C-Sections: Just the Facts
If you're concerned that the C-section procedure is in your future, learning the facts can help ease your mind. Here are 15 facts you should know about Cesarean births.
1. Definition, Please
A C-section is the surgical delivery of an infant via an incision in the mother’s belly and uterus while the mother is under anesthesia. The baby is delivered through the incision, either manually or with the help of a vacuum or forceps.
2. Statistics, Please
Almost 33 percent of deliveries in US are by C-section, says Dr. Jeotsna Grover, member of the board of directors for the
Perinatal Advisory Council: Leadership, Advocacy, and Consultation (PAC/LAC). Broken down by race and ethnicity, black moms have the highest overall rate of any group at 34 percent; rates among Hispanic moms are 31 percent, slightly below the national average. C-sections are the most commonly performed operation in American hospitals.
3. Emergency C-sections
Emergency C-sections are those performed at some point after labor has begun due to complications or inability to deliver the baby vaginally. Some reasons for an emergency C-section are:
- Fetal distress
- Failure to progress in labor due to size of the baby or ineffective uterine contractions
- Cord prolapse (when the cord enters the birth canal before the baby, which may result in compression during a vaginal birth)
- Abnormal presentation like breech or buttocks first
- Uterine rupture
- Placental abruption (detachment of the placenta from the uterus prematurely)
- Placenta previa (partial or complete blockage of the cervix by the placenta)
- Development of preeclampsia during labor
4. Elective C-sections
While some refer to elective C-sections as “too posh to push,” there are medical reasons that a C-sections would be scheduled, including:
Pregnancy of multiples
Known breech presentation
Maternal genital herpes outbreak
Known medical issues/defects in the infant
Medical issues in the mother, such as heart or neurological conditions
Large baby, especially a possibility in diabetic mothers
5. Let’s Talk Meds
C-sections, being considered major surgery, requires
anesthesia. There are a couple of choices. The first is regional anesthesia (spinal,
epidural, or combined spinal and epidural). Regional anesthesia is generated by sticking a needle into the back, and delivering the anesthetic directly. It numbs the lower half of the body allowing the surgery to be performed while the mother is awake.This is the preferred method of anesthetic in most cases, as it allows the mother to interact with her baby immediately after delivery.
6. General Anesthetic
General anesthesia is generally reserved for emergency situations when the surgery must proceed quickly and there isn’t time to wait for regional anesthetic to take effect. It may also be used when the mother has excessive bleeding and may not tolerate regional anesthesia or if she has neurologic issues or has the possibility of infection being spread with the use of regional anesthesia. With general anesthetic, of course, you will be asleep and not able to interact with your infant until you’ve recovered.
7. The Incision
The type of incision chosen will depend on several factors, including surgeon preference, the position of the baby, and maternal preference.
Classical incision: A vertical incision made in the midline of the abdomen. This is rarely used these days, due to possibility of increased risk of complications.
Low transverse incision: This is the most frequently performed incision, which involves a horizontal incision just above the bladder. This incision is easier to repair and involves less blood loss than a classical incision. It is usually positioned below the pubic hairline, so is less visible when it heals and the hair grows back and covers it.
8. Know the Risks
“One of the things we are doing at PAC/LAC is ensuring that women understand that the benefits of C-section must be weighed with the risks,” says Dr. Grover. “Of course a woman should follow the advice of her physician, but she should also do her research in advance so that she can be an informed, empowered patient.”
Let’s explore the risks to Mom and Baby…
9. Risks for the Newborn
Vaginal delivery is, of course, the preferred method of delivery in almost all cases due to possible increased risks to both mother and infant during a C-Section. Risks to the newborn include possible injury during delivery, temporary sluggishness after delivery due to the anesthesia, and increased risk of breathing problems due to fluid in the lungs even if the infant is full term. Infants born by C-section also have higher risk of
NICU admissions and longer hospital stays.
10. Risks for Mom
C-sections, while relatively safe, are still major surgery. The risks may include bleeding that may require blood transfusion, infection or hernia at the incision site, injury to bowel or bladder, increased risk of blood clots, as well as risks from the anesthetic used during the procedure. Risks for later complications after C-sections includes the development of adhesions from the abdominal surgery, possible weakening of the uterine muscles from the incision, which may increase the risk of uterine rupture during future pregnancies.
11. Dad's Involvement
Most hospitals will allow the birth partner/spouse to be present in the operating room during a C-section to provide support and encouragement to the mother and to interact with the infant after birth. Drapes will keep the surgical procedure from view for the most part and may be lowered after delivery to view the infant and for the partner to cut the cord if so desired.
12. The Hospital Stay
While a hospital stay for a vaginal birth is usually about 48 hours, moms who have had C-sections generally remain hospitalized for three to four days after delivery depending on how quickly their bowel and bladder function returns, how well they are eating moving around, as well as the absence of any signs of infection or other complications from the surgery. Insurance allowances may also factor in the length of time Mom stays hospitalized.
13. Recovery Time
Recovery time for C-sections is longer than it is for vaginal birth, as well as being generally more painful. Full recovery time from the surgery may take four to six weeks. Some of this time, you will probably be on narcotic pain medications as your abdominal muscles heal. “Since staples/stitches are removed prior to discharge from the hospital, a two-week followup is scheduled to evaluate mother’s general condition and her wound,” says Dr. Grover.
14. Going Home
Upon returning home, you’ll be put on certain restrictions by your doctor. These will likely include no driving for two to three weeks (or while on narcotics), no sex for four to six weeks, and no bathing or soaking in a tub until your incision is completely healed. You’ll be required to watch your incision for infection, as well as to visit your doctor on the schedule he provides, likely at about two and six weeks after the surgery.
15. Future Pregnancies
Doctors will recommend not becoming pregnant again for at least 12 to 18 months after a C-section, in order to give all the layers of the uterus time to heal. Even so, the incision in the uterus can cause weakness in the uterine muscles, making the chance of a repeat C-section with a subsequent pregnancy more likely. However, about half of moms go on to have a
vaginal birth after a Cesarean (VBAC).
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