Caesarean Section

A caesarean section is a surgical procedure that delivers a baby through incisions made in the mother’s abdomen and uterus when a vaginal birth isn’t safe or possible. It is one of the most common surgical procedures performed today, accounting for about 30% of all births in the United States.

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C-section, cesarean section, cesarean delivery, caesarean delivery

• Abdomen
• Uterus (womb)
• Pelvis
• Cervix
• Placenta
• Umbilical cord

Table of contents

• What is a caesarean section?
• When is a caesarean section needed?
• How common are caesarean sections?
• What happens during the procedure?
• Anesthesia options
• Recovery after a caesarean section
• Risks and complications
• Future pregnancies after a caesarean section
• When to call the doctor

What is a caesarean section?

A caesarean section is a surgical procedure in which a baby is born through cuts made in the mother’s abdominal wall and the wall of the uterus (womb). The procedure is performed when a vaginal delivery isn’t possible or safe, or when the health of the mother or baby is at risk.^[1]

A caesarean section can be planned ahead of time if your doctor knows in advance that a vaginal birth might not be safe. This is called a planned caesarean or elective caesarean. Planned caesareans are usually done from the 39th week of pregnancy.^[4] In other cases, a caesarean section may need to be performed as an emergency if problems occur during labor. This is called an unplanned caesarean or emergency caesarean.^[5]

When is a caesarean section needed?

There are many medical reasons why a caesarean section might be necessary. Your doctor may plan a caesarean section ahead of time if certain conditions exist during your pregnancy.^[1]

Reasons for a planned caesarean section include:^[1][5]

• Cephalopelvic disproportion (CPD): This means your baby’s head or body is too large to pass safely through your pelvis, or your pelvis is too small to deliver an average-sized baby
• Previous caesarean section: Although vaginal birth after a previous caesarean is sometimes possible, it’s not an option for everyone
• Expecting multiples: While twins can often be delivered vaginally, two or more babies might require a caesarean section
• Placenta previa: In this condition, the placenta (the organ that nourishes the baby during pregnancy) is attached too low in your uterus and blocks your baby’s exit through your cervix (the opening to the womb)
• Breech presentation: Your baby is positioned feet-first or bottom-first in your uterus instead of head-first. Some doctors may attempt to turn your baby, but a caesarean will be necessary if that’s unsuccessful
• Transverse lie: Your baby is lying in a horizontal or sideways position in your uterus
• Certain health conditions: Conditions like heart disease could worsen with labor during a vaginal birth. A caesarean section is also necessary if you have genital herpes at the time of delivery
• Obstruction: A large uterine fibroid (a non-cancerous growth), a pelvic fracture, or certain birth defects in the baby may also be reasons for a caesarean section

An unplanned or emergency caesarean section might be necessary if any of the following conditions arise during your labor:^[1][5]

• Labor isn’t progressing: Also called prolonged labor or labor dystocia, this means your cervix stops dilating (opening), doesn’t thin properly, or your baby stops moving down the birth canal
• Umbilical cord problems: The umbilical cord is looped around your baby’s neck or body, caught between your baby’s head and your pelvis, or comes out of your cervix before your baby does
• Placental abruption: The placenta separates from the wall of your uterus before your baby is born
• Fetal distress: Your baby develops problems that cause an irregular heart rate during labor, suggesting the baby can no longer tolerate labor
• Baby’s head doesn’t fit through the pelvis: Your baby’s head does not move down or fit through your pelvis during labor

Some women choose to have a caesarean section for non-medical reasons. If you ask for a caesarean when there are no medical reasons, your doctor or midwife should explain the overall benefits and risks compared with a vaginal birth. If you’re anxious about giving birth, you should be offered support during your pregnancy and labor. If after discussing all the risks you still feel that a vaginal birth is not acceptable, you should be offered a planned caesarean.^[4]

How common are caesarean sections?

Caesarean sections are very common. According to the U.S. Centers for Disease Control and Prevention (CDC), caesarean sections account for about 30% of all deliveries in the United States.^[1] In the United Kingdom, around 1 in 4 pregnant women has a caesarean birth.^[4]

The caesarean delivery rate increased significantly from 5% in 1970 to 31.9% in 2016. This sharp increase can be attributed to various factors, including changes in maternal age, medical advancements allowing more complicated pregnancies to proceed, and evolving practices in obstetrics.^[3] Caesarean delivery is now considered the most common and safe surgical procedure in the United States, with over 1 million women undergoing caesarean deliveries annually.^[3]

What happens during the procedure?

