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What you can expect

By Mayo Clinic staff

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Illustration of abdominal incisions used during C-sections Abdominal incisions used during C-sections
Illustration of uterine incisions used during C-sections Uterine incisions used during C-sections

During the procedure
An average C-section takes about 45 minutes to one hour. In most cases, your spouse or partner can stay with you in the operating room during the procedure.

  • Preparation. Before the C-section, a member of your health care team cleanses your abdomen. A tube (catheter) may be placed into your bladder to collect urine. IV lines are placed in a vein in your hand or arm to provide fluid and medication. A member of your health care team may also give you an antacid to reduce your risk of an upset stomach during the procedure.

  • Anesthesia. Regional anesthesia — one which numbs only the lower part of your body — is most often used during C-sections. One type of regional anesthesia that can be used is a spinal block. With a spinal block, the medication is injected directly into the sac surrounding your spinal cord. Another type of regional anesthesia used during C-sections is epidural anesthesia. With epidural anesthesia, pain medication is injected into your lower back just outside the sac that surrounds your spinal cord.

    If there's a need to start the procedure quickly, a spinal block is often used because it takes effect faster than epidural anesthesia.

    If you receive a regional anesthesia, you'll be awake during the procedure and will be able to hear and see the baby right after delivery.

    In an emergency, you may need general anesthesia. This type of anesthesia is usually started with medication delivered through an IV line in your arm, but sometimes it can be started with a gas that you breathe from a mask. With general anesthesia, you won't be able to see, feel or hear anything during the birth.

  • Abdominal incision. Your doctor makes an incision through your abdominal wall. It's usually done horizontally near the pubic hairline (bikini incision). If a large incision is needed or your baby must be delivered very quickly, your doctor may make a vertical incision from just below the navel to just above the pubic bone.
  • Uterine incision. After the abdominal incision, your doctor makes an incision in your uterus. The uterine incision is usually horizontal across the lower portion of the uterus (low transverse incision). Other types of uterine incisions may be used depending on your baby's position within your uterus and whether you have complications, such as placenta previa.
  • Delivery. If you have epidural or spinal anesthesia, you'll likely feel some movement as the doctor gently removes your baby from your uterus — but you won't feel pain. The doctor clears your baby's mouth and nose of fluids, and clamps and cuts the umbilical cord. The placenta is removed from your uterus, and the incisions are closed with stitches.

Although you may not be able to hold your baby immediately, you'll likely be able to see your baby right away.

After the procedure

  • In the hospital. After a C-section, most mothers and babies stay in the hospital for about three days. To control pain as the anesthesia wears off, you may use a pump that allows you to adjust the dose of IV pain medication.

    Within the first 24 hours after your C-section, you'll be encouraged to get up and walk. Moving around can speed your recovery and help prevent constipation and potentially dangerous blood clots. The catheter and IVs will likely be removed within 12 to 24 hours of the C-section.

    While you're in the hospital, your health care team will monitor your incision for signs of infection. They'll also monitor your appetite, how much fluid you're drinking, and bladder and bowel function.

    Before you leave the hospital, talk with your doctor about any preventive care you may need, including vaccinations. It's a good time to make sure your immunizations are up to date to help protect your health and the health of your baby.

  • Breast-feeding. IVs and discomfort near the C-section incision can make breast-feeding somewhat awkward. With help, however, you'll be able to start breast-feeding soon after the C-section. Ask your nurse or the hospital's lactation consultant to teach you how to position yourself and support your baby so that you're comfortable.

    Trying to breast-feed when you're in pain may only make the process more difficult. Your health care team will select medications for your post-surgical pain with breast-feeding in mind. Continuing to take the medication shouldn't interfere with breast-feeding.

When you go home
It takes about four to six weeks for a C-section incision to heal. Fatigue and discomfort are common. While you're recovering:

  • Take it easy. Give yourself time to rest. Keep everything that you and your baby might need within reach. For the first two weeks, don't lift anything heavier than your baby.
  • Support your abdomen. Use good posture when you stand and walk. Hold your abdomen near the incision during sudden movements, such as coughing, sneezing or laughing. Use pillows or rolled up towels for extra support while breast-feeding.
  • Drink plenty of fluids. Drinking lots of fluids can help replace those lost during delivery and breast-feeding, as well as prevent constipation. Remember to empty your bladder frequently to reduce the risk of urinary tract infections.
  • Avoid sex. Many doctors recommend waiting six weeks before resuming intercourse. But don't give up on intimacy. Spend time with your partner, even if it's just a few minutes in the morning or after the baby goes to sleep at night.
  • Take medication as needed. Your doctor may recommend acetaminophen (Tylenol, others) to relieve pain. If you're constipated or bowel movements are painful, your doctor may recommend an over-the-counter stool softener or a mild laxative, such as milk of magnesia.

