Cesarean Section (C-Section)

A quick look at C-sections

A cesarean section, or C-section, is the surgical delivery of a baby through an incision in the mother’s abdomen and an incision in the uterus.

Benefits of a C-section over a normal vaginal delivery are that it can avoid potential risks to the mother’s or baby’s health due to a variety of factors. These include size and positioning of the baby, danger to the baby from an abnormal heart rate, a multiple birth of twins or more, and maternal infections or medical conditions such as high blood pressure.

Risks of a C-section include those of any surgery, but they occur in less than 1% of women having the procedure and are easily treated. These include infection, blood loss, blood clots, reaction to medication or anesthesia, and injury to the bowel or bladder. Our OB-GYNs discuss all risk aspects of this delivery option, arriving at a consensus with the patient and her partner.

What is a C-section?

A C-section, or cesarean delivery, is a procedure to deliver a baby by surgical means (compared with a vaginal delivery). It involves an incision in the mother’s abdomen and one in the uterus (womb). The baby is removed from the uterus and through the incision in the abdomen.

We typically recommend this form of birth for pregnant women with risks factors for vaginal delivery or when unexpected problems arise during labor that endanger the baby or the mother. According to the Centers for Disease Control and Prevention, roughly 1 in 3 deliveries in the United States are by C-section.

The woman’s OB-GYN will perform the C-section, not a separate surgeon (except in rare cases of complications). The same doctors the woman has seen and come to trust throughout her pregnancy care would also be the doctors performing her C-section.

Common reasons for C-sections

• Breech presentation, meaning the baby is “upside down,” or the head is up and the feet, or butt, are down (closer to the birth canal).
• If the cervix does not open wide enough, known as arrest of dilation.
• If the baby does not drop down into the birth canal, known as arrest of descent.
• Fetal distress or intolerance of labor.
• Health problems in the mother (infections, blood pressure, heart disease, etc.).
• Multiple births (e.g., twins, etc.)
• The size of the baby.

Planned and elective C-sections

Though most C-sections occur due to the circumstances above, some C-sections are planned in advance. This is generally due to the mother having a previous C-section, which can present more risk for that mother and her child if the second delivery is vaginal. However, this is becoming less common of a concern.

Women can also request a C-section even if vaginal delivery is an option. This is known as an elective primary C-section. This occurs in about 2.5% of all births in the U.S., according to the American College of Gynecologists and Obstetricians.

Women may request a cesarean delivery due to fear of pain from vaginal birth. Other reasons are concern over potential vaginal tearing or pelvic floor problems like prolapse and urinary incontinence that are sometimes caused by vaginal delivery. Some women are embarrassed about giving birth vaginally. The physicians at CU Medicine OB-GYN East Denver talk over such concerns with each woman requesting an elective C-section.

Myths about C-sections

Cesarean section has generated several myths and common misconceptions. These often frighten women away from a procedure that is beneficial for them and their child. Here are some of the more common myths and misconceptions we hear.

The surgery cuts abdominal muscles, creating weakness and complications.

No. We do not cut the abdominal muscles. We do cut the abdominal skin, but we carefully stretch the muscles to the side, they are not cut.

Activity is severely limited after the surgery.

There aren’t as many physical restrictions as people think. By the time they leave the hospital, most moms are able to walk up and down stairs, go for a walk in the neighborhood, shower, and take care of themselves and their baby.

I won’t be able to breastfeed after a cesarean section.

You will be able to breastfeed. Milk flow begins when the uterus is emptied, no matter whether it was emptied through vaginal birth or cesarean delivery. Skin-to-skin contact right after delivery helps the baby figure out breastfeeding.

The recovery time after C-section is much longer.

Actually, it is only about 2 weeks longer than in vaginal birth, with a recommended 8 weeks off work. The first two weeks are the hardest, then it gets easier.

A mother can’t have a vaginal birth after C-section (VBAC).

While some women are not good candidates for VBAC, most are. Our physicians talk with each woman who has had a previous cesarean delivery about the VBAC option.

A walkthrough of what to expect in a C-section procedure

We understand that the idea of having surgery to deliver a child can cause some apprehension. Our OB-GYNs are committed to enlightening patients about the procedure before the time comes. The following steps are what women undergoing a cesarean section can expect.

• For a planned C-section, we usually administer a spinal anesthesia through the lower back into the spinal fluid.
• For an unplanned C-section, if the mother has been given an epidural we can administer different medications through that catheter that remains in place.
• Most women undergoing a C-section receive an epidural or spinal block to numb the body while remaining lucid. Rarely, general anesthesia is also used.
• In most cases, another person is allowed in the room during the surgery, even during the spinal placement.
• We then place a cuff on the woman’s legs to help with circulation and prevent blood clots. Mom can feel them inflating and deflating, but she should not be afraid of that feeling.
• Once she is numb, we’ll put a catheter in the urethra, if one isn’t already in place, to dispose of urine.
• Then we wash her belly with sterile soap, and we’ll use sterile sheets to build a little wall around her but not in such a way as to make her feel trapped. Her partner can sit in a chair next to her and watch if desired. Photos are OK, but no videos, please.
• A simple pinch test on both sides of her body ensures that she is fully numb prior to beginning the procedure. In extremely rare circumstances, a spinal or epidural doesn’t work during testing, and general anesthesia is used instead.
• Next, the OB-GYN will make a horizontal incision above the pubic hair line, usually about 4-6 inches in length. This cut is in the shape of a smiley face and is sometimes called a “bikini cut” due to its placement.
• After the initial incision, the doctor gently parts the incision and muscles in order to reach the uterus, where another incision is made sideways on the base of the uterus, allowing the doctor to pull the baby out of the womb.
• The baby’s nose and mouth are cleaned of amniotic fluid, then we wait 60 seconds and clamp the umbilical cord. The first umbilical cord cut is done by the doctor for safety, but a partner can optionally perform the second, or trimming, cut.  As long as the baby is OK, we bring the baby right up to mom so she can have skin-to-skin contact.
• A nurse from the nursery or a nurse practitioner are available with a warmer should the baby need help transitioning from water breathing to breathing air. This allows the family to stay together.
• Then, the doctor removes the placenta through the same incisions and closes them using dissolvable stitches.

After surgery, women may experience pain, numbness or grogginess, especially if general anesthesia was used. The bladder catheter is removed 12-24 hours after surgery, once the woman is able to sit up and walk around.

Recovery time can vary, but women should plan for a 2-4 day hospital stay after a cesarean birth and 8 weeks for full recovery (2 more weeks than with vaginal birth).

What to expect post-surgery: dos and don’ts

In the weeks following surgery, keep the area clean by washing it with mild soap and water with a sponge or shower. Baths should be avoided.

Overall, women should take extra care as their body heals – get plenty of rest and avoid strenuous activities and lifting heavy objects. Also wait to use tampons, go swimming or have sex until okayed by a doctor. In most cases, that is 6 weeks after surgery.

The incision may feel sore for the first week or two but the pain will gradually decrease as the incision heals and uterus contracts.

The surgery will leave a scar but over time it will fade and become thinner and flatter.

About Our Care

C-section risks

Like any surgery, a cesarean does have inherent risks but these are generally rare. Some of the risks are pain, bleeding, blood clots, infection and allergic reaction to anesthesia. Women may also experience uterine cramping or difficulty urinating.

The more C-sections a woman has, the more complications may arise in future pregnancies, including the risk of placenta accreta. This placental abnormality can cause severe bleeding and injury to other organs at the time of delivery. It also can prompt the need for early delivery and, potentially, require a hysterectomy.