cesarean section with baby

What is a cesarean delivery?

A cesarean delivery or cesarean section is the abdominal delivery of a baby after an incision is made through the abdomen and the uterus.

Most of the time a pregnant woman will be able to give birth to a baby vaginally. In the United States, about 1 in 3 babies are being born by cesarean section (C-Section). This number has remained stable for the last decade. A cesarean section is an operative delivery done by cutting through the mother's abdomen and uterus and delivering the baby through the incision. About 1 in 3 cesareans are done as "repeat cesareans" which are C-sections done in women who previously had a cesarean. When vaginal births are too risky or the birth must happen very quickly, a cesarean section, or c-section, is chosen for the safety of both baby and mom.

When is a C-section warranted?

About 80% of cesarean sections are done for one of the following four reasons:

  1. Repeat cesarean section
  2. Abnormal labor progress
  3. Non-reassuring fetal status (some call it "fetal distress")
  4. Breech (baby with head up/butt down)

Other reasons for cesarean delivery include premature babies, placenta previa, abruptio placentae, high blood pressure, a large baby, and medical complications.

Having one C-section does not mean every birth will end with a cesarean birth. VBAC, or vaginal birth after cesarean, is a choice she will need to discuss with her doctor the next time she is ready to give birth. There are indications for doing a cesarean section before and during labor:

Before labor

  • If you had a previous cesarean and don’t want to go into labor (repeat cesarean)
  • If you had a previous cesarean with a vertical (up-and-down) incision in the uterus or another surgery cutting into the uterus
  • If you have a placenta previa
  • If the baby is breech or transverse
  • If the baby is too big
  • If the baby shows an abnormal fetal evaluation and/or cannot tolerate labor
  • If you have triplets or more babies
  • If you have a medical condition and can’t tolerate labor
  • Obstruction to the birth canal, such as fibroids or ovarian tumors
  • An infection such as herpes or HIV

During labor

  • Presumed fetal compromise: If your baby cannot tolerate labor or shows problems (abnormal fetal tracing)
  • If you develop medical or other complications such as abruptio placentae or preeclampsia and need to be delivered quickly
  • When the baby does not fit through the pelvis (cephalopelvic disproportion=CPD) 

Types of anesthesia

C-sections are often performed under so-called "regional anesthesia," either spinal or epidural anesthesia, with mom awake and able to talk and understand the entire procedure. Mom will often be sleepy or sedated to a point where she may appear groggy. The epidural leaves the anesthesiologist the option to use more or less anesthesia as needed. The spinal, on the other hand, is a one-shot delivery of anesthesia that cannot be controlled nor repeated.

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The idea is to block pain completely while allowing the woman to be a part of the birthing process. Typically, spinal anesthesia provides deeper pain relief and takes less time to fully block pain. Spinal can be given in the operating room just before the doctor starts C-section delivery. Spinals are also commonly used for emergency C-sections. 

If there are complications during the C-section delivery, general anesthesia may be used to put mom “under” if only for a short while. The use of general anesthesia increases the risks associated with C-section delivery and recovery. 

How is a cesarean delivery performed?

During the cesarean section, the lower abdomen just below the bikini line will be cut from hip to hip. This cut is officially called a "Pfannenstiel incision" named after the obstetrician Hermann Joannes Pfannenstiel (1862-1909). It is more commonly called a “bikini cut” due to the fact that the resulting scar can be hidden when mom chooses to wear a bikini in the future. After the outer layers of the abdomen are opened, the obstetrician will quickly cut through the layers of muscle and connective fibers until the uterus is reached.

Once the doctor has reached the uterus, the time has arrived to introduce baby to the world. The obstetrician will cut through the uterus and break the bag of waters surrounding the baby. The baby will be lifted from the abdomen, quickly shown to mom and dad and rushed off for the first tests of his or her life.

After the baby is removed from the belly, the obstetrician will then tend to mom. The uterus will be removed from the abdominal cavity and placed on the stomach or it may be left inside the abdomen, and the placenta and any debris left from the weeks of gestation are removed. Once the uterus is clean, sutures will close the opening in the uterus. The doctor will suture the fascia surrounding the muscles and then the skin in order to completely close the wound.

A C-section is a safe but major operation with few complications. There is nothing commonplace about opening the abdominal cavity in order to birth a baby and thus the safety and health precautions surrounding the C-section are very stringent. Often, the father will be allowed to sit in the room while the baby is born, but the surgical area will be protected from view by a drape leaving dad to sit with mom the entire time.

After the surgery and post-recovery, mom will be given an IV solution to help the uterus contract back to normal, pre-pregnancy size. This IV medication will cause cramping and may be slightly painful.

Recovery after C-section

It can take six weeks or more for a woman to recover from a C-section. Pain medications are given in most cases to control pain while caring for the baby. New moms will also have a longer hospital stay after a C-section to ensure she is safely recovery from major surgery. Once home, she will need to keep lifting, twisting and bending to a minimum. Walking, however, is permitted and encouraged. Just a few hours after having a C-section, moms are allowed to walk around as pain permits. 

The recovery time after a C-section can range from 3 weeks to 12 weeks depending on each mom's health and the level of activity after the operation. Mom will usually stay in the hospital for 3 to 4 days after surgery to make sure there are no complications with the surgery and that the body is returning to normal.

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