If you have a planned caesarean section, you will discuss the procedure with your doctor and sign consent forms. The anesthesiologist will discuss options for pain relief during the surgery. Most often, you’ll receive an epidural or spinal block that numbs you from your breasts down to your feet, allowing you to remain awake during the procedure.^[1]

Before the surgery begins, the following preparations take place:^[1]

• Hair in the area around the incision will be clipped or shaved
• A catheter (a thin, flexible tube) will be inserted to keep your bladder empty
• Heart and blood pressure monitors will be applied
• You’ll get an intravenous line (IV) in your hand or arm to give you medicine and fluid

During the caesarean section:^[1][4]

• A screen is placed across your body so you cannot see what’s being done, but the doctors and nurses will let you know what’s happening
• A cut about 10 to 20 centimeters (about 4 to 8 inches) long will usually be made across your lower abdomen, just below your bikini line
• The skin of the abdomen is cleaned with an antiseptic solution
• The uterus is then opened with a second incision and the baby is delivered
• You may feel some tugging and pulling during the procedure
• You and your birth partner will be able to see and hold your baby as soon as they have been delivered if they’re well
• The incisions are then stitched closed

A caesarean section typically takes between 40 to 50 minutes to complete.^[4] The whole operation normally takes about 45 minutes to an hour.^[2] A woman can typically begin breastfeeding as soon as she is out of the operating room and awake.^[2]

Anesthesia options

Most caesarean sections are carried out under spinal or epidural anesthesia. This means you’ll be awake, but the lower part of your body is numbed so you will not feel any pain.^[4] It may be done with a spinal block, where the woman is awake, or under general anesthesia.^[2]

Occasionally, a general anesthetic (where you’re asleep) may be used, particularly if the baby needs to be delivered more quickly in an emergency situation.^[4]

Recovery after a caesarean section

Recovering from a caesarean section usually takes longer than recovering from a vaginal delivery. You’ll probably be in hospital for 1 to 2 days after a caesarean section.^[10] Most women stay in the hospital for 2 to 4 days after delivery.^[16] They also typically take about six weeks to heal from, longer than vaginal birth.^[2]

While in hospital:^[10]

• You’ll be given painkillers to reduce any discomfort
• You’ll have regular close contact with your baby and can start breastfeeding
• You’ll be encouraged to get out of bed and move around as soon as possible
• You can eat and drink as soon as you feel hungry or thirsty
• A catheter will remain in your bladder for at least 12 hours
• Your wound will be covered with a dressing for at least 24 hours

When you’re well enough to go home, you’ll need to arrange for someone to give you a lift, as you will not be able to drive for a few weeks.^[10]

Caring for your incision

Your midwife or doctor should advise you on how to look after your wound. You should:^[10][9]

• Gently clean and dry the wound every day using warm, soapy water, usually when you shower
• Pat the area dry after cleaning
• Wear loose, comfortable clothes and cotton underwear
• Keep the area dry and clean

If your doctor used tape strips on your incision, let them fall off on their own. This usually takes about a week.^[9] Non-dissolvable stitches or staples will usually be taken out by your midwife after 5 to 7 days.^[10]

At first, your incision will be raised slightly and darker in color than the rest of your skin. It will likely appear somewhat puffy. Over time, your scar will become thinner and flatter. The wound in your abdomen will eventually form a scar, usually a horizontal scar about 10 to 20 centimeters long, just below your bikini line. The scar will probably be red and obvious at first, but should fade with time and will often be hidden by your pubic hair.^[1][10]

Managing pain and discomfort

Most women experience some discomfort for the first few days after a caesarean, and for some women the pain can last several weeks. You should have regular painkillers to take at home for as long as you need them.^[10] Your doctor might suggest ibuprofen (Advil, Motrin IB, others), acetaminophen (Tylenol, others), or other medicines to relieve pain. Most pain relief medicines are safe to take while breastfeeding.^[13]

Any pain should decrease after 2 or 3 days, but your incision will remain tender for up to 3 weeks or more. Most women need pain medicine for the first few days to 2 weeks.^[12]

You may also have some vaginal bleeding. This is called lochia and is normal. You may have bleeding from your vagina for up to 6 weeks. It will slowly become less red, then pink, and then will have more of a yellow or white color.^[12] Use period pads rather than tampons to reduce the risk of spreading infection into the vagina.^[10]

Physical activity and daily life

Try to stay mobile and do gentle activities, such as going for a daily walk, while you’re recovering to reduce the risk of blood clots. Be careful not to overexert yourself.^[10] Getting up and walking around once you are home will help you heal faster and can help prevent blood clots.^[12]

For the first 6 to 8 weeks after your caesarean:^[9][12]

