What to Expect if You Have a Cesarean Delivery

By Andrea Hecht
WebMD Feature

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 surgery
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 common reasons:

The baby is predicted to be too large to pass through your pelvis.
The baby is in a breech or transverse position.
You have placenta previa.
You have an active genital herpes infection.
You have previously had a cesarean section.

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 an antacid.)
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 circumstances).
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 delivery.
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 instead.
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 around.
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.