Cesarean

It’s Not Like in the Movies

Delivering by C-section

By Lynsey Caldwell, MD

As your due date nears, you may start to think about your baby’s birth, envisioning the who-who-he breathing, followed by lots of yelling, and the doctor popping up and shouting, “It’s a boy (or girl)!” This scene is very common in movies, but your experience could be very different from what you have seen in film. You may not realize that almost one in every three mothers gives birth via cesarean (C-section) delivery. As the rate of C-sections in the United States is currently about 30 percent, it is important to understand why this type of delivery may be necessary and what to expect if it is indeed recommended.

Why You May Need a C-Section

For some women, the recommendation to have a C-section is made early in the pregnancy, before the onset of labor. For example, women who have had previous uterine surgery, such as a C-section with a vertical incision on the uterus or the removal of a fibroid, may be advised not to labor. There are various maternal medical conditions, as well as some fetal issues — such as certain birth defects, multiple gestations (twins, triplets, etc.) or abnormal implantation of the placenta — that may make a C-section the safer option for mother or baby. In these cases, C-sections
are usually scheduled far in advance, and there’s plenty of time to learn about the procedure and recovery. In other cases, the necessity of a C-section may not be recognized until closer to the due date. For instance, women whose babies are not in the head-down position by the middle-to-the-end of the third trimester are usually counseled to deliver by C-section. In addition, your provider may be concerned about your baby being very

In other cases, the necessity of a C-section may not be recognized until closer to the due date. For instance, women whose babies are not in the head-down position by the middle-to-the-end of the third trimester are usually counseled to deliver by C-section. In addition, your provider may be concerned about your baby being very large, and may discuss the possibility of avoiding a vaginal delivery due to the increased risk of difficult, prolonged labors and associated complications.

Many times, an unplanned C-section is recommended unexpectedly during labor. Having a baby is a very unpredictable process, and there are many different factors that may result in the need for a C-section during labor. For some mothers, their babies simply do not fit through the birth canal, either because of the baby’s position or the size and shape of the pelvis relative to the baby’s head. This issue may become evident when the cervix stops dilating or when the baby stops descending through the pelvis during pushing. Other times, a baby’s fetal heart rate pattern may change, indicating excessive stress during labor, so a C-section is recommended. Finally, sometimes it may be safer for the health of the mother — due to problems such as infection or bleeding — for delivery to occur in a timely way, and performing a C-section can be the quickest way to deliver. These are the most common reasons for a C-section, but there are many.

What to Expect With a C-Section

In most cases, a C-section is done under spinal or epidural anesthesia. You will be awake and receive medication through a catheter placed in your back so that you will not
experience pain during the surgery. You should expect to feel some touching, including pressure, and maybe a sensation of pulling. The advantage of this type of anesthesia is that you will be awake and alert when your baby is born, so you can hear the first cries and even engage with your baby as your support person holds the newborn. Most of the time the incision made is a “bikini incision,” which is low in your abdomen and horizontal, so it does not show, even in a bathing suit. However, in rare emergency situations, where there is urgent concern for the mother or the baby’s well-being, it may be necessary to perform the surgery very quickly, in which case general anesthesia (being asleep with a breathing tube in place) could be required. Occasionally a vertical skin incision is used in this setting.

Recovery

It’s important to remember that a C-section is major surgery, so your recovery time will certainly be longer than with a vaginal delivery. Most women require narcotic pain medicines for at least the first few days following delivery, after which ibuprofen or acetaminophen may still be needed for a month or so. During the first two weeks, it is very helpful to have family and friends help with chores such as cooking and cleaning so that you can focus on your own recovery and care of your infant. After this time, you may start to feel up to some light regular activity, and by six weeks, feel like yourself again.

Planning Future Deliveries

If you have had a C-section, you should talk to your healthcare provider about the recommendation for your next pregnancy. In some cases, an attempt at a vaginal birth after cesarean (VBAC) may be appropriate. Other times, it may not be advised. This conversation should be started ideally before or early in the course of your next pregnancy. Regardless of how your baby is delivered, you should keep in mind that the overall goal is always to minimize risks and maximize benefits for the health of mom and baby.

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