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Cesarean Section

By

Sarah Lewis, PharmD

What is a cesarean section?

A cesarean section, or C-section, is the delivery of a baby through an incision in the lower abdomen and uterus. The uterus is a pear-shaped organ located in the lower abdominal (pelvic) area where a baby grows during pregnancy. 

A cesarean birth is sometimes safer than vaginal birth for the mother, the baby, or both. Doctors sometimes decide during pregnancy that a C-section will be necessary and they schedule it ahead of time. In other cases, doctors decide during labor that a C-section is the best way to deliver a baby. This is an emergency C-section.

A C-section is a major surgery with significant risks and potential complications. You may have less invasive delivery options. Consider getting a second opinion about all your delivery choices if there is time before having a scheduled C-section. 

Types of C-section

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C-section procedures vary according to the incisions:

  • Horizontal (transverse) cesarean incisions extend low across the pubic hairline. This is the most common type of C-section because the surgical incision heals better with less bleeding. It also increases the chance of having a successful vaginal delivery with any future pregnancies.

  • Vertical (longitudinal) cesarean incisions extend from the belly button or naval down to the pubic hairline.

Other procedures that may be performed

Doctors sometimes perform a tubal ligation with a C-section. This is an option for a woman who knows that she will not have more children. 

Tubal ligation is the surgical closing of a woman’s fallopian tubes. This procedure is a form of birth control, commonly known as “tying the tubes.” A woman who has had a tubal ligation can no longer become pregnant.

Why is a cesarean section performed? 

Your doctor may recommend a C-section if it is the safest method of delivery for you, your baby, or both. Your doctor may only consider a C-section if other delivery options with less risk of complications are not appropriate or have failed. Ask your doctor about all of your delivery options and consider getting a second opinion if there is time before deciding on a C-section. 

C-section is performed for the following conditions: 

  • Cephalopelvic disproportion, a condition in which the baby’s head is too large to fit through the mother’s pelvis

  • Labor problems including failure of labor to progress or prolonged labor. This is sometimes called arrested labor.

  • Macrosomia, a very large baby

  • Maternal infection, such as a mother with HIV or active genital herpes

  • Multiple pregnancy, a pregnancy with two or more babies in your uterus

  • Placenta abruptio, in which the placenta detaches from the wall of the uterus before the baby is born

  • Placenta previa, in which the placenta is in an abnormal position, usually too close to or covering the cervix. The cervix is the opening of the uterus.

  • Previous uterine surgery including a previous C-section

  • Problems with the baby, such as an abnormal heart rate, developmental problems (hydrocephalus or spina bifida), or abnormal positioning crosswise (transverse) or feet-first (breech)

  • Severe maternal illness, such as a mother with serious heart disease, toxemia, preeclampsia or eclampsia

  • Umbilical prolapse, an umbilical cord that comes through the vagina before the baby. This can compress the umbilical cord and cause a drop in the baby’s heart rate.

  • Uterine fibroids near the cervix or the opening of the uterus

Who performs a cesarean section?

An obstetrician-gynecologist (Ob/Gyn) performs C-sections. An obstetrician-gynecologist is a doctor who specializes in the medical and surgical care of women's health and pregnancy.

How is a cesarean section performed?

Your C-section will be performed in a hospital. It is an open surgery involving an incision that allows your doctor to directly view and access the surgical area. Your doctor will make the incision in your lower abdomen and the wall of your uterus. The incision may be horizontal (transverse) or vertical (longitudinal).

Your doctor will advise you on which type of C-section is best for you and how long you need to stay in the hospital based on  your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different C-section surgeries and ask why your doctor will use a particular type for you.

Types of anesthesia that may be used

Your surgeon will perform a C-section using either general anesthesia or regional anesthesia. The type of anesthesia depends on many factors, including the health and well-being of both you and your baby. 

  • General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.

  • Regional anesthesia is also known as a nerve block, epidural, or spinal anesthesia. This involves injecting an anesthetic medication around certain nerves in the spine so you do not feel anything below the waist. This is the most common form of anesthesia for non-emergency C-sections because it allows you to remain awake to experience the delivery.

What to expect the day of your C-section

The day of your surgery, you can generally expect to:

  • Have your birth partner with you in the operating room for delivery. This may not be the case in emergency C-sections.

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.

  • Talk with the anesthesiologist or nurse anesthetist about your pregnancy, medical history, and the type of anesthesia you will have.

  • A surgical team member will start an IV. You may also have a urinary catheter to drain your urine. Keeping your bladder empty decreases the risk of injuring it during surgery.

  • The anesthesiologist or nurse anesthetist will start your anesthesia.

  • A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.

