Cesarean delivery, also known as a C-section, is a surgical procedure used to deliver a baby, during which the baby is removed from a woman's uterus via an incision in the abdomen.
C-sections are performed for a number of reasons, including complications during pregnancy or delivery, prior cesarean births or certain health conditions. In some cases, a cesarean delivery is scheduled, but some mothers undergo a C-section unexpectedly. Regardless of your personal situation, there are some things all women should know about a C-section, including the risks, benefits and recovery.
We spoke with Reut Bardach, MD, an OBGYN with Medical City of Trinity in Trinity, Florida, to find out everything you need to know about the procedure, including ways to have a smooth delivery and speedy recovery.
1. You’ll (Most Likely) Be Awake Through the Whole Procedure
Depending on the reason for the C-section, logistics may vary, but most women are awake and alert during the procedure. Most often, a woman's body is numbed below the waist using a regional anesthesia, like an epidural, spinal block or both.
A spinal block is a one-time spinal injection of a narcotic, like fentanyl, or anesthetic. An epidural is also administered in a woman's back, but it's done using a catheter that remains in place, so more anesthetic can be given as needed. Although a woman won't likely feel pain during surgery, she may feel some pressure.
In the case of an emergency C-section, doctors may administer general anesthesia, meaning a mother will be unconscious and unable to hear, feel or see any part of the procedure.
Once anesthesia—local or general—is administered, your doctor will make an incision on the lower part of your abdomen, through which the baby will be delivered.
2. Sometimes, C-Sections Are Safer Than Vaginal Deliveries
Many women hope for a quick vaginal delivery, but that's not always a possibility. In fact, almost one-third of babies in the US are born via C-section, making the procedure one of the most common surgeries in the country.
Both planned and unplanned C-sections are performed to help protect mother and baby from potential complications of vaginal delivery. A cesarean section may be scheduled if:
- The baby is in a breech position, or feet first
- The mother has had previous C-sections
- The woman is pregnant with multiples
- The mother has diabetes, preeclampsia, HIV or active case of genital herpes
Doctors and mothers can't always plan for complications, but it's important to be ready if such issues arise. According to Dr. Bardach, "Common reasons for an unplanned cesarean section generally include things like excessive bleeding during vaginal delivery, cord [entanglement] or placental abruption."
Urgent C-sections may also be performed if labor does not progress or the baby's heartrate is slow, a sign of fetal distress.
3. There Are Some Risks to C-Sections
"The good news about C-sections is that most obstetricians perform hundreds and thousands," Bardach says. "Although it's major surgery, and it definitely poses some risk of complication, and most people are very comfortable and confident performing C-sections, so they generally run smoothly."
By and large, C-sections are safe for many women, but like any other surgical procedure, a C-section has some risks—for mother and baby.
"The first risk in an abdominal surgery, and especially in C-sections, is bleeding," Bardach says. "By the mere fact that we're using scalpels, there's going to be some blood loss involved."
There are some other risks for the mother, including infection, damage to surrounding organs and blood clots. Although unlikely, it's possible for the baby to sustain surgery-related injuries, like small cuts. Babies born via C-section are also at an increased risk of developing a breathing problem known as transient tachypnea, in which the baby experiences rapid breathing in the days following delivery.
Cesarean deliveries pose low risk to mother and child, and most doctors perform them only when necessary. "My personal philosophy is that having a vaginal delivery is safer for the woman," Bardach says. "Our bodies are designed to have babies vaginally, but both options have their own benefits."
4. You’re Going to Have a Scar
With the joy and happiness of your baby’s birth, a scar on your lower abdomen will likely be the last thing on your mind. But as with any procedure that involves an incision, a C-section will leave a lasting mark.
Incisions are typically placed horizontally just above the pelvis, in an area often covered by a swimsuit and even your underwear. In some case, primarily when a large incision is needed or the baby must be removed quickly, the doctor may make a vertical just below the belly button.
Still, the scar, a patch of skin that grows over a wound, will gradually become smaller and fade overtime. If the scar bothers you, there are several treatment options to help minimize the appearance, including creams, injections and laser therapy.
5. “Once a C-Section, Always a C-Section” Isn’t Always True
Despite common belief, not all women who have a C-section with one child will have the same procedure with future pregnancies. Many women, between 60 percent and 80 percent, in fact, have safe vaginal deliveries following one previous cesarean. It really depends on the reasons for the initial cesarean and what, if any, complications there were as a result.
Women who deliver their babies via C-section because of existing conditions, and have those conditions during subsequent pregnancies, will likely have a repeat procedure. Mothers with a prior vertical incision are at an increased risk for a second cesarean. C-sections increase a woman's risk for placental complications, which might lead to additional procedure.
If you've already had a C-section but want to try for a vaginal delivery, speak with your doctor throughout your pregnancy about the possibility.
6. You’ll Need Help During Recovery
A woman's body is powerful, but after a major abdominal surgery, like a C-section, she'll need some time to recover. "Postoperatively a lot of women need assistance, and having supportive family and friends is a huge benefit," Bardach says.
Recovery from a C-section is longer than that of a vaginal delivery, and will likely require a hospital stay of three or four days following surgery. For days, and even weeks, after the procedure, a woman might feel tired, soreness near the incision, constipated or gassy and may struggle to get out of bed or lift their baby.
Upon return home, women are encouraged to rest when possible, drink plenty of fluids, avoid sex and take medication to manage pain when needed. Walking may also relieve discomfort and help prevent blood clots, but it's important not to tire yourself out. Using a pillow to support your abdomen when you sneeze, cough or laugh may also be helpful to relieve abdominal pressure. Most women are back to normal activities between six and eight weeks after delivery.
There are no restrictions on breastfeeding, and most women are free to nurse as soon as they're feeling up to it. Bardach emphasizes one thing, however, when it comes to breastfeeding: Persistence. "Women who are breastfeeding tend to struggle with the discomfort of healing from the surgery, as well as the discomfort of the changes happening in the breast tissue. It's not impossible. It's difficult, but a woman's body's very resilient," she says.