• Do not lift anything heavier than your baby
• Short walks are an excellent way to increase strength and stamina
• Light housework is okay, but avoid heavy housecleaning
• Expect to tire easily and listen to your body
• Do not do jogging, most exercises, sit-ups, or any activities that make you breathe hard or strain your muscles
• Don’t drive a car for at least 2 weeks (it is okay to ride in a car, but make sure you wear your seat belt)
• Use tampons or douche only when you have your doctor’s permission
• Take baths only after your incision is healed and your postpartum bleeding has stopped
• Do not participate in rigorous activity or do core muscle exercises until your doctor clears you for activity
• Have sex only when your doctor says you can (usually after 6 weeks)

You should be able to do most of your regular activities in 4 to 8 weeks.^[12] You will need a checkup with your healthcare provider in 4 to 6 weeks.^[12]

Diet and nutrition

Taking care of your body after surgery means getting the right nutrition. You should:^[9][12]

• Drink enough water and other fluids
• Eat a well-balanced, healthy diet
• Take a fiber supplement daily to help avoid constipation
• Eat plenty of fruits and vegetables
• Drink 8 cups (2 liters) of water a day to keep from getting constipated
• Eat smaller meals than normal and have healthy snacks in between

Don’t crash diet. Ask your doctor when you can start trying to lose the baby weight.^[9]

Risks and complications

A caesarean section is generally a very safe procedure, but like any type of surgery it carries a certain amount of risk. Caesarean sections result in a small overall increase in poor outcomes in low-risk pregnancies.^[2] It carries more risk than a vaginal delivery, with a slightly longer recovery period.^[1]

As a major surgery, caesarean delivery carries risks, including infection, bleeding, and longer recovery times compared to vaginal births.^[3]

Risks to the mother

Possible complications for the mother include:^[1][4][5]

• Infection of the wound or womb lining
• Blood clots
• Excessive bleeding
• Damage to nearby areas, such as the bladder or the tubes that connect the kidneys and bladder
• Postpartum bleeding
• Amniotic fluid embolism (when amniotic fluid enters the mother’s bloodstream)
• Adhesions (scar tissue that forms inside the abdomen and pelvis)

Risks for subsequent pregnancies

Having a caesarean section can affect future pregnancies. Possible complications include:^[5]

• An increased risk of respiratory distress for your baby
• Complications with future pregnancies
• Problems with the placenta in future pregnancies

Risks to the baby

The increased risks for the baby include:^[2]

• Breathing problems in the baby
• Accidentally cutting the baby when the uterus is opened (though this is rare)
• Temporary breathing difficulties

Established guidelines recommend that caesarean sections not be used before 39 weeks of pregnancy without a medical reason.^[2]

Future pregnancies after a caesarean section

If you have a baby by caesarean, it does not necessarily mean that any babies you have in the future will also have to be delivered this way. Most women who have had a caesarean section can safely have a vaginal delivery for their next baby, known as vaginal birth after caesarean (VBAC).^[4]

Although it’s possible to have a vaginal birth after a previous caesarean section, it’s not an option for everyone. A trial of vaginal birth after caesarean section may be possible.^[2] Factors that can affect this include the type of uterine incision used in the previous caesarean section and the risk of uterine rupture.^[1]

When to call the doctor

Contact your healthcare provider straight away if you have any of the following symptoms after a caesarean section:^[9][10][14]

• Depression, sadness, hopelessness, or troubling thoughts
• Signs of infection including pain, pus, swelling, redness, swollen lymph nodes, or a fever
• A fever of more than 100.4 degrees Fahrenheit (38 degrees Celsius)
• Difficulty breathing or chest pain
• Discharge from the vagina that smells bad
• Severe pain in your abdomen
• Bright red vaginal bleeding that soaks through more than one pad every 2 hours (or less)
• Vaginal bleeding that gets worse or is still bright red more than 4 days after you’ve had your baby
• Heavy vaginal bleeding
• Signs of a blood clot, including pain in your thigh, groin, back of knee, or calf
• Your incision comes open
• Your wound becomes more red, painful and swollen
• A discharge of pus or foul-smelling fluid from your wound
• Leaking urine
• Pain when peeing
• Swelling or pain in your lower leg
• A cough or shortness of breath
• Nausea or vomiting
• Vaginal clotting larger than a golf ball
• Trouble passing urine or stool

These symptoms may be the sign of an infection or blood clot, which should be treated as soon as possible.^[10]

Taking care of yourself after having a caesarean section is just as important as taking care of your newborn. Allow yourself to take it easy. Rest whenever possible, and call your doctor if you have concerns about your health.^[14]