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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 Caesarean section (also spelled Cesarean 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. 

Almost one in three pregnant women in the United States gave birth by C-section in 2013, according to the most recent birth statistics from the Centers for Disease Control and Prevention (CDC). But in the early 1990s, about one in five pregnant women had a child this way. 

These increased rates of Caesarean deliveries have been linked with a variety of different factors from rising rates of obesity, diabetes and multiple births to increased maternal age, which can all lead to more risky deliveries. 

Other reasons for high C-section rates include the use of epidurals and techniques that induce labor, both of which may cause complications that could result in the need to perform a surgical delivery. 

Although Caesarean births can be life saving for both mother and baby, the American College of Obstetricians and Gynecologists has expressed concern that C-section deliveries might be overused, and they have recommended ways to reduce the national rate

These new guidelines call for allowing most women with low-risk pregnancies to spend more time in the first stage of labor as well as encouraging women to avoid excessive weight gain during pregnancy.

The key to reducing high C-section rates in the United States is preventing unnecessary first C-sections, said Dr. Allison Bryant, a maternal fetal medicine specialist at Massachusetts General Hospital in Boston.

These days, the majority of women who have had a first C-section will wind up having a repeat C-section somewhere down the road, she said. 

"It's important to understand why one-third of American babies are being delivered by Caesarean," Bryant said. "We need to figure out which babies really need to be delivered by C-section to protect their health." 

Bryant said one way to possibly reduce C-section rates in this country is to educate women about the benefits of vaginal delivery.

The following information will help educate pregnant women about what is involved in a surgical delivery, and how they may feel before, during and after a C-section. 

Before surgery

To prepare for the operation, an IV will be placed in a woman's arm or hand to give fluids and medications needed during surgery. Her abdomen will be washed and her pubic hair may be clipped or trimmed. 

A catheter is placed into a woman's bladder to remove urine, and it will stay for a day after the surgery. 

Women are usually given regional anesthesia, either an epidural block or a spinal block. Both numb the lower half of the body but will allow the mother to be awake when her baby is born. This tends to be safer than general anesthesia, where a woman would be totally asleep during the delivery, Bryant said.

How a C-section is done

The obstetrician will use a knife to make a horizontal incision in the skin and the abdominal wall, usually along the bikini line, meaning that it's low enough down on the pelvis that it would be covered up by underwear or a bikini bottom, Bryant said. Some women may get a vertical, or up-and-down cut, she said. 

After the abdomen is opened, an incision is made in the uterus. Typically, a side-to-side (horizontal) cut is made, which ruptures the amniotic sac surrounding the baby, Bryant said. Once this protective membrane is ruptured, the baby is removed from the uterus, the umbilical cord is cut, and the placenta is removed. The baby is examined then given back to the mother for skin-to-skin contact, Bryant said. 

Bryant explained that the cut made to a woman's uterine wall is an important one because the way this uterine scar heals can affect her ability to have a vaginal birth in the future. 

Once the delivery and afterbirth are completed, the cuts made to the mother's uterus are repaired with stitches, which will eventually dissolve under the skin. The abdominal skin is closed with stitches or with staples, which are removed before a woman leaves the hospital. 

A woman typically spends 60 to 120 minutes in the operating room for a C-section, depending upon whether any complications arise during the delivery, Bryant said. 

After the surgery, a woman will be taken to the hospital's maternity ward to recover. 

Recovering from a C-section

After a C-section, a woman may spend two to four days in the hospital, but it may take her up to six weeks to feel more like herself again, Bryant said.

Her abdomen will feel sore from the surgery and the skin and nerves in this area will need time to heal. Women will be given narcotic pain medications to take the edge off any post-surgery pain, and most women use them for about two weeks afterward, Bryant said.

A woman may also experience bleeding for about four to six weeks after a surgical birth. She is also advised to not have sex for a few weeks after her C-section and to also avoid strenuous activities, such as lifting heavy objects. 

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