The Facts About C-Sections

A cesarean section (C-section) is an operation to deliver your baby that can be planned or unplanned. In 2020, C-section was the delivery method for just less than 32 percent of all live births in the United States, so it is a common procedure.

This type of procedure is usually carried out if there are potential risks involved in giving birth vaginally. In some circumstances, it may be necessary to have a C-section for the safety of you and your baby. But there are many reasons your healthcare provider might perform a C-section. Let's look at the reasons for a C-section and what is involved in the procedure in a little more detail.

There are two types of cesarean section, emergency and elective.

Emergency C-section: This is unplanned and carried out if your baby needs to be delivered quickly. If the health of you or your baby is at risk during delivery, then a C-section might be carried out. It could be an option if labor isn't progressing and your baby's well-being is a concern. Although it is an emergency procedure, in most cases, your doctor has time to discuss it before it happens and gives you all the information you need to make an informed decision.

Planned elective C-section: Your doctor might plan a C-section with you in advance if you have complications in your pregnancy that could lead to a risky delivery for you or your baby. Your healthcare team usually plans your C-section for week 39 of gestation so it occurs before you go into labor naturally. Patients always have a choice with any medication or procedure. However, if a doctor recommends a procedure, going against that advice is generally not wise unless there is a safe alternative.

An emergency C-section might be needed if:

• Your baby is not getting enough oxygen
• The baby's head is too big for your pelvis or is in the wrong position
• You become seriously unwell and are unable to deliver naturally
• Maternal hemorrhage occurs
• The fetus needs to be born urgently due to a placental abruption, prolapsed umbilical cord or uterine rupture
• The baby is in fetal distress, and you are not far enough along for a forceps or vacuum delivery

Your OB-GYN might discuss a planned C-section with you if:

• The baby is in a breech position and has not turned
• You have placenta previa (a low-lying placenta)
• You have severe preeclampsia (pregnancy-related high blood pressure) remote from delivery
• You are expecting multiples: triplets, quadruplets or more
• You are expecting twins and they share a placenta or are in a difficult position for delivery
• You have certain infections, such as HIV or genital herpes
• You've already had one or more cesarean sections
• You have a health problem or medical complication that might make delivery risky for you

This is a basic overview of what might happen during a C-section, although the actual procedure may differ depending on your circumstances. For a planned C-section, your doctor talks you through the procedure the day before.

First, you need to have anesthesia, usually in the form of an epidural or spinal block. An intravenous line is placed in your arm to administer medicine and fluids, and a catheter is placed into your bladder to catch urine. The medical team places a drape or screen near the top of your abdomen so you can't see the incision. Most of the time, you can have a support partner with you throughout the surgery.

The surgeon makes an incision horizontally through the skin across the lower abdomen below the belly button. Then they make further incisions through the fat and uterus, and the abdominal muscles are separated.

The doctor might remove some fluids at this point or use some tools, and you may feel pressure, tugging or pulling but not pain. They deliver the head of the baby first and suction its nose and mouth to get rid of fluids normally squeezed out in a vaginal birth. Then the doctor delivers the rest of the baby. The team cuts the umbilical cord, delivers the placenta and checks the baby over if necessary.

You may be able to hold your baby at this point or have a person hold your baby close to you. Finally, the doctor stitches up the incisions, and you and your baby go to the recovery room for monitoring. The whole operation takes about 40 to 50 minutes.

Every type of surgery comes with risks. Therefore, complications should always be discussed and considered. Here are a few:

• Blood clots
• Infection of the uterus or wound 
• Excessive bleeding, which may lead to needing a blood transfusion
• Damage to other nearby organs, such as the bladder 
• Accidentally cutting your baby when your womb is opened
• Temporary breathing difficulties in your baby
• A longer recovery and hospital stay
• Hysterectomy, though this is uncommon

Occasionally, having a C-section can also lead to problems with future pregnancies, such as placenta previa or placenta accreta, which occurs when the placenta grows too deeply into the uterine wall.

If your OB-GYN recommends a C-section, it's likely the safest delivery method for you and your baby. There is also a lower risk of pain, vaginal injury, pelvic organ prolapse and loss of bladder control compared to vaginal birth.

Another benefit, if you have older children, is knowing the date of your planned C-section to prearrange childcare. You also won't have to deal with contractions.

However, you may experience some of the same problems posed by a vaginal birth, such as pain during sex, a weakened pelvic floor and bowel problems.

The average length of hospital stay after a C-section is around two to three days, although you may be able to go home sooner. You might need a little help at home at first, but you can return to your usual activities as soon as you feel ready.

Gentle walking is good for recovery but try to avoid driving, carrying anything heavy, having sex or doing heavy housework until you don't have pain and feel entirely able to do these activities.

If you have stitches or staples that need to be removed, your healthcare provider takes them out five to seven days after the operation. It's vital to keep your wound clean and dry. Avoid wearing anything too tight or that irritates the wound area; loose clothing is best.

Your doctor might prescribe pain relievers for the first few days after your C-section. Although small amounts of some medications can pass into breast milk, it's unlikely to affect your baby if you take it as prescribed by your doctor.

Your healthcare team advises you on how to get in and out of bed, how to massage and look after your scar, and what postoperative checks you need. Full recovery takes approximately six weeks.

What happens during a C-section?

During the procedure, you receive an anesthetic, usually in the form of an epidural or spinal block. A screen or drape is placed near the top of your abdomen so you can't see the operation, and you can have a birth partner with you.

The doctor makes incisions through your skin, fat and uterus to access the baby. The healthcare team delivers your baby's head first and suction fluids from its nose and mouth. They then deliver the rest of the baby, cut the umbilical cord, and the baby is checked over and handed to you or your partner.

Your doctor delivers your placenta and stitches up the incisions made. Both you and the baby are taken to the recovery room to be monitored after the surgery.

How painful is a C-section?

Pain levels can be different for every woman. Your doctor can prescribe appropriate pain relief that is safe to take when breastfeeding and advise you on how to take it.

How long does C-section pain last?

Most women have some pain and discomfort for the first few days after a C-section. For some women, the pain can last several weeks.