Pregnancy, Cesarean Section

What is a cesarean section?

A cesarean section, also called a C-section, is an operation done to deliver your baby through your abdomen (belly). It may be done when delivery through the birth canal (vagina) is not possible or safe for you or the baby. The cuts made in the abdomen and the uterus to deliver the baby are usually horizontal, or across. This allows the muscles in the uterus to safely stretch for future childbirth. Many women are able to deliver the next baby through the birth canal. Sometimes the cut in the abdomen may be vertical, or from below the belly button down to just above the pubic bone.

A C-section may be performed before labor begins if there are medical reasons for not having labor or a vaginal delivery, including:

• You have severe preeclampsia (high blood pressure caused by pregnancy)
• You have primary high blood pressure (also called essential hypertension) that existed before getting pregnant
• The placenta may be partially or completely covering the opening of the cervix (called placenta previa)
• You have a scar on your uterus caused by a previous operation on your uterus, such as certain types of C-sections or surgery to remove fibroids (myomectomy). Because scar tissue is weaker than normal uterus muscle, the scar from your previous operation might open during labor, especially if the cut went through the inside lining of your uterus.

A C-section may also be done after labor begins, if certain problems occur, including:

• The baby may be in a breech position, which means the bottom, knees, or feet will come out before the head in a delivery through the vagina (birth canal)
• Your cervix may not fully dilate for the baby to pass through
• The baby may be too large for your birth canal
• The baby may be having an abnormal fetal heart rate during labor (the heartbeat is too fast, too slow, or irregular)

How is a cesarean section done?

Before the procedure:

• Your healthcare provider will ask you to sign a consent form for any necessary treatment during childbirth, including a cesarean section. The consent form will state any possible treatments you may need during delivery, what happens during delivery, and what you may expect afterward.
• There is risk with every treatment or procedure. Talk to your healthcare provider for complete information about whether any of these risks apply to you:
  • Anesthesia problems
  • Bleeding
  • Blood clots
  • Infection
• Tell your healthcare provider if you have any food, medicine, or other allergies such as latex.
• Tell your healthcare provider if you are taking any medicines, including nonprescription drugs, herbal remedies, or recreational or illegal drugs.
• You will have a small tube (IV catheter) inserted into a vein in your hand or arm. This will allow for medicine to be given directly into your blood and to give you fluids, if needed.
• If you have a planned cesarean section:
  • Follow the instructions provided by your healthcare provider before surgery.
  • If you are to have general anesthesia, do not eat or drink anything after midnight and during the morning before the procedure.
  • Ask your provider if you should take any of your normal medicines the morning of the surgery.

During the procedure:

• You may be given a sedative through your IV to help you to relax.
• You will be given medicines to prevent pain during your surgery. These may include:
  • An epidural block, which is pain-relieving medicine given in the lower spinal area of your back. Usually a small tube is inserted into your back, inside the spinal canal, through the needle. Then the needle is removed, leaving the tube in place. More medicine can later be given through the tube instead of with another shot.
  • In rare cases, general anesthesia may be necessary. General anesthesia relaxes your muscles and puts you into a deep sleep. It also keeps you from remembering the operation. While you are asleep, you will have a tube in your throat to help you breath and to make sure you are getting enough oxygen. The tube may be removed before you wake up after the surgery.
• You may have a small tube (catheter) placed into your bladder to drain and measure urine.
• Your healthcare provider will make a cut below your bellybutton and into the lower part of the uterus to remove the baby.
• Your provider will remove the baby, placenta, and birth sac.
• Your provider will then sew the uterus and abdomen closed.

After the procedure:

• You will be checked often by nursing staff.
• Your blood oxygen level will be monitored by a sensor that is attached to your finger or earlobe.
• Your heart rate, blood pressure, and temperature will be checked regularly.
• Your surgery site will be checked often and dressings will be changed if necessary.
• You may need help with positioning your baby comfortably for feeding.
• Your provider may prescribe medicine to:
  • Treat pain
  • Treat or prevent an infection
  • Soften your bowel movement and reduce straining
• Your provider may recommend other types of therapy to help relieve pain, other symptoms, or side effects of treatment.

What can I do to help?

• You will need to tell your healthcare team if you have new or worsening:
  • Dizziness or lightheadedness
  • Nausea or vomiting
  • Shortness of breath
  • Bloating or belly pain
  • Diarrhea, constipation, or other intestinal problems
  • Swelling, redness, or pain in your legs
  • Redness, swelling, pain, warmth, or drainage from your surgical wound
  • Fever, chills, or muscle aches
• Ask questions about any medicine or treatment or information that you do not understand.

How long will I be in the hospital?

How long you stay in the hospital depends on many things. The average amount of time to stay in the hospital after childbirth with a cesarean section is 3 to 4 days. Talk with your provider about how long your stay may be.