth of a baby through a surgical incision in the mother's lower abdominal wall and uterus rather than through the vagina. Doctors usually turn to cesarean delivery after labor has begun either because of an unexpected complication or because labor is failing to progress.
Sometimes, however, cesarean deliveries are planned in advance because of certain complications, including the following:
Placenta previa. If the placenta is positioned abnormally low within the uterus, there is a chance that the placenta will block the cervix. This could prevent the baby from advancing through the birth canal and could cause severe bleeding or hemorrhaging in the mother.
Size. If the baby is very large, a cesarean can sometimes be the safest way to deliver.
Position. Babies who are breech (presenting buttocks first or feet first) or traverse (side or shoulder first) sometimes require cesarean delivery.
Medical problems in the mother. Long-standing diabetes or active genital herpes can make vaginal delivery dangerous to mother or baby.
Previous cesarean. Some women with previous cesareans can deliver vaginally, but for others, another cesarean is the safer choice.
Birth defects. Depending on the situation, a baby with a major birth defect may have a better outcome if delivered by cesarean.
Multiples. Twins and triplets may be delivered vaginally or by cesarean, depending on the situation. The more babies you are carrying, the more likely it is that your doctor will recommend a planned cesarean.
A cesarean poses more potential risks to a woman and her baby than a vaginal delivery does. These risks are worth taking when mother or baby has a health problem or complication, but they are not worth taking in an otherwise normal pregnancy in a healthy woman. Most doctors consider it unethical to choose the higher-risk cesarean procedure without medical cause, and so does the American College of Obstetricians and Gynecologists (ACOG). "If the physician believes that performing a cesarean would be detrimental to the overall health and welfare of the woman and her fetus, he or she is ethically obliged to refrain from performing the surgery," says an ACOG opinion statement.
The anesthesiologist will explain the different pain medications available. Most use an epidural, a spinal block, or a combined spinal-epidural block; these will leave you awake but numb from below your breasts to your toes. You can discuss the possibility of having a small amount of morphine in your spinal or epidural as well; this may help control pain after the procedure for up to 24 hours.
Once you have anesthesia, the nurse will put a catheter in your bladder to drain urine before surgery begins; this lowers the risk of injuring your bladder during the procedure and makes it easier to deliver the baby. She'll then shave the lower part of your abdomen and clean your belly with antiseptic solution.
The doctor will drape you with sterile sheets and put up a low screen across your chest to prevent you from seeing the surgery; however, in some institutions, you're allowed to have a mirror or you can request that your view not be blocked.
If your partner wants to accompany you to the operating room, he will have to put on hospital scrubs, booties, and a mask. He will sit beside your head, so he can talk with you, hold your hand, and give you support during the procedure.
For most cesareans, the doctor will make a horizontal incision in your abdomen along your bikini line; in some emergency situations the cut will be made from your navel down to your pubic bone. The doctor will then make another horizontal or vertical incision in your uterus, depending on the position of the baby and the placenta.
Afterward she will break the amniotic sac, if it is not already broken, and allow some fluid to escape. She'll then gently put her hand in to lift the baby out through the incision, headfirst. The tugging and pushing you may feel occur as the head emerges through the incision and the surgical assistant is pushing at the top of your uterus to expel the baby. The doctor will clamp and cut the cord, then hand the baby to a pediatrician or skilled nurse who will examine the baby immediately and then wrap her up and hand her to your partner.
After delivering your baby, your doctor will bring the placenta out through the same incision; then she'll massage your uterus. The actual delivery of your baby will happen only 10-15 minutes after the start of the procedure. The rest of the surgery--stitching up the two incisions and getting you into recovery--takes approximately 30 minutes more. Throughout the procedure you won't feel much more than tugging or pulling sensations.
After a cesarean, you'll be taken to a recovery room where your blood pressure, bleeding, pulse rate, and respiration will all be monitored. The catheter may remain in for about 12-24 hours after surgery, and you'll continue to get fluids through an IV until the next day. You may stay in bed the first day, though you'll be encouraged to change positions, roll over, and sit up in bed. You should be able to breastfeed your baby by laying a pillow across your abdomen to help support him in your arms as he nurses, and you should be walking within 24 hours. Your doctor will give you pain medication for discomfort, and you will be released from the hospital in about 3 or 4 days.
Originally published in You & Your Baby: Pregnancy.
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