When a Cesarean Section is Necessary or Chosen

If you can't deliver vaginally, C-section delivers the fetus surgically. You may be able to plan and schedule your Cesarean. Or, you may have one done because of problems during labor.

Cesarean section (or C-section) is the surgical delivery of a baby through a cut (incision) made in the mother's abdomen and uterus. Health care providers use it when they believe it is safer for the mother, the baby, or both.

The incision made in the skin may be made in two ways:
  • Up-and-down (vertical). This incision extends from the belly button to the pubic hairline.
  • Across from side-to-side (horizontal). This incision extends across the pubic hairline. It is used most often, because it heals well and there is less bleeding. This method also increases the chance for vaginal birth in a future pregnancy.
The type of incision that is made depends on the condition of the mother and the fetus. The incision in the uterus may also be either vertical or transverse.

Several conditions make a Cesarean delivery more likely. These include:
  • Abnormal fetal heart rate. The fetal heart rate during labor is a good sign of how well the fetus is doing. Your provider will monitor the fetal heart rate during labor. The normal rate varies between 120 to 160 beats per minute. If the fetal heart rate shows there may be a problem, your provider will take immediate action. This may be giving the mother oxygen, increasing fluids, and changing the mother's position. If the heart rate doesn’t improve, he or she may do a Cesarean delivery.
  • Abnormal position of the fetus during birth. The normal position for the fetus during birth is head-down, facing the mother's back. Sometimes a fetus is not in the right position. This makes delivery more difficult through the birth canal.
  • Problems with labor. Labor that fails to progress or does not progress the way it should.
  • Size of the fetus. The baby is too large for your provider to deliver vaginally.
  • Placenta problems. This includes placenta previa, in which the placenta blocks the cervix. (Premature detachment from the fetus is known as abruption.)
  • Certain conditions in the mother, such as diabetes, high blood pressure, or HIV infection.
  • Active herpes sores in the mother’s vagina or cervix
  • Twins or other multiples
  • Previous C-section

What are the Risks of a C-section?

As with any medical procedures, mothers are concerned about the health of the baby and their own health. At Tenet Health Central Coast, we want you to understand the possible complications of a C-section including:
  • Reactions to the medicines used during surgery
  • Bleeding
  • Abnormal separation of the placenta, especially in women with previous Cesarean delivery
  • Injury to the bladder or bowel
  • Infection in the uterus
  • Wound infection
  • Trouble urinating and/or urinary tract infection
  • Delayed return of bowel function
  • Blood clots
After a C-section, woman may not be able to have a vaginal birth in a future pregnancy. It will depend on the type of uterine incision used. Vertical scars may not be strong enough to hold together during labor contractions. You may have other risks that are unique to you. Be sure to discuss any concerns with your health care provider before the procedure, if possible. Your health care provider may have other reasons to recommend a Cesarean delivery.

How Do I Prepare for a C-section?

Your doctor will explain the procedure to you and you can ask questions. You will be asked when you last had anything to eat or drink. If your C-section is planned and requires general, spinal, or epidural anesthesia, you will be asked to not eat or drink anything for 8 hours before the procedure. Other preparations to consider would be to:
  • Tell your doctor if you are sensitive to or are allergic to any medicine, latex, iodine, tape, or anesthesia.
  • Tell your doctor of all medicine (prescription and over-the-counter), vitamins, herbs, and supplements that you are taking.
  • Tell your doctor if you have a history of bleeding disorders or if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. You may be told to stop these medicines before the procedure.
You may be given medicine to decrease the acid in your stomach. These also help dry the secretions in your mouth and breathing passages. Plan to have someone stay with you after a C-section. You may have pain in the first few days and will need help with the baby. Follow any other instructions your provider gives you to get ready.

What happens During a C-section? Will I be Awake?

A C-section will be done in an operating room or a special delivery room. Procedures may vary depending on your condition and your doctor’s practices.

In most cases, you will be awake for a C-section. Only in rare cases will a mother need drugs that put you into a deep sleep (general anesthesia). Most C-sections are done with a regional anesthesia such as an epidural or spinal. With these, you will have no feeling from your waist down, but you will be awake and able to hear and see your baby as soon as he/she is born.

After your Cesarean Section

In the recovery room, nurses will watch your blood pressure, breathing, pulse, bleeding, and the firmness of your uterus. Usually, you can be with your baby while you are in the recovery area. In some cases, babies born by Cesarean will first need to be monitored in the nursery for a short time. Breastfeeding can start in the recovery area, just as with a vaginal delivery. Other monitoring and recovery includes:
  • After an hour or 2 in the recovery area, you will be moved to your room for the rest of your hospital stay.
  • As the anesthesia wears off, you may get pain medicine as needed. This can be either from the nurse or through a device connected to your intravenous (IV) line called a PCA (Patient Controlled Analgesia) pump. In some cases, pain medicine may be given through the epidural catheter until it is removed.
  • You may have gas pains as the intestinal tract starts working again after surgery. You will be encouraged to get out of bed. Moving around and walking helps ease gas pains. Your doctor may also give you medicine for this. You may feel some uterine contractions called after-pains for a few days. The uterus continues to contract and get smaller over several weeks.
  • The urinary catheter is usually removed the day after surgery.
  • You may be given liquids to drink a few hours after surgery. You can gradually add more solid foods as you can handle them.
  • You may be given antibiotics in your IV while in the hospital and a prescription to keep taking the antibiotics at home.

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