Cesarean birth happens through an incision in the abdominal wall and uterus rather than through the vagina. There has been a gradual increase in cesarean births over the past 30 years. In November of 2005, the Centers for Disease Control and Prevention (CDC) reported the national cesarean birth rate at 29.1%, which was the highest rate ever recorded involving more than a quarter of all births.

This means that more than 1 in 4 women are likely to experience a cesarean birth.

What can I expect in a Cesarean procedure?

The normal cesarean procedure averages 45 minutes to an hour. The baby is usually delivered in the first 5-15 minutes with the remaining time used for closing the incision.

Pre-surgery:

Before surgery, you will be given an anesthetic (general, spinal, or epidural) if you have not already been given one earlier in your labor. A general anesthetic is normally only used for emergency cesareans because it works quickly and the mother is sedated.
The spinal and epidural anesthesia will numb the area from the abdomen to below the waist (sometimes the legs can be numb also), so that nothing can be felt during the procedure. In this procedure, you will probably receive a catheter to collect urine while your lower body is numb.

How is a Cesarean performed?

The health care provider will make an incision in the abdomen wall first.  In an emergency cesarean, this will most likely be a vertical incision (from the navel to the pubic area) which will allow the health care provider to deliver the baby faster.

The most common incision is made horizontally (often called a bikini cut), just above the pubic bone. The muscles in your stomach will not be cut. They will be pulled apart so that the health care provider can gain access to the uterus.

An incision will then be made into the uterus, horizontally or vertically.  The same type of incision does not have to be made in both the abdomen and uterus. The classical incision made vertically is usually reserved for complicated situations such as placenta previa, emergencies, or for babies with abnormalities.

Vaginal birth after cesarean (VBAC) is not recommended for women with the classical incision. Another type of incision that is rarely used is the lower segment vertical incision.  This would only be used in cases where problems with the uterus would not allow another type of incision to be made.

The most common incision is the low transverse incision. This incision has fewer risks and complications than the others and allows most women to attempt a VBAC in their next pregnancy with little risk of uterine rupture.

The health care provider will then suction out the amniotic fluid and then deliver the baby through the incisions. The baby’s head will be delivered first so that the mouth and nose can be cleaned out to allow it to breathe. Once the whole body is delivered, the health care provider will lift up and show you your baby. THe uterus will be closed with stitches that will dissolve in the body. Stitches or staples are used to close your abdominal skin.

Most health care providers will then pass the baby on to the nurse for evaluation.  Finally, your placenta will be delivered (you may feel some tugging) after which the surgical team will begin the closeup process.

What should I expect after the procedure?

If you are awake for the surgery, you can probably hold your baby right away. You will be taken to a recovery room or directly to your room. Your blood pressure, pulse rate, breathing rate, amount of bleeding, and abdomen will be checked regularly. If you are planning on breastfeeding, be sure to let your doctor know. Having a cesarean delivery does not mean you will not be able to breastfeed your baby. You should be able to begin breastfeeding right away.

You may need to stay in bed for a while. The first few times you get out of bed, a nurse or other adult should help you.

Soon after surgery, the catheter is removed from the bladder. The abdominal incision will be sore for the first few days. Your doctor can prescribe pain medication for you to take after the anesthesia wears off. A heating pad may be helpful. There are many different ways to control pain. Talk with your ob-gyn or other health care professional about your options.

A hospital stay after a cesarean birth usually is 2–4 days. The length of your stay depends on the reason for the cesarean birth and on how long it takes for your body to recover. When you go home, you may need to take special care of yourself and limit your activities.

What should I expect during recovery?

While you recover, the following things may happen:

  • Mild cramping, especially if you are breastfeeding
  • Bleeding or discharge for about 4–6 weeks
  • Bleeding with clots and cramps
  • Pain in the incision

To prevent infection, for a few weeks after the cesarean birth you should not place anything in your vagina or have sex. Allow time to heal before doing any strenuous activity. Call your ob-gyn or other health care professional if you have a fever, heavy bleeding, or the pain gets worse.

What else you should know about Cesarean Birth:

 

Compiled using information from the following sources:

1. William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 25.

2. Coalition for Improving Maternity Services (CIMS)

https://www.motherfriendly.org

3. Centers for Disease Control and Prevention: www.cdc.gov

4. The American College of Obstetricians and Gynecologists