What is a Cesarean Section?
Cesarean section (often called a c-section or surgical birth) is a birth during which a mother receives local anesthetic and her baby is surgically removed through an incision in the abdomen and uterine wall.
Approximately one third of births in the United States are cesarean sections.
How Are Cesareans Performed?
Cesarean section preparations are similar to that of other surgeries. The pregnant woman is taken to a sterile room and hooked up to an IV to receive fluids and any necessary medications (i.e. antibiotics to ward off infection). The abdomen is washed with antiseptic and a catheter is placed in the urethra to help drain the bladder. A curtain is usually set up to block the mother's view of the surgery site.
Anesthesia - usually an epidural block or a spinal block - is administered for pain prevention and works by numbing the bottom half of the body. In some cases, general anesthesia is used when it is best to have the mother asleep for the birth.
After the baby is removed from the uterus through the incision, the physician will stitch up the cesarean incision and may use staples to aid in holding the wound together and aid healing.
Why Have a Cesarean Section?
Cesarean section is a helpful method of delivering a baby when vaginal birth is not possible or would cause great harm to the mother or child.
Common situations warranting a c-section include:
- Multiples birth
- Positioning of the baby is not conducive to vaginal birth (breech or transverse)
- Placental problems (i.e. placenta previa or accreta)
- Maternal health condition requiring immediate treatment
- Certain birth defects are present
- Labor stops or does not progress
- Maternal infection (such as HIV)
- Fetal distress
- Umbilical cord prolapse
- Pelvic anomalies (cephalopelvic disproportion)
Timing a Cesarean Section
Cesarean births may be scheduled in advance of the expected date of delivery. If both mother and baby are healthy, cesarean births are usually scheduled to occur between 36-38 weeks gestation in order to avoid the onset of labor. After 36 weeks gestation, the baby is considered to be full-term and will usually be fully developed physically.
In medical emergencies a cesarean may be ordered prior to 36 weeks gestation. In these cases, the mother may receive steroid injections in order to help mature the baby's lungs prior to birth.
Complications From Cesarean Section
As with all surgeries, complications may occur during or after a cesarean section. Women may experience:
- Infection (i.e. thrush) at the incision site or within the abdomen
- Injury to the bladder, bowel, or other abdominal organs
- Adverse effects from anesthesia
- Excessive bleeding/hemorrhage which can result in hysterectomy
- Blood clots
- Muscle loss in lower abdomen
- Uterine scarring or adhesion
- Severe complications resulting in death
Call your physician immediately if you have any of the following symptoms post-cesarean:
- Fever of 100.4 or higher
- Blood or pus draining from the incision
- Pain that doesn't lessen or that gets worse
- Difficulty with breathing
- Bleeding that doesn't diminish or that worsens
Infants sometimes experience complications, as well, including:
Recovering From a Cesarean Section
A cesarean section is a surgical procedure and, as such, requires recovery time. Typically mothers who've had a c-section will have longer stays in the hospital following delivery, around 3-5 days. In addition, physical recovery from a cesarean section takes 4-6 weeks.
Before leaving the hospital, women who've had a cesarean section should be able to urinate without a catheter. If staples were used to close the incision, they will likely be removed prior to discharge.
Residual aches and pains are common following birth due to involution (the uterus shrinking back to normal size) and tenderness at the incision site. Too much activity may aggravate the recovering body. Most physicians will provide a prescription for pain reliever prior to discharge.
Bleeding called lochia will also occur for up to six weeks following birth. Stock up on menstrual pads designed for heavy bleeding.
Recovery after c-section can be aided by:
- Taking showers instead of baths until the incision site has healed
- Avoiding activities such as exercise, climbing stairs, sexual intercourse, and lifting anything heavier than the baby
- Drinking plenty of fluids
- Setting up baby supplies in an easy-to-reach place
- Help from family and friends with errands, household chores, meals, etc.
Repeat Cesarean Sections
Cesarean sections may be repeated in subsequent births for many reasons:
- Risk of uterine rupture from labor
- Conditions are similar to prior cesarean section birth
- Prior traumatic birth
- Preference of the mother
There may be some risk to a woman's health after three c-sections, particularly if uterine adhesions are present. Complications such as uterine rupture, placental problems, excess bleeding, and injuries to the bladder are more likely with each additional cesarean.
It is important to speak with your doctor about the risks and benefits of a repeated cesarean section, as every woman's body is unique.
Breastfeeding and Cesarean Section
For mothers planning to breastfeed, it is extremely important to attempt nursing within 4-6 hours, if not within the ideal first hour after birth. If breastfeeding is delayed or the infant has problems with latch due to disabilities or injury, speak with the obstetrical staff about acquiring a hospital-grade breast pump.
In some cases, supplementation with donor milk or formula may be necessary if there are complications with lactation.
A certified lactation consultant can be very helpful in aiding with positioning the baby for breastfeeding and helping a mother to avoid pressure at the incision site.
For more information about breastfeeding, see our Breastfeeding Resource Page.
Additional Cesarean Section Resources
What Every Woman Needs to Know About Cesarean Sections - Information, including a downloadable booklet from Childbirth Connection
The American College of Obstetricians and Gynecologists FAQ for Cesarean Birth
Breastfeeding After C-Section from Kellymom.com
C-Section Support in England - help with trauma from c-section
CARES, Inc. (Cesarean Awareness Recovery Education Support) - Australia-based education and support site