(Cesarean Section, C-section, Cesarean Birth)
What is a cesarean delivery?
Cesarean delivery (also called a cesarean section or C-section) is the surgical delivery of a baby by an incision through the mother's abdomen (belly) and uterus(womb). This procedure is done when it is determined to be a safer method than a vaginal delivery for the mother, baby, or both.
In a cesarean delivery, an incision (cut) is made in the skin and into the uterus at the lower part of the mother’s abdomen. The incision in the skin may be vertical (longitudinal) or transverse (horizontal), and the incision in the uterus may be vertical or transverse.
A transverse incision extends across the pubic hairline, whereas, a vertical incision extends from the navel to the pubic hairline. A transverse uterine incision is used most often, because it heals well and there is less bleeding. Transverse uterine incisions also increase the chance for vaginal birth in a future pregnancy. However, the type of incision depends on the conditions of the mother and the fetus.
Reasons for the procedure
If a woman is unable to deliver vaginally, the fetus is delivered surgically by performing a cesarean delivery. Some cesarean deliveries are planned and scheduled, while others may be done as a result of problems that occur during labor.
There are several conditions which may make a cesarean delivery more likely. These include, but are not limited to:
Abnormal fetal heart rate. The fetal heart rate during labor is a good sign of how well the fetus is handling the contractions of labor. The heart rate is monitored during labor, with the normal range varying between 120 to 160 beats per minute. If the fetal heart rate shows there may be a problem, immediate action can be taken, such as giving the mother oxygen, increasing fluids, and changing the mother's position. A cesarean delivery may be necessary.
Abnormal position of the fetus during birth. The normal position for the fetus during birth is head-down, facing the mother's back. However, sometimes a fetus is not in the right position, making delivery more difficult through the birth canal.
Labor that fails to progress or does not progress normally
Baby is too large to be delivered vaginally
Placental complications (such as placenta previa, in which the placenta blocks the cervix and presents the risk of becoming detached from the uterus too soon). Premature detachment from the fetus is known as abruption.
Certain maternal medical conditions (such as diabetes, high blood pressure, or human immunodeficiency virus [HIV] infection)
Active herpes lesions in the mother’s vagina or cervix
Twins or other multiples
Previous cesarean delivery
There may be other reasons for your doctor to recommend a cesarean delivery.
Risks of the procedure
As with any surgical procedure, complications may occur. Some possible complications of a cesarean delivery may include, but are not limited to:
Abnormal separation of the placenta, especially in women with previous cesarean delivery
Injury to the bladder or bowel
Infection in the uterus
Difficulty urinating and/or urinary tract infection
Delayed return of bowel function
A woman may or may not be able to have a vaginal birth with a future pregnancy, called a vaginal birth after cesarean (VBAC). Depending on the type of uterine incision used for the cesarean birth, the scar may not be strong enough to hold together during labor contractions.
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.
Before the procedure
Your doctor will explain the procedure to you and give you the chance to ask any questions that you might have about the procedure.
You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear. If you want to have a tubal ligation (a permanent method of birth control in which the fallopian tubes are cut, cauterized, or banded to keep the eggs from getting into the uterus) as part of your surgery, you must sign a consent form for this procedure.
You will be asked when you last had anything to eat or drink. If your cesarean delivery is a planned procedure and requires general, spinal, or epidural anesthesia, you will be asked to fast (not eat or drink anything) for eight hours before the procedure, generally after midnight.
Notify your doctor if you are sensitive to or are allergic to any medications, latex, iodine, tape, and anesthetic agents (local and general).
Notify your doctor of all medications (prescription and over-the-counter) and herbal supplements that you are taking.
Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. You may need to stop these medications prior to the procedure.
You may be given medication to decrease the acid in your stomach and to help dry the secretions in your mouth and breathing passages.
Plan to have someone stay with you after a cesarean delivery. You may have pain in the first few days and will need help with the baby.
