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Cesarean Birth
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Cesarean Birth

(C-Section)

En Español (Spanish Version)

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Definition

In a cesarean birth (C-section), the baby is delivered through an incision in the mother's abdomen. In the US, 15%-40% of all births are delivered by C-section.

Cesarean Delivery

Cesarean Delivery

© 2011 Nucleus Medical Media, Inc.

Reasons for Procedure

The following situations may require a C-section:

  • Large baby
  • Baby is not in a head down position
  • Maternal medical conditions (eg diabetes , high blood pressure , active herpes infection, HIV positive)
  • Placenta previa—The placenta (the organ that links the mother and the baby) may be blocking the birth canal.
  • Failure of labor to progress—Effective labor slows or stops before the baby is born.
  • Baby shows signs of distress, such as an abnormal heart rate during labor
  • Previous cesarean birth—In some cases, after one cesarean birth, it is best to have other babies delivered by cesarean.
  • Fetal anomalies—Fetal problems that have been diagnosed by testing during the pregnancy may require a C-section.

Possible Complications

Cesarean birth is a surgery, and there are risks involved. The estimated risk of a woman dying after a cesarean birth is less than one in 2,500. The risk of death after a vaginal birth is less than one in 10,000. Other risks include:

  • Infection—The uterus or nearby pelvic organs, such as the bladder or kidneys, can become infected.
  • Bleeding—The average loss is about twice as much with cesarean birth as with vaginal birth.
  • Decreased bowel function—The bowel sometimes slows down for several days after surgery, resulting in distention, bloating, and discomfort.
  • Damage to other organs in the abdomen
  • Longer hospital stay and recovery time—Cesarean stay is typically 4-5 days in the hospital after a cesarean delivery, and 1-3 days for a vaginal birth.
  • Reactions to anesthesia—The mother's health could be endangered by unexpected responses to anesthesia or other medicines.
  • Risk of additional surgeries—These may include hysterectomy, bladder repair, or repeat C-sections with future pregnancies.

Factors that may increase the risk of complications include:

Cesarean birth also carries risks for babies, especially those who are born prematurely. The risk of death for premature babies delivered by elective C-section is 54 out of 10,000, while the risk of death for premature babies born vaginally is 14 out of 10,000.

What to Expect

Prior to Procedure

Having a C-section is often unplanned. If you have a scheduled C-section, you may be asked to not eat or drink after midnight before the procedure.

Anesthesia

You may be given:

  • General anesthesia—You will be asleep.
  • Regional anesthesia (eg, epidural or spinal block)—An area of your body will be numb, but you will be awake.

Many women prefer regional anesthesia so that they can be awake to see their new baby.

Description of the Procedure

The doctor will make incisions in the abdominal skin and uterus. There are two different types of abdominal skin incisions: vertical (up and down) or horizontal (side to side). There are three different types of incisions for the uterus:

  • Low transverse incisions—most common type, usually bleed less, form stronger scars, and present less danger of rupture during future labors
  • Classical incisions (high vertical incisions)—associated with the highest risk of bleeding and future rupture of the uterus, used only in emergency situations
  • Low vertical incisions—used to deliver a baby in an awkward position or if the incision may need to become a classical incision

Once the incisions are made, the baby will be delivered. Your uterus will be closed with stitches that later dissolve on their own. Stitches or staples will be used to close the abdomen.

Immediately After Procedure

Your baby will be examined. Depending on the condition of you and your baby, you may be able to hold your baby.

How Long Will It Take?

45-60 minutes

Will It Hurt?

Anesthesia prevents pain during the surgery. You may feel some pressure and tugging as the uterus is opened and the baby and placenta are removed. You will receive pain medicines while you recover to manage pain and discomfort.

Average Hospital Stay

3-5 days

Post-procedure Care

At the Hospital

  • Very soon after birth, your baby may be placed on your chest. This skin-to-skin contact may lead to improved breasfeeding success.
  • You may need some help learning breastfeeding positions. The correct position will keep you from putting too much pressure on your incision.
  • You may need medicine to help with nausea or pain.
  • You will likely experience some uterine cramping and pain.
  • Your bowels will work more slowly than usual. You may need to eat a light diet at first. Chewing gum may help speed the process of your bowel function returning to normal.
  • You may be given special compression stockings. They will help to decrease the possibility of blood clots forming in your legs.
  • For lung health, you may be asked to use an incentive spirometer and cough often. These steps will help you breathe deeply.
  • You will be encouraged to walk very soon after surgery. You will be asked not to lift anything heavier than your baby.
  • After any delivery, there will be heavy vaginal bleeding. You will need to use an absorbent sanitary napkin.
  • You may be on a clear liquid diet after surgery. You will advance to a normal diet as you are able.

At Home

When you return home, do the following to help ensure a smooth recovery:

  • Avoid lifting anything heavier than your baby for the first weeks after surgery.
  • Do not drive until you doctor says it is all right to do so.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Delay having sexual intercourse or putting any objects in the vagina until you have had your 6-week check-up.
  • Breastfeeding is encouraged.
  • Consider joining a support group for new mothers. You can get encouragement and learn new parenting strategies.
  • Be sure to follow your doctor’s instructions.

You should heal quickly and completely after a C-section. Talk with your doctor about the type of incision used. It may play a role in decisions about future births.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

  • Signs of infection, including fever and chills
  • Excessive bleeding, redness, swelling, increasing pain, or discharge from the incision site
  • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
  • Pain that you cannot control with the medicines you have been given
  • Swelling and/or pain in one or both legs
  • Cough, shortness of breath, or chest pain
  • Joint pain, fatigue, stiffness, rash, or other new symptoms
  • Dizziness or faintness
  • Heavy vaginal bleeding
  • Foul-smelling vaginal discharge

In case of an emergency, CALL 911.

RESOURCES:

American Congress of Obstetricians and Gynecologists
http://www.acog.org/publications/patient_education/

March of Dimes Birth Defects Foundation
http://www.marchofdimes.com/

CANADIAN RESOURCES:

The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org/index_e.asp

Women's Health Matters
http://www.womenshealthmatters.ca/

References:

C-section. Mayo Clinic.com website. Available at: http://www.mayoclinic.com/health/c-section/MY00214. Updated January 2009. Accessed November 12, 2010.

Cesarean fact sheet. International Cesarean Awareness Network website. Available at: http://www.ican-online.org/pregnancy/cesarean-fact-sheet. Accessed June 10, 2008.

Cesarean section. Childbirth.org website. Available at: http://www.childbirth.org/section/section.html . Accessed June 10, 2008.

7/21/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: De Luca R, Boulvain M, Irion O, Berner M, Pfister RE. Incidence of early neonatal mortality and morbidity after late-preterm and term cesarean delivery. Pediatrics. 2009;123:e1064-1071.

10/23/2009 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Abd-El-Maeboud KH, Ibrahim MI, Shalaby DA, Fikry MF. Gum chewing stimulates early return of bowel motility after caesarean section. BJOG. 2009;116:1334-1339.

12/4/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Marín Gabriel M, Llana Martín I, López Escobar A, et al. Randomized controlled trial of early skin-to-skin contact: effects on the mother and the newborn. Acta Paediatr. 2009 Nov 12. [Epub ahead of print]

6/2/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.



Last reviewed September 2010 by Silpa Senchani, MD


Last updated Updated: 6/2/2011

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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