Cesarean Section

Topic Overview

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If you have had a C-section and would like information about how a cesarean affects future deliveries, see the topic Vaginal Birth After Cesarean (VBAC).

What is a cesarean section?

A cesarean section is the delivery of a baby through a cut (incision) in the mother’s belly and uterus. It is often called a C-section. In most cases, a woman can be awake during the birth and be with her newborn soon afterward. See a picture of a delivery by C-section.

If you are pregnant, chances are good that you will be able to deliver your baby through the birth canal (vaginal birth). But there are cases when a C-section is needed for the safety of the mother or baby. So even if you plan on a vaginal birth, it’s a good idea to learn about C-section, in case the unexpected happens.

When is a C-section needed?

A C-section may be planned or unplanned. In most cases, doctors do cesarean sections because of problems that arise during labor. Reasons you might need an unplanned C-section include:

• Labor is slow and hard or stops completely.
• The baby shows signs of distress, such as a very fast or slow heart rate.
• A problem with the placenta or umbilical cord puts the baby at risk.
• The baby is too big to be delivered vaginally.

When doctors know about a problem ahead of time, they may schedule a C-section. Reasons you might have a planned C-section include:

• The baby is not in a head-down position close to your due date.
• You have a problem such as heart disease that could be made worse by the stress of labor.
• You have an infection that you could pass to the baby during a vaginal birth.
• You are carrying more than one baby (multiple pregnancy).
• You had a C-section before, and you have the same problems this time or your doctor thinks labor might cause your scar to tear (uterine rupture).

In some cases, a woman who had a C-section in the past may be able to deliver her next baby through the birth canal. This is called vaginal birth after cesarean (VBAC). If you have had a previous C-section, ask your doctor if VBAC might be an option this time.

In the past 40 years, the rate of cesarean deliveries has jumped from about 1 out of 20 births to about 1 out of 4 births.¹ This trend has caused experts to worry that C-section is being done more often than it is needed. Because of the risks, experts feel that C-section should only be done for medical reasons.

What are the risks of C-section?

Most mothers and babies do well after C-section. But it is major surgery, so it carries more risk than a normal vaginal delivery. Some possible risks of C-section include:

• Infection of the incision or the uterus.
• Heavy blood loss.
• Blood clots in the mother’s legs.
• Injury to the mother or baby.
• Problems from the anesthesia, such as nausea, vomiting, and severe headache.
• Breathing problems in the baby if it was delivered before its due date.

If she gets pregnant again, a woman with a C-section scar has a small risk of the scar tearing open during labor (uterine rupture). She also has a slightly higher risk of a problem with the placenta, such as placenta previa.

How is a C-section done?

Before a C-section, the mother gets medicine (either epidural or spinal anesthesia) to numb her belly and legs. A nurse may put a tiny needle called an IV in one of the mother's veins to give her a sedative to help her relax. Fast-acting general anesthesia, which makes the mother sleep during the surgery, is only used in an emergency.

Once the anesthesia is working, the doctor makes the incision. Usually it is made low across the belly, just above the pubic hair line. This may be called a “bikini cut.” Sometimes the incision is made from the navel down to the pubic area. See a picture of C-section incisions. After lifting the baby out, the doctor removes the placenta and closes the incision with stitches.

How long does it take to recover from a C-section?

Most women go home 3 to 5 days after a C-section, but it may take 4 weeks or longer to fully recover. By contrast, women who deliver vaginally usually go home in a day or two and are back to their normal activities in 1 to 2 weeks.

Before you go home, a nurse will tell you how to care for the incision, what to expect during recovery, and when to call the doctor. In general, if you have a C-section:

• You will need to take it easy while the incision heals. Avoid heavy lifting, intense exercise, and sit-ups. Ask family members or friends for help with housework, cooking, and shopping.
• You will have pain in your lower belly and may need pain medicine for 1 to 2 weeks.
• You can expect some vaginal bleeding for several weeks. (Use sanitary pads, not tampons.)

Call your doctor if you have any problems or signs of infection, such as a fever or red streaks or pus from your incision.

Frequently Asked Questions

Learning about cesarean section:	How is a cesarean section done? When is a cesarean section necessary? What are the risks of cesarean section? What is recovery after a cesarean section like? When should I call my doctor after a cesarean section?
Ongoing concerns:	Should I have a VBAC trial of labor after a previous cesarean?

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Author:	Monica Rhodes	Last Updated: February 28, 2008
Medical Review:	Sarah Marshall, MD - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology
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