What to Expect if You Have a Cesarean Delivery
A cesarean section involves delivering a baby through an incision in a
woman's abdomen and uterus. Approximately 15% to 20% of U.S. babies are born by
cesarean section -- a significant increase from the 3% to 5% rate of 25 years
ago. Although the media like to put a negative spin on this increase by
focusing on the number of unnecessary cesareans, what often gets left out of
the discussion is the number of babies whose lives have been saved or improved
because of this increase in the cesarean rate.
This isn't to say that the 25% or higher cesarean rate at some institutions
is something to cheer about, however. Cesareans continue to be four times
riskier than vaginal deliveries (at least according to oft-quoted studies; in
some patient populations, however, the difference in risk appears to be
significantly smaller). Potential complications include
infections (particularly of the uterus, the
nearby pelvic organs, and the incision)
excessive blood loss
complications from the anesthesia
blood clots due to decreased mobility after
bowel and bladder injuries
You may have heard a common myth about cesareans: that the baby misses out
on the squeezing motion of a vaginal delivery -- a process that helps clear
amniotic fluid from the lungs and stimulate the circulation. There's no
evidence showing that babies delivered through cesarean section are at a
disadvantage because of this so-called lack of squeezing. In truth, a fair bit
of squeezing does occur as the doctor guides your baby out through the incision
he or she has made in your uterus.
Still, most caregivers agree that cesareans should be planned only when
there's a solid medical reason for avoiding a vaginal delivery. Here are some
The baby is predicted to be too large to pass
through your pelvis.
The baby is in a breech or transverse
You have placenta previa.
You have an active genital herpes
You have previously had a cesarean
Note: Not all women who have previously had a cesarean section are
candidates for a repeat cesarean. The cause of your previous cesarean (for
example, a one-time emergency versus a chronic problem), the type of uterine
incision used, and your obstetrical status during your subsequent pregnancy
will determine whether another cesarean will be necessary. We'll be discussing
this issue further on in this chapter.
What a cesarean birth is like
If your section is planned rather than the result of an obstetrical
emergency, you can expect your birth to proceed something like this:
You will be given medication to dry the
secretions in your mouth and upper airway. You may also be given an antacid.
(In the event that you vomit and then inhale some of the contents of your
stomach, the damage that your lungs sustain will be reduced if you have taken
The lower part of your abdomen will be washed
and possibly shaved as well.
A catheter will be placed in your bladder to
keep it empty and to reduce the chances of injury.
An intravenous needle will be inserted into a
vein in your hand or arm to allow for the administering of fluids and
medications during your surgery.
You will be given an anesthetic (typically an
epidural or spinal, but general anesthesia may be used in certain
Your abdomen will be washed with antiseptic
solution and covered with a sterile drape.
A screen will be placed in front of your face
to keep the surgical field sterile, blocking your view of the
Once the anesthetic has had an opportunity to
take effect, an incision will be made through the wall of your abdomen and then
the wall of your uterus. You will probably feel slight pressure at the incision
site, but not any pain. Although your caregiver will attempt to use a so-called
bikini cut (a horizontal cut that is low on your abdomen), a vertical skin
incision is sometimes made in an emergency.
Regardless of the type of skin incision, the
uterine incision is made horizontally and low down on the uterus unless the
position of your baby or the placenta demands a vertical cut
The amniotic sac will be opened and the
amniotic fluid will pour out.
Your baby will be eased out manually or, on
occasion, with the aid of forceps or a vacuum extractor. You may feel a slight
tugging sensation as well as feelings of pressure, if you've had an epidural.
You probably won't feel anything, if you've had a spinal, except pressure on
your upper abdomen if the doctor needs to apply pressure to push the baby out
through the incision.
Your baby's nose and mouth will be suctioned.
The umbilical cord will be clamped and cut, and the placenta will be removed.
The doctor will hand the baby to the nurse or other caregiver responsible for
suctioning the baby.
The baby's caregiver will assess the baby and
perform the Apgar test.
Your uterus and abdomen will be stitched up.
The stitches in your uterus will dissolve on their own. Depending on your
doctor's preference, your abdominal incision will be closed with
stainless-steel staples or nonabsorbent sutures, which can be removed anytime
after three or four days, or absorbable sutures below the skin surface, which
dissolve on their own.
If you feel up to it, you may have the
opportunity to hold your baby in the delivery room.
You will be taken to the recovery room, where
your blood pressure, pulse rate, and respiratory rate will be monitored, and
you will be watched for excessive bleeding and other potential complications.
You may be given antibiotics to minimize your chances of infection and will be
offered pain medication either through the IV or in an injection after the
anesthetic wears off.
You will be moved to a room on the postpartum
floor. If you are intending to breastfeed, your nurse will show you how to
position yourself and your baby to ensure that you are as comfortable as
possible, despite your incision. (You will want to either place a pillow over
your incision and rest your baby on that while you sit up straight in a chair,
or feed your baby when you are lying on one side.)
Six to eight hours after your surgery, your
catheter will be removed and you will be encouraged to get out of bed and move
You will require intravenous fluids for a day
or two until you're able to start eating and drinking.
Your doctor will probably prescribe an
analgesic to help you cope with the discomfort and pain that typically
accompany a cesarean recovery.
You will be discharged from hospital three to
five days after your surgery, and you will be able to resume your normal
activities four to six weeks after your baby's birth.
Up until now, we've been talking about planned cesarean sections. An
emergency cesarean section may be required if, during the course of labor,
the baby's heart rate becomes irregular,
indicating that she may be in distress and may not be able to withstand the
stress of continued labor;
the flow of blood and oxygen through the
umbilical cord is being excessively restricted because of the position of the
cord or the baby;
the placenta has started to detach from the
uterine wall (placental abruption);
the baby is not moving down into the birth
canal because the cervix has stopped dilating or the baby is too large for the
mother's pelvis, or because of some other obstetrical complication.