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C-Section: Procedure & Recovery

c-section, cesarean section, delivery, birth
A baby is delivered by C-section through an incision in the mother's abdomen.
Credit: Francois Etienne du Plessis | Shutterstock

A C-section, or Cesarean section (also spelled Caesarean section), is a type of surgery used to deliver a baby. The baby is surgically removed through an incision in the mother's abdomen and then a second incision in the uterus. Fairly common, 25 percent of delivering mothers have their babies with this surgery.

They are often necessary when unexpected problems occur during the delivery, including health problems in the woman, the baby's position, the baby's size, or signs of distress in the baby. C-sections are, understandably, more common with women carrying more than one baby.

Though it is relatively safe, a C-section is still a major surgery. Like any major surgery, it carries risks. The incision may leave a weak spot on the wall of the uterus, causing problems with vaginal birth later. However, most women who have C-sections can still undergo vaginal birth later.

Who has C-sections?

C-sections are used when they are a safer option than vaginal delivery. This is often the case if labor is stalled, for example. The most common reasons for a C-section are the cervix not opening enough or the baby's head being too big to fit through the birth canal.

C-sections are also used when the baby is in distress, either not getting enough oxygen or if the heartbeat is changing. The baby could also be in an abnormal position, like breech (feet or buttocks enter the birth canal first) or transverse (side or shoulder first). This is more common if the woman is carrying twins, triplets or other multiple births.

Other problems that warrant a C-section include placenta abruption, umbilical cord problems or problems in health of the mother or baby, including heart problems or brain problems. A C-section may also be recommended if the mother can pass an infection, such as herpes or HIV, on to her baby through vaginal delivery. If there are medical reasons for a C-section that are known ahead of time, you can schedule your C-section, generally after 39 weeks of pregnancy.

The C-section procedure

Before the surgery, an intravenous line will be put in a vein to enable the delivery of fluids and medication during the surgery. A catheter is placed in the urethra to drain the bladder, decreasing the chance of bladder injury during the surgery. The woman's abdomen will be washed, and medication will be administered to prevent infection.

Anesthesia will be administered through general anesthesia, an epidural block or a spinal block. With general anesthesia, the woman will not be awake during the surgery. An epidural or spinal block, the most common choice, numbs the lower half of the body, with medication delivered through an epidural or directly into the spinal fluid.

In the surgery itself, an incision is made through the skin and wall of the abdomen. The muscles of the abdomen are separated, and may or may not be cut. After the muscles are separated, another incision is made in the wall of the uterus. The baby will be delivered through these incisions, the umbilical cord will be cut, and the placenta removed. Stitches are used to close the uterus, and stitches or staples are used to close the abdominal skin. The entire surgery usually takes less than an hour.

Risks of the procedure

Like any major surgery, there are risks. For the baby, transient tachypnea, or abnormally fast breathing, can develop. There's also the risk of nicks or cuts on the baby during the incision process.

For the mother, risks include inflammation and infection, excessive bleeding, reactions to anesthesia, blood clots and increased risk for uterine rupture. After the C-section, keep an eye out for signs of infection — fever, chills, foul-smelling discharge or redness at the incision site.

The best way to minimize these risks is to fully prepare for the C-section with doctors. The Mayo Clinic recommends talking to a healthcare provider about the anesthesia options, or consult with an anesthesiologist. The medical team may also consider certain blood tests in case the mother needs a transfusion during the C-section. For the sake of the baby, they may consider amniocentesis to test the baby's lung maturity if the C-section is taking place before 39 weeks.

Even if you are expecting a vaginal birth, it's a good idea to prepare for a C-section in the event of an emergency.

Recovery from a C-section

Generally, the mother and baby will stay in the hospital for two to four days to recover in a safe environment. The healthcare team will monitor the mother for signs of infection, as well as movement and mobility to reduce the risk of blood clots. Pain medication will be provided intravenously to reduce pain around the abdominal incision as the mother heals.

Breast feeding may be more of a challenge for women who have undergone a C-section. The discomfort near the incision site can make breast feeding awkward and difficult. A lactation consultant can provide guidance on positioning to enable comfortable breast feeding.

After the hospital stay, it's just as important to focus on recovery at home. The mother will likely need to limit activities and rest. During recovery, it's common to feel mild cramping, bleeding or discharge for four to six weeks, and pain in the incision. To reduce the risk of infection, she should not place anything in the vagina or have sex for a few weeks. She should avoid any strenuous activity, and keep everything she and the baby needs within reach. For the first six to eight weeks, she shouldn't lift anything heavier than the baby. Short walks and light housework is okay, but anything that makes her out of breath or strains her muscles is not. She should not drive a car for the first three weeks, or take a bath, swim or be in a hot tub.

During routine standing and walking, it's important for her to keep good posture. If she feels a sudden change coming, like coughing or sneezing, she should hold her abdomen near the incision. While at home, it's important for the mother to drink plenty of fluids to replace those during delivery and breastfeeding, as well as preventing constipation.

As the incision heals, it may leave a scar, which will turn white or fade into the color of the skin. It will also become thinner and flatter.

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