Cesarean Delivery (C-Section): All You Must Know

A cesarean birth (aka cesarean section or surgical birth) is a surgical procedure employed to deliver a baby. It utilizes regional (or rarely general) anesthesia (spinal or epidural) to prevent pain; a vertical or horizontal ("bikini line") incision in the skin of the lower abdomen; and dissection of the underlying tissues to expose the uterus. An incision in the uterus allows the removal of the baby and placenta. Other procedures, like tubal ligation (a permanent birth control), may also be carried out during a cesarean birth.

When is C-Section Recommended?

A C-section (or cesarean birth) is indicated when a vaginal delivery can't be done safely. Some cesarean births are planned and scheduled beforehand because of maternal or fetal conditions. However, others are unplanned and executed during labor because of maternal or fetal problems that arise during the delivery. 

A C-section is planned under the following conditions-

• Cephalopelvic disproportion (CPD): In this condition, the baby's head or body is too big to pass safely through your pelvis, or the pelvis is too small to deliver an average-sized baby.

• Previous C-section: It increases the chances of having a C-section and depends on the type of uterine incision used during the last C-section and the risk of uterine rupture.

• Expecting multiples: Although it is possible to deliver twins vaginally, two or more babies might require a C-section.

• Placenta previa: This condition witnesses low attachment of the placenta in the uterus, which blocks the baby's exit through the cervix, demanding a C-section.

• Transverse lie: A horizontally or sideways-lying baby in the uterus is delivered via C-section.

• Breech presentation: It represents the baby's feet- or bottom-first position inside the uterus. Some doctors may attempt to turn the baby, but a C-section will be required if that's unsuccessful.

• Health conditions: Conditions like heart disease and genital herpes at the time of delivery will require cesarean birth.

• Obstruction: By a large uterine fibroid, a pelvic fracture, or congenital anomalies in the baby may also require cesarean birth.

An unplanned C-section delivery may be carried out under the following circumstances during labor-

• Non-progressive or prolonged labor wherein the cervix dilates and stops, doesn't efface (or thin), or the baby stops moving down the birth canal.

• Umbilical cord compression: The umbilical cord forms a loop around the baby's neck or body or is caught between the baby's head and your pelvis.

• Umbilical cord prolapse: The umbilical cord enters the cervix before the baby.

• Placental abruption: The placenta separates from the uterine wall before the baby's birth.

• Fetal distress: In some cases, the baby might develop problems that cause an irregular heart rate during labor, which may make a C-section necessary.

How is C-Section Carried Out?

Before the Procedure –

Before planning the surgery, the doctor will discuss the various types of anesthesia available and the risks and benefits of each. They will instruct how to prepare for surgery, including avoiding all food and drinks for at least two and often for several hours before the surgery.

Most planned C-sections use epidural anesthesia to keep you awake during delivery. However, in some cases, they may use general anesthesia. 

During the Procedure –

First, the obstetrician scrubs your abdomen with an antiseptic and places an oxygen mask over your mouth and nose to increase oxygen to your baby. Then draws a 3- to 4-inch incision into your skin and wall of your abdomen and uterus using either a vertical or transverse incision (bikini incision) and finally, remove your baby through incisions. They will snip the umbilical cord, remove the placenta and seal the incisions with stitches and staples. Emergency C-sections follow the same step. 

You'll be under anesthesia during a C-section, so you won't feel any pain (except for a tug or pull). The typical C-section takes nearly 45 minutes from start to completion.

After the Procedure -

Post-delivery, the stitches should dissolve, but staples are removed at the hospital after a week. Your abdomen may remain sore for several days or weeks. The provider may also prescribe some pain medications.

You may have to limit your activities once you go home after a c-section delivery. A typical C-section surgery demands at least a two to three-day stay in the hospital.

What are the complications and risks associated with C-Section Delivery?

It should be remembered that, like any other surgery, a C-section involves some risks. It has slightly higher risks of complications than vaginal delivery. These might include:

• Infection.

• Blood loss (hemorrhage).

• A dislodged blood clot that may enter your bloodstream.

• Damage to the bowel or bladder.

• A cut that might weaken the wall of the uterus.

• Placental abnormalities in future pregnancies.

• Risks from general anesthesia.

• Fetal injury.

C-sections may also have some disadvantages over vaginal delivery, like-

• Its recovery may be more complex.

• It may cause chronic pelvic pain.

• You have increased chances of C-sections in future pregnancies.

• Your baby may have a problem with breastfeeding.

• Your baby may be at a higher risk for breathing problems.

Post-operative Care and Recuperation

A full recovery after a c-section can take at least a month. You can experience cramping, bleeding for up to six weeks, and discomfort around the incision. The doctor may recommend avoiding steps, lifting, exercise, and other strenuous activities for several weeks. 

You will experience a vaginal discharge (called lochia) after the surgery due to the shedding of your uterine lining. It will be red initially and yellow later. Visit your doctor if you experience heavy bleeding or the discharge has a foul odor. Use sanitary pads, not tampons, during the recovery period.

The bottom line

C-sections are often necessary for the mother's and her baby's health. If you have a planned C-section, your obstetrician can explain the procedure and discuss the recovery process with you in advance. However, when a C-section is unexpected, you may feel upset that your birth plan didn't go as expected. But remember that most doctors prefer a vaginal delivery and that a C-section was carried out for you or your baby's wellbeing. Reach out to your doctor immediately if you ever feel any discomfort.