C-section

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

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Definition

Cesarean delivery — also known as a C-section — is a surgical procedure used to deliver a baby through an incision in the mother's abdomen and a second incision in the mother's uterus.

A C-section may be planned ahead of time if you develop pregnancy complications or you've had a previous C-section and aren't considering vaginal birth after C-section (VBAC). Often, however, the need for a first-time C-section doesn't become obvious until labor has already started.

If you're pregnant, knowing what to expect during a C-section — both during the procedure and afterward — 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 health care provider may recommend a C-section if:

• Your labor isn't progressing. Stalled labor is one of the most common reasons 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 health care provider is concerned about changes in your baby's heartbeat, he or she may recommend a C-section.
• Your baby is in an abnormal position. A C-section may be the safest way to deliver the baby if his or her feet or buttocks enter the birth canal first (breech) or the baby is positioned side or shoulder first (transverse).
• 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, a C-section 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 safest 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's head is too large for your birth canal. Some babies are simply too big to safely deliver vaginally.
• You have a health concern. Your health care provider may suggest a C-section if you have a medical condition that could make labor dangerous, such as unstable heart disease or high blood pressure. In other cases, 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 concern. A C-section is sometimes safer for babies who have certain developmental conditions, such as excess fluid in the brain (hydrocephalus).
• You've had a previous C-section. Depending on the type of uterine incision and other factors, you may be able to attempt a vaginal delivery after a previous C-section. In some cases, however, your health care provider may recommend a repeat C-section.

In addition, some women request C-sections with their first babies — typically to avoid labor or the possible complications of vaginal birth. If you're considering a C-section for your first delivery, work with your health care provider 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 transient tachypnea — a breathing problem marked by abnormally fast breathing during the first few days after birth. 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 — a condition that makes it difficult to breathe.
• 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. Blood transfusions are rarely needed, however.
• Reactions to anesthesia. After regional anesthesia, it's possible to 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 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 health care team 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.
• Surgical injury. Although rare, surgical injuries to nearby organs can occur during a C-section. If this happens, additional surgery 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 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 health care provider may suggest you talk with an anesthesiologist to discuss options for anesthesia during delivery. Your health care provider may also recommend certain blood tests before your C-section. These tests will provide information about your blood type and your level of hemoglobin — the main component of red blood cells. These details will be helpful to your health care team in the unlikely event that you need a blood transfusion during the C-section.

Even if you're planning a vaginal birth, it's important to prepare for the unexpected. Discuss the possibility of a C-section with your health care provider well before your due date. Ask questions, share your concerns and review the circumstances that might make a C-section the best option. In an emergency, your health care provider may not have time to explain the procedure and answer your questions.

After a C-section, you'll need time to rest and recover. Consider recruiting help ahead of time for the weeks following the birth of your baby. This may include household help or child care for other children.

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 can usually be done in less than an 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 will cleanse your abdomen. A tube (catheter) may be placed into your bladder to collect urine. IV lines will be 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 the risk of an upset stomach during the procedure.
• Anesthesia. Most C-sections are done under regional anesthesia — one which numbs only the lower part of your body. A common choice is a spinal block, in which pain medication is injected directly into the sac surrounding your spinal cord. Another option may be epidural anesthesia, in which pain medication is injected into your lower back just outside the sac that surrounds your spinal cord. If you receive 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, general anesthesia is sometimes needed. With general anesthesia, you won't be able to see, feel or hear anything during the birth.
• Abdominal incision. The doctor will make 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, the doctor may make a vertical incision from just below the navel to just above the pubic bone.
• Uterine incision. After the abdominal incision, the doctor will make 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 — when the placenta partially or completely blocks the uterus.
• Delivery. If you have epidural or spinal anesthesia, you'll likely feel some movement as the doctor gently removes the baby from your uterus — but you shouldn't feel pain. The doctor will clear your baby's mouth and nose of fluids, then clamp and cut the umbilical cord. The placenta will be removed from your uterus, and the incisions will be closed with sutures.

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
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. Soon 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 shortly after the C-section as well.

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.

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. Remember that trying to breast-feed when you're in pain may 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.

Before you leave the hospital, talk with your health care provider about any preventive care you may need, including vaccinations. Making sure your vaccinations are up to date can help protect your health and your baby's health.

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 few 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. Don't have sex until your health care provider gives you the green light — often four to six weeks after surgery. You don't have to give up on intimacy in the meantime, though. 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 health care provider may recommend acetaminophen (Tylenol, others) or other medications to relieve pain. If you're constipated or bowel movements are painful, your health care provider may recommend an over-the-counter stool softener.

It's also important to know when to contact your health care provider. Make the call if you experience:

• Any signs of infection — such as a fever higher than 100.4 F (38 C), severe pain in your abdomen, or redness, swelling and discharge at your incision site
• Breast pain accompanied by redness or fever
• Foul-smelling vaginal discharge
• Painful urination
• Bleeding that soaks a maxipad within an hour or contains large clots
• Leg pain or swelling

Postpartum depression — which can cause severe mood swings, loss of appetite, overwhelming fatigue and lack of joy in life — is sometimes a concern as well. Contact your health care provider if you suspect that you're depressed, especially if your signs and symptoms don't fade on their own, you have trouble caring for your baby or completing daily tasks, or you have thoughts of harming yourself or your baby.

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• See Also

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Section Focus
• Placenta previa
• Genital herpes
• C-sections: Is there a limit?
• VBAC (vaginal birth after C-section)
• Elective C-section: Keep fear out of the decision
• To VBAC or not to VBAC?
• Study looks at C-section before 39 weeks
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