C-Section (Caesarean Section): Procedure, Reasons, Recovery, Risks & VBAC

C-section (cesarean section) delivery birth definition and facts

Women should find out what C-sections are, why they are performed, and the pros and cons of this surgery.

• Cesarean delivery, also called C-section, is surgery to deliver a baby. The baby is taken out through the mother's abdomen. Most cesarean births result in healthy babies and mothers. But c-section is major surgery and carries risks. Healing also takes longer than with vaginal birth.
• Most healthy pregnant women with no risk factors for problems during labor or delivery have their babies vaginally. Still, the cesarean birth rate in the United States has risen greatly in recent decades.
• Public heath experts think that many C-sections are unnecessary, so it is important for pregnant women to get the facts about C-sections before they deliver. Women should find out what C-sections are, why they are performed, and the pros and cons of this surgery.

What is a C-section delivery?

A cesarean delivery, also called a C-section or cesarean birth, is the surgical delivery of a baby through a surgical cut or incision in a woman's abdomen and uterus. After the baby is removed from the womb, the uterus and abdomen are closed with stitches that later dissolve.

According to the U.S. Centers for Disease Control and Prevention, in 2015, 32% of births were by cesarean delivery—the lowest rate since 2007. Between 1996 and 2008, the number of cesarean deliveries increased by 72%.

What Are the Symptoms and Signs of Labor?

Symptoms and signs that labor is near or has begun are:

1. Water breaking: Spontaneous rupture of the fetal membranes is referred to as one’s “water breaking.” Once this occurs, labor will generally ensue spontaneously. If it does not,
   it may be necessary to induce labor to avoid infections. Usually, the ruptured membranes do not occur until labor has already begun.

2. Contractions:
   Finally, labor begins with the onset of contractions. At that point, the cervix begins to thin out and dilate. When contractions begin to occur less than ten minutes apart, this frequently signals the onset of labor.
3. Braxton-Hicks contractions: Irregular contractions, known as Braxton-Hicks contractions or “false labor,” occur toward the end of pregnancy during the third trimester, and they do not necessarily signify that labor is imminent. Some women even experience these contractions during the second trimester. Braxton-Hicks contractions are usually milder than those of true labor are, and they do not occur at regular intervals.

Click for more information about what to expect during labor and delivery »

What are the reasons for a C-section?

Cesarean delivery may be necessary in the following circumstances:

1. Labor is not progressing. Contractions may not open the cervix enough for the baby to move into the vagina for delivery.
2. The infant's health is in danger. The umbilical cord, which connects the fetus to the uterus, may become pinched, or the fetus may have an abnormal heart rate. In these cases, a cesarean delivery allows the baby to be delivered quickly to address and resolve the baby's health problems.
3. The baby is in the wrong position. Most often when this occurs, the baby is breech, or in a breech presentation, meaning that the baby is coming out feet first instead of head first. The baby may also be in a transverse (sideways) or oblique (diagonal) position.
4. The pregnant woman is delivering two or more fetuses (multiple pregnancy). A cesarean delivery may be needed if labor has started too early (preterm labor), if the fetuses are not in good positions within the uterus for natural delivery, or if there are other problems.
5. The baby is too large. Larger infants are at risk for complications during delivery. These include shoulder dystocia (pronounced dis-TO-she-ah), when the infant's head is delivered through the vagina but the shoulders are stuck.⁴ Women with gestational diabetes, especially if their blood sugar levels are not well controlled, are at increased risk for having large babies.
6. The placenta has problems. Sometimes the placenta is not formed or working correctly, is in the wrong place in the uterus, or is implanted too deeply or firmly in the uterine wall. These issues can cause problems, such as preventing needed oxygen and nutrients from reaching the fetus or causing vaginal bleeding.⁵
7. The mother has an infection, such as HIV or herpes, that could be passed to the baby during vaginal birth. Cesarean delivery could help prevent transmission of the virus to the infant.
8. The mother has a specific medical condition. A cesarean delivery enables the health care provider to better manage the mother's health issues.

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What questions should you ask your doctor before a C-section?

1. Can I have a support person with me during the operation?
2. What are my options for blocking pain?
3. Can I have music played during the surgery?
4. Will I be able to watch the surgery if I want?

What are your options to control pain during a C-section?

Women who have a cesarean delivery may be given pain medication with an epidural block, a spinal block, or general anesthesia.

1. An epidural block numbs the lower part of the body through an injection in the spine.
2. A spinal block also numbs the lower part of the body, but through an injection directly into the spinal fluid.
3. Women who receive general anesthesia, often used for emergency cesarean deliveries, will not be awake during the surgery.

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What should you expect during a C-section?

The doctor will make an incision that is about 6 inches long and goes through the skin, fat, and muscle. Most incisions are made side to side and low on the abdomen, called a bikini incision. Once inside the abdominal cavity, the doctor will make an incision to open the uterus. The opening is made just wide enough for the baby to fit through. One doctor will use a hand to support the baby while another doctor pushes the uterus to help push that baby out. Fluid will be suctioned out of your baby's mouth and nose. The doctor will hold up your baby for you to see.