  • The surgical team will monitor you and your baby’s vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are both alert, breathing effectively, and your vital signs are stable.

What are the risks and potential complications of a cesarean section?  

As with all surgeries, a C-section involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.

General risks of surgery 

The general risks of surgery include: 

  • Anesthesia reaction, such as an allergic reaction and problems with breathing

  • Bleeding, which can lead to shock

  • Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.

  • Infection and septicemia, which is the spread of a local infection to the blood

Potential complications of a C-section

Complications of a cesarean birth include:

  • Bowel or bladder damage
  • Delayed return of bowel function
  • Difficulty urinating
  • Higher risk for problems in future pregnancies
  • Infection of the uterus
  • Urinary tract infection

Reducing your risk of complications

You can reduce the risk of some complications by following your treatment plan and:

  • Following activity, dietary and lifestyle restrictions and recommendations before surgery (for a scheduled C-section) and during recovery

  • Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage

  • Taking your medications exactly as directed

  • Telling all members of your care team if you have any allergies

How do I prepare for my cesarean section? 

You are an important member of your own healthcare team. The steps you take before a scheduled C-section can improve your comfort and delivery outcome. 

You can prepare for a C-section by:

  • Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure.

  • Stopping smoking as soon as possible. 

  • Taking medications exactly as directed. This may include taking a medication to reduce the amount of acid in your stomach.

Questions to ask your doctor

Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment.  Contact your doctor with concerns and questions before surgery and between appointments.  

It is also a good idea to bring a list of questions to your appointments. Questions can include:

  • Why do I need a C-section? Are there any other options for treating my condition?

  • What type of C-section procedure will I need?

  • How long will the surgery take? 

  • When can I hold my baby? When can I nurse my baby?  Will my birth partner be allowed in the operating room with me?

  • When can I go home?

  • What restrictions will I have after the surgery?

  • What kind of assistance will I need at home?

  • What medications will I need before and after the surgery? 

  • How will you treat my pain?

  • When should I follow up with you?

  • How should I contact you? Ask for numbers to call during and after regular hours.

What can I expect after my cesarean section?

Knowing what to expect can help make your road to recovery after a C-section as smooth as possible. 

How long will it take to recover?

You will probably hold your baby very soon after delivery if you were awake for your C-section. You may stay briefly in the recovery room until your vital signs are stable. In other cases, you may go directly to your room. A C-section usually requires a hospital stay of two to four days. 

Recovery after a cesarean birth is a gradual process. Recovery time varies depending on the procedure, type of anesthesia used, your general health, age, and other factors. Recovery after a cesarean delivery is longer than a vaginal delivery. Full recovery takes four to six weeks.

Will I feel pain?

Pain control is an important element to healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes in any way because it may be a sign of a complication.

When should I call my doctor?

It is important to keep your follow-up appointments after a C-section. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:

  • Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing

  • Change in alertness, such as passing out, dizziness, unresponsiveness, or confusion

  • Chest pain

  • Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.

  • Foul-smelling vaginal discharge

  • Heavy vaginal bleeding

  • Inability to urinate or have a bowel movement

  • Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot

  • Pain that is not controlled by your pain medication

  • Severe abdominal pain

  • Unexpected drainage, pus, redness or swelling of your incision

How might a C-section affect my everyday life?

A C-section may be the safest delivery option for both you and your baby but involves some limitations including:

  • Avoiding sex or inserting anything into your vagina for several weeks as directed

  • Avoiding strenuous activities and heavy lifting for four to six weeks after surgery. This may include limitations on using stairs.

  • Not driving until cleared by your doctor

  • Possibly changing your plan for future births. A cesarean delivery does not necessarily prevent you from having vaginal deliveries with future pregnancies. However, vaginal birth after cesarean (VBAC) does carry a small risk of uterine rupture. This is a serious complication that can endanger both you and your baby. Your healthcare provider is best able to guide your delivery choices based on your circumstances.

Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Sep 9, 2016

© 2017 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

View Sources

Medical References

  1. Cesarean Birth. American College of Obstetricians and Gynecologists. http://www.acog.org/~/media/For%20Patients/faq006.pdf?dmc=1&ts=20130423T1303445571
  2. Cesarean Delivery. BetterMedicine. http://www.bettermedicine.com/article/cesarean-delivery
  3. Delivery by Cesarean Section. American Academy of Pediatrics. http://www.healthychildren.org/English/ages-stages/prenatal/delivery-beyond/pages/Delivery-by-Cesare...
  4. Pile, JC. Evaluating postoperative fever: A focused approach. Cleveland Clinic Journal of Medicine. 2006;73 (Suppl 1):S62. http://ccjm.org/content/73/Suppl_1/S62.full.pdf

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