  • Know when to contact your doctor. Promptly report any signs of infection to your doctor. These include a fever over 100.4 F (38 C); severe pain in your abdomen; redness, swelling and discharge at your incision site; or flu-like symptoms accompanied by pain in one or both breasts.

    Contact your doctor if you develop a rash or hives; foul-smelling vaginal discharge; burning with urination; blood in your urine; extremely heavy bleeding that soaks a maxi pad within one hour or passing large clots; or swollen, red or painful areas in your legs.

    Postpartum depression may be a concern as well. If your mood is consistently low, you find little joy in life or you have trouble summoning the energy to start a new day, seek help promptly.

If you're disappointed that you had a C-section rather than a vaginal birth, remind yourself that your health and your baby's health are more important than the method of delivery. Although it takes longer to recover from a C-section than from a vaginal birth, the end result is the same — and the adventure of caring for your baby is likely to overshadow it all.

How you prepare
References
  1. Berghella V. Patient information: Cesarean delivery. http://www.uptodate.com/home/index.html. Accessed Aug. 21, 2008.
  2. Berghella V. Cesarean delivery: Postoperative issues. http://www.uptodate.com/home/index.html. Accessed Aug. 21, 2008.
  3. Risks of a Cesarean procedure. American Pregnancy Association. http://www.americanpregnancy.org/labornbirth/cesareanrisks.html. Accessed Aug. 21, 2008.
  4. Reasons for a Cesarean birth. American Pregnancy Association. http://www.americanpregnancy.org/labornbirth/reasonsforacesarean.html. Accessed Aug. 21, 2008.
  5. Creating a positive Cesarean experience. American Pregnancy Association. http://www.americanpregnancy.org/labornbirth/positivecesarean.html. Accessed Aug. 21, 2008.
  6. Landon MB. Cesarean delivery. In: Gabbe SG, et al. Obstetrics: Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2007. http://www.mdconsult.com/das/book/body/102752869-3/0/1528/181.html?tocnode=54291973&fromURL=181.html#4-u1.0-B978-0-443-06930-7..50021-9_954. Accessed June 23, 2008.
  7. Kennare R, et al. Risks of adverse outcomes in the next birth after a first cesarean delivery. Obstetrics & Gynecology. 2007;109(2):270-276.
  8. Daltveit AK, et al. Cesarean delivery and subsequent pregnancies. Obstetrics & Gynecology. 2008:111(6):1327-1334.
  9. Sun C. Post-lumbar puncture headache. http://www.uptodate.com/home/index.html. Accessed Aug. 22, 2008.
  10. Berghella V. Cesarean delivery: Preoperative issues. http://www.uptodate.com/home/index.html. Accessed Aug. 12, 2008.
  11. About Cesarean childbirth. American College of Surgeons. http://www.facs.org/public_info/operation/cesarean.pdf. Accessed Sept. 9, 2008.
  12. Cesarean birth after care. American Pregnancy Association. http://www.americanpregnancy.org/labornbirth/cesareanaftercare.html. Accessed Sept. 23, 2008.
  13. Cesarean procedure. American Pregnancy Association. http://www.americanpregnancy.org/labornbirth/cesareanprocedure.html. Accessed Sept. 23, 2008.
  14. Berghella V. Cesarean delivery: Technique. http://www.uptodate.com/home/index.html. Accessed Aug. 12, 2008.
  15. Prevention of pertussis, tetanus, and diphtheria among pregnant and postpartum women and their infants: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Centers for Disease Control and Prevention. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5704a1.htm. Accessed Sept. 22, 2008.
  16. Is it possible to breastfeed after a Cesarean birth? La Leche League. http://www.llli.org//FAQ/cesarean.html. Accessed Sept. 5, 2008.
  17. Grant GJ. Anesthesia for cesarean delivery. http://www.uptodate.com/home/index.html. Accessed Aug. 12, 2008.
  18. Harms RW (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 9, 2009.
  19. Tita AT, et al. Timing of elective repeat Cesarean delivery at term and neonatal outcomes. The New England Journal of Medicine. 2009;360:111.

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Jan. 20, 2009

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