Once your baby is delivered, the umbilical cord is cut, and the placenta is removed. Then, the doctor cleans and stitches up the uterus and abdomen. The repair takes up most of the surgery time. Questions to ask:

• Can my partner cut the umbilical cord?
• What happens to my baby right after delivery?
• Can I hold and touch my baby during the surgery repair?
• When is it okay for me to try to breastfeed?
• When can my partner take pictures or video?

How long does a C-section procedure take?

• Cesarean delivery takes about 45 to 60 minutes. It takes place in an operating room. So if you were in a labor and delivery room, you will be moved to an operating room. Often, the mood of the operating room is unhurried and relaxed.
• A doctor will give you medicine through an epidural or spinal block, which will block the feeling of pain in part of your body, but allows you to stay awake and alert.
• Spinal blocks work right away and completely numbs your body from the chest down.
• Epidural blocks take away pain, but you might be aware of some tugging or pushing.
• Medicine that makes you fall asleep and lose all awareness usually is only used in emergency situations.
• Your abdomen will be cleaned and prepped.
• You will have an IV for fluids and medicines.
• A nurse will insert a catheter to drain urine from your bladder. This is to protect the bladder from harm during surgery. Your heart rate, blood pressure, and breathing also will be monitored.

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

• You will be moved to a recovery room and monitored for a few hours.
• You might feel shaky, nauseated, and very sleepy.
• Later, you will be brought to a hospital room.
• When you and your baby are ready, you can hold, snuggle, and nurse your baby.
• Many people will be excited to see you. But don't accept too many visitors.
• Use your time in the hospital, usually two to four days, to rest and bond with your baby.
• C-section is major surgery, and recovery takes about six weeks (not counting the fatigue of new motherhood).

In the weeks ahead, you will need to focus on healing, getting as much rest as possible, and bonding with your baby — nothing else. Be careful about taking on too much and accept help as needed. Questions to ask:

• Can my baby be brought to me in the recovery room?
• What are the best positions for me to breastfeed?

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What are the risks and complications of a C-section?

Cesarean delivery is a type of surgery, so it has risks and possible complications for both mother and baby.

Possible risks from a cesarean delivery include:

• Infection
• Blood loss
• Blood clots in the legs, pelvic organs, or lungs
• Injury to surrounding structures, such as the bowel or bladder
• Reaction to medication or anesthesia used
• It is important to note that these risks also apply, to some degree, to vaginal birth.

A woman who has a cesarean delivery may also have to stay in the hospital longer than a woman who has had a vaginal delivery.

The more cesarean deliveries a woman has, the greater her risk of certain medical problems and problems with future pregnancies, such as uterine rupture and problems with the placenta.

Can you request a C-section?

Some women may want to have a cesarean birth even if vaginal delivery is an option. Women should discuss their options in detail with their doctor before making a decision about a type of delivery. The decision should consider the impact of the delivery not only on the current pregnancy, but also on future pregnancies. The safest method of delivery for both the mother and the fetus is an uncomplicated vaginal delivery.

Regardless of the type of delivery, unless there is a medical necessity, delivery should not occur before 39 weeks of pregnancy (called "full term"). Watch this video to learn why it is important for the mother's and infant's health to wait until at least 39 weeks to deliver unless there is a medical reason to do so earlier.

Can you have a vaginal birth after a C-section (VBAC)?

Some women who have delivered previous babies by c-section would like to have their next baby vaginally. This is called vaginal delivery after c-section or VBAC. Women give many reasons for wanting a VBAC. Some want to avoid the risks and long recovery of surgery. Others want to experience vaginal delivery.

Today, VBAC is a reasonable and safe choice for most women with prior cesarean delivery, including some women who have had more than one cesarean delivery. Moreover, emerging evidence suggests that multiple c-sections can cause serious harm. If you are interested in trying VBAC, ask your doctor if you are a good candidate. A key factor in this decision is the type of incision made to your uterus with previous c-sections.

Your doctor can explain the risks of both repeat cesarean delivery and VBAC. With VBAC, the most serious danger is the chance that the c-section scar on the uterus will open up during labor and delivery. This is called uterine rupture. Although very rare, uterine rupture is very dangerous for the mother and baby. Less than 1 percent of VBACs lead to uterine rupture. But doctors cannot always predict if uterine rupture is likely to occur in a woman. This risk, albeit very small, is unacceptable to some women.

The percent of VBACs is dropping in the United States for many reasons. Some doctors, hospitals, and patients have concerns about the safety of VBAC. Some hospitals and doctors are unwilling to do VBACs because of fear of lawsuits and insurance or staffing expenses. Many doctors, however, question if this trend is in the best interest of women's health.

Choosing to try a VBAC is complex. If you are interested in a VBAC, talk to your doctor and read up on the subject. Only you and your doctor can decide what is best for you. VBACs and planned c-sections both have their benefits and risks. Learn the pros and cons and be aware of possible problems before you make your choice. If your doctor or hospital does not support VBAC, it may be necessary to find providers who will accommodate your wishes.