Cesarean Birth

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 camera.

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 or lungs.
  • 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, a needle called an IV is put in one of the mother’s veins to give fluids and medicine (if needed) during the surgery. She will then get medicine (either epidural or spinal anesthesia) to numb her belly and legs. 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 incisionscamera. 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.

 

What is a vaginal birth after cesarean (VBAC)?

If you have had a cesarean delivery (also called a C-section) before, you may be able to deliver your next baby vaginally. This is called vaginal birth after cesarean, or VBAC.

Most women, whether they deliver vaginally or by C-section, don’t have serious problems from childbirth. See pictures of a vaginal birthcamera and a cesarean deliverycamera.

If you and your doctor agree to try a VBAC, you will have what is called a “trial of labor.” This means that you plan to go into labor with the goal to deliver vaginally. But as in any labor, it is hard to know if a VBAC will work. You still may need a C-section. As many as 4 out of 10 women who have a trial of labor need to have a C-section.1

 

Is a VBAC trial of labor safe to try?

Having a vaginal birth after having a C-section can be a safe choice for most women. Whether it is right for you depends on several things, including why you had a C-section before and how many C-sections you’ve had. You and your doctor can talk about your risk for having problems during a VBAC trial of labor.

A woman who chooses VBAC is closely monitored. As with any labor, if the mother or baby shows signs of distress, an emergency cesarean section is done.

 

What are the benefits of a VBAC?

The benefits of a VBAC compared to a C-section include:

  • Avoiding another scar on your uterus. This is important if you are planning on a future pregnancy. The more scars you have on your uterus, the greater the chance of problems with a later pregnancy.
  • Less pain after delivery.
  • Fewer days in the hospital and a shorter recovery at home.
  • A lower risk of infection.
  • A more active role for you and your birthing partner in the birth of your child.
  • What are the risks of VBAC?
  • The most serious risk of a VBAC is that a C-section scar could come open during labor. This is very rare. But when it does happen, it can be very serious for both the mother and the baby. The risk that a scar will tear open is very low during VBAC when you have just one low cesarean scar and your labor is not started with medicine. This risk is why VBAC is often only offered by hospitals that can do a rapid emergency C-section.

 

If you have a trial of labor and need to have a C-section, your risk of infection is slightly higher than if you just had a C-section.

 

This information is provided by WebMD.