Based upon your medical condition, your doctor may need you to do other things to be ready for this surgery.
During the procedure
A cesarean delivery will be done in an operating room or a designated delivery room. Procedures may vary depending on your condition and your doctor’s practices.
In most cases, you will be awake for a cesarean delivery. Only in rare situations will a mother require general anesthesia (you will be given drugs that make you sleep) for this type of birth. Most cesarean deliveries today are done with a regional anesthesia such as an epidural or spinal. With these types of anesthesia, you will have no feeling from your waist down, and you will be awake and able to hear and see your baby as soon as he/she is born.
Generally, a cesarean delivery follows this process:
You will be asked to undress completely and put on a hospital gown.
You will be positioned on an operating or examination table.
A urinary catheter may be put in if it was not done before coming to the operating room.
An intravenous (IV) line may be started in your arm or hand.
For safety reasons, straps will be placed over your legs to secure your position on the table.
Hair around the surgical site may be clipped and the skin will be cleaned with an antiseptic solution.
Your abdomen will be draped with sterile material. A drape will also be placed above your chest to screen the surgical site.
The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the procedure.
Once the anesthesia has taken effect, an abdominal incision will be made above the pubic bone, either transverse or vertical. You may hear the sounds of an electrocautery machine that is used to seal off bleeding.
Deeper incisions will be made through the tissues and muscle until the uterine wall is reached. A final incision will be made in the uterus. This incision is either transverse or vertical.
The amniotic sac will be opened, and the baby will be delivered through the opening. You may feel some pressure and/or a pulling sensation.
The umbilical cord will be cut.
Medication to help the uterus contract and expel the placenta will be given in your IV.
The placenta will be removed.
The uterus will be examined for any tears or remaining pieces of placenta.
Sutures will be used to close the incision in the uterine muscle and the uterus will be repositioned in the pelvic cavity.
The muscle and tissue layers will be closed with sutures and the skin incision will be closed with sutures or surgical staples.
A sterile bandage/dressing will be applied.
After the procedure
In the hospital
You will be taken to the recovery room for observation. Nurses will monitor your blood pressure, breathing, pulse, bleeding, and the firmness of your uterus.
Usually, your baby can be brought to you while you are in the recovery area after surgery. In some cases, babies born by cesarean will first need to be monitored in the nursery for a short time. Breastfeeding can begin in the recovery area, just as with a vaginal delivery.
After about one to two hours in the recovery area, you will be moved to your room for the rest of your hospital stay.
As your anesthesia wears off, you may receive pain medication as needed, either by a nurse or by administering it yourself through a device connected to your intravenous line. In some cases, pain medication may be given through the epidural catheter until it is removed.
In addition to the soreness of your abdomen, you may also have gas pains as the intestinal tract begins working again after surgery. You will be encouraged to get out of bed. Moving around and walking help relieve gas pains. Your doctor may also recommend medication for this. You may feel some uterine contractions called after-pains for a few days. The uterus continues to contract and get smaller over several weeks.
Your urinary catheter is removed the day after surgery.
Depending on your situation, you may be given liquids to drink a few hours after surgery. Your diet may be gradually advanced to more solid foods as tolerated.
You may be given antibiotics in your IV while in the hospital and a prescription to continue the antibiotics at home.
You will need to wear a sanitary pad for bleeding. It is normal to have vaginal bleeding for several days after birth, followed by a discharge that changes from dark red/brown to a lighter color over several weeks.
You should not douche, use tampons, or have sex until the time recommended by your doctor. You may also have other restrictions on your activity, including no strenuous activity, driving, or heavy lifting.
Take a pain reliever as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.
Arrangements will be made for a follow-up visit with your doctor, usually two to three weeks after the surgery.
Notify your doctor if you have any of the following:
Foul-smelling drainage from your vagina
Fever and/or chills
Severe abdominal pain
Increased pain, redness, swelling, or bleeding or other drainage from the incision site
Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.