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Giving birth by cesarean section


Approved by the Medical Advisory Board
Reviewed by Natan Haratz-Rubinstein, M.D. and Ann Linden, CNM
Last updated: October 2005



By the BabyCenter editorial staff


What is a cesarean section?
A c-section is a surgical procedure that involves making an incision in your abdomen and uterus through which your baby is delivered. In certain circumstances, a c-section is scheduled in advance; in others, it's done when an unforeseen complication arises. According to the Centers for Disease Control and Prevention, nearly 28 percent of American women gave birth by cesarean delivery in 2003, up from 6 percent in 1970, 17 percent in 1980, and 23 percent in 1990. A c-section is major abdominal surgery, so it is riskier than a vaginal delivery. Moms who have c-sections are more likely to have an infection, excessive bleeding, blood clots, injuries to the bladder or bowel (though these are very rare), more postpartum pain, and a longer hospital stay. Plus, if you plan to have more children, each c-section you have increases your risk in future pregnancies of placenta previa and placenta accreta. That said, not all c-sections can — or should — be prevented. In some situations a c-section is necessary for the well-being of you or your baby.

Why would I have a planned c-section?
Sometimes it's clear that a woman will need a cesarean even before she goes into labor. Conditions that may necessitate a planned c-section include:
• You've had a "classical" cesarean (with a vertical uterine incision) or more than one previous c-section. (If you've had only one previous c-section with a horizontal incision, you may be a good candidate for a vaginal birth after cesarean or VBAC.)

• You've had some other invasive uterine surgery.

• You're carrying triplets or more.

• Your baby is expected to be very large (this is known as macrosomia), especially if you're diabetic or if you had a previous baby of the same size or smaller who suffered serious trauma during a vaginal birth.

• Your baby is in a breech (bottom first) or transverse (sideways) position. (In some cases, such as a twin pregnancy in which the first baby is head-down but the second baby is breech, a breech baby may be delivered vaginally.)

• You have placenta previa (when the placenta is so low in the uterus that it covers the cervix).

• The baby has a known fetal illness or abnormality that would make a vaginal birth risky.

• You're HIV positive and blood tests done near the end of pregnancy show that you have a high viral load.

Why would I have an unplanned cesarean delivery?
You may need to have a c-section if problems arise that make inducing or continuing labor risky. These include the following:

• Your cervix stops dilating or your baby stops moving down the birth canal, and attempts to stimulate contractions to get things moving again haven't worked.

• Your baby's heart rate gives your practitioner cause for concern and she decides that your baby can't withstand induction or continued labor.

• The umbilical cord slips through your cervix (this is called a prolapsed cord). If that happens your baby needs to be delivered immediately, because a prolapsed cord can cut off his oxygen supply.

• Your placenta starts to separate from your uterine wall (placental abruption), which means your baby won't get enough oxygen unless he's delivered right away.

• You have a genital herpes outbreak when you go into labor or when your water breaks (whichever happens first). Delivering your baby via c-section will help protect him from contracting the infection. Also, if you first get genital herpes in your third trimester (and blood tests confirm that you've never had it before), some experts recommend having a cesarean section — even if you don't have symptoms when you go into labor or your water breaks — because the risk of transmission to your baby is high if you contract genital herpes within a few months of delivery.


How would I be prepped for a c-section?
First, your practitioner explains why she believes a c-section is necessary and you're asked to sign a consent form. If your usual practitioner is a midwife, you're assigned an obstetrician for the surgery who makes the final decision and gets your consent.

Typically, your husband or partner can be with you during most of the preparation and for the birth. In the rare instance that a c-section is such an emergency that there's no time for your partner to change clothes, or if you need general anesthesia, your partner might not be allowed to stay in the operating room with you.

An anesthesiologist then comes by to review various pain-management options with you. It's rare these days to be given general anesthesia, which would knock you out completely, except in the most extreme emergency situations or if you can't have regional pain relief for some reason.

More likely, you'd be given an epidural or spinal block, which numbs the lower half of your body but leaves you awake and alert for the birth of your baby. If you already had an epidural for labor, it's used for your c-section, too. Before the surgery, you get extra medication through the catheter to ensure that you're completely numb. (You may still feel some pressure or a tugging sensation at some point during the surgery.)

A catheter is then inserted to drain urine during the procedure and an IV started if you don't have one already. The top section of your pubic hair is shaved, and you're moved into an operating room. Anesthesia is administered and a screen raised above your waist so you won't have to see the incision being made.

If you'd like to witness the moment of birth, ask a nurse to lower the screen slightly so you can see the baby but not much else. Your partner or husband, freshly attired in operating room garb, may take a seat by your head.

How is a c-section done?
Once the anesthesia takes effect, your belly is swabbed with an antiseptic and the doctor most likely makes a small, horizontal incision in the skin above your pubic bone (sometimes called a "bikini cut"). She cuts through the underlying tissue, working her way down to your uterus layer by layer. When she reaches your abdominal muscles, she usually separates them manually (rather than cutting through them) and spreads them to expose what's underneath.

When she reaches your uterus, she makes a horizontal cut in the lower section of it. This cut is called a "low-transverse" incision. In rare circumstances, your doctor will opt for a vertical or "classical" uterine incision. This might be the case if your baby is very premature and the lower part of your uterus is not yet thinned out enough to cut.

Then the doctor reaches in and pulls your baby out. You have a chance to see him briefly before he's handed off to a pediatrician or nurse. While the staff is examining your baby, the doctor delivers your placenta and then begins the process of stitching you up.

When your baby has been examined, the pediatrician or nurse may hand him to your partner, who can hold him right next to you so you can admire, nuzzle, and kiss him while you're being stitched up, layer by layer. The final layer — the skin — may be closed with stitches or staples, which are usually removed three to four days later. Closing your uterus and belly takes a lot longer than opening you up. This part of the surgery usually takes about 30 minutes.

After the surgery is complete, you're wheeled into a recovery room, where you're closely monitored for a few hours. If your baby is fine, he'll be with you in the recovery room and you can finally hold him. If you plan to breastfeed, give it a try now. You may find nursing more comfortable if both you and your newborn lie on your sides facing each other.

You can expect to stay three to four days in the hospital before going home. For the full scoop on what happens, see our article on recovering from a c-section.