C-section

• Definition
• Why it's done
• Risks
• How you prepare
• What you can expect

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Definition

Caesarean delivery — also known as a C-section — is a surgical procedure used to deliver your baby through an incision in your abdomen. Some C-sections are planned due to pregnancy complications or because you've had a previous C-section. But, in many cases, the need for a first-time C-section doesn't become obvious until labor has already started. Knowing what to expect during the procedure and recovery can help you prepare.

Why it's done

Sometimes a C-section is safer for you or your baby than is a vaginal delivery. Your doctor may recommend a C-section if:

• Your labor isn't progressing. Stalled labor is the most common reason for a C-section. Perhaps your cervix isn't opening enough despite strong contractions over several hours. Or the baby's head may simply be too big to pass through your birth canal.
• Your baby's heartbeat suggests reduced oxygen supply. If your baby isn't getting enough oxygen or your doctor is concerned about changes in your baby's heartbeat, he or she may recommend a prompt C-section.
• Your baby is in an abnormal position. A baby whose feet or buttocks enter the birth canal before the head is in the breech position. If your doctor isn't able to move the baby into a more favorable position before labor begins, you may need a C-section to reduce the risk of complications. A C-section is also needed if your baby is lying horizontally across your uterus.
• Your baby's head is in the wrong position. If your baby enters the birth canal chin up or with the top of the forehead or face leading the way, he or she may not fit through your pelvis. A C-section may be the safer way to deliver the baby.
• You're carrying twins, triplets or other multiples. When you're carrying multiple babies, it's common for one or more of the babies to be in an abnormal position. In this case, Caesarean birth is often safer — especially for the second baby.
• There's a problem with your placenta. If the placenta detaches from your uterus before labor begins (placental abruption) or the placenta covers the opening of your cervix (placenta previa), C-section is often the safer option.
• There's a problem with the umbilical cord. A C-section may be recommended if a loop of umbilical cord slips through your cervix ahead of your baby or if the cord is compressed by the uterus during contractions.
• Your baby is very large. Some babies are simply too big to safely deliver vaginally. Typically this is only a factor if you have diabetes.

• You have a health problem. If you have a condition such as diabetes, heart disease or lung disease, your doctor may induce labor early to reduce the risk of pregnancy-related complications. If the induction isn't successful, you may need a C-section.

  In other circumstances, a C-section may be recommended if you have an active genital herpes infection or another condition that your baby might acquire while passing through the birth canal.

• Your baby has a health problem. A C-section may be safer for babies with certain developmental problems, such as failure of the spine to close properly (spina bifida) or excess fluid in the brain (hydrocephalus).
• You've had a previous C-section. Depending on the type of incision and other factors, you may be able to attempt a vaginal delivery after a previous C-section. In some cases, however, your doctor may recommend a repeat C-section.

In addition, some women request elective C-sections with their first babies — typically to avoid labor or the possible complications of vaginal birth. If you're considering an elective C-section, work with your doctor to make the best decision for you and your baby.

Risks

Recovery from a C-section takes longer than does recovery from a vaginal birth. And like other types of major surgery, C-sections also carry a higher risk of complications.

Risks to your baby include:

• Breathing problems. Babies born by C-section are more likely to develop a breathing problem marked by abnormally fast breathing during the first few days after birth (transient tachypnea). Elective C-sections done before 39 weeks of pregnancy or without proof of the baby's lung maturity may increase the risk of other breathing problems, including respiratory distress syndrome.
• Fetal injury. Although rare, accidental nicks to the baby's skin can occur during surgery.

Risks to you include:

• Inflammation and infection of the membrane lining the uterus. This condition — known as endometritis — may cause fever, chills, back pain, foul-smelling vaginal discharge and uterine pain. It's often treated with intravenous (IV) antibiotics.
• Increased bleeding. You may lose more blood with a C-section than with a vaginal birth. However, blood transfusions are rarely needed.
• Urinary tract infection. You may develop a urinary tract infection in the bladder or kidneys.
• Decreased bowel function. Any abdominal surgery slows the movement of waste material through your intestines. Some medications for pain relief may further contribute to this problem, leading to constipation.
• Reactions to anesthesia. After regional anesthesia, a small number of women may experience a headache caused by a leak of the fluid around the spinal canal into the tissues of the back. Allergic or adverse reactions to the anesthetic also are possible.
• Blood clots. The risk of developing a blood clot inside a vein — especially in the legs or pelvic organs — is about four times greater after a C-section than after a vaginal delivery. If a blood clot travels to your lungs (pulmonary embolism), the damage can be life-threatening. Your doctors will take steps to prevent blood clots. You can help, too, by walking frequently soon after surgery.
• Wound infection. An infection at or around the incision site is possible. When a wound is infected, it may open at the skin and release pus.
• Additional surgeries. Although rare, surgical injuries to nearby organs can occur during a C-section. If this happens, additional operations may be needed.
• Increased risks during future pregnancies. After a C-section, you face a higher risk of potentially serious complications — including bleeding, placenta previa, abnormal fetal positions and tearing of the uterus along the scar line from the prior C-section (uterine rupture) — in a subsequent pregnancy than you would after a vaginal delivery.

How you prepare

If your C-section is scheduled in advance, your doctor may suggest you talk with an anesthesiologist to discuss your questions about anesthesia and options for pain relief during delivery.

Your doctor may also recommend you have blood tests before your C-section. This is so that information about your blood type and your levels of hemoglobin — the iron-rich protein in red blood cells that gives blood its red color — are available to your health care team during the procedure. This information can be helpful to your medical team in the unlikely event that you need a blood transfusion.

After a C-section, you'll need several weeks to rest and recover. So, before your C-section, consider requesting help at home for the weeks following the birth of your baby. This may include arranging for extra child care if you have older children.

Preparing for the unexpected
Getting the unexpected news that you need a C-section can be stressful, both for you and your partner. And in an emergency, your doctor may not have time to explain the procedure and answer your questions. So, discuss the possibility of a C-section with your doctor well before your due date. Ask questions, share your concerns and review the circumstances that might make a C-section the best option.

What you can expect

CLICK TO ENLARGE

	Abdominal 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.

• See Also

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• Placenta previa

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