What exactly is a cesarean section, why are they performed, what should you expect, and what is recovery like? Cesarean births are common, safe, and nothing to be afraid of. While most expectant parents plan on a vaginal birth, about 32% of birthing parents in the U.S. give birth via cesarean section. Let’s dive into all things cesarean.
What is a Cesarean birth?
A cesarean birth also called a C-section, is when a baby is delivered through incisions made in the abdomen and uterus. It’s a safe surgical procedure that is often performed when complications come up that make vaginal birth difficult or put the birthing parent or baby at risk.
Why are cesareans performed?
You can undergo a cesarean birth in three different scenarios:
1. A planned cesarean
2. A non-emergency, unplanned cesarean
3. An emergency, unplanned cesarean
Planned cesareans are exactly what they sound like. The birthing parent and physician decide together that a C-section is the best option, and schedule the procedure usually around 39 weeks. Why would you plan a cesarean birth? Reasons include:
• Baby is transverse or breech
• Baby is expected to be large
• You have had a prior uterine surgery
• There are multiple babies
• There is a problem with the placental location
• There are active herpes lesions or high HIV viral loads
Some people also choose to have a C-section without any of these circumstances. While this is generally not recommended, given that it is major abdominal surgery, a cesarean birth can be performed at the birthing parent’s request for reasons of anxiety, past vaginal surgery, or history of abuse.
Non-emergency, unplanned cesareans are the most common type of C-section birth. In this situation, the birthing parent usually planned to deliver vaginally, but something happened over the course of labor that made a cesarean a safer way to give birth. That might include:
• Cervical dilation stopped
• Baby is not moving down the birth canal
• Baby is showing signs of distress
The good news about a non-emergency unplanned cesarean birth is that you still have time to process the situation and ask questions. Even when things change, you can still advocate for yourself and your baby and prepare for the new course of events.
Emergency cesarean births are the least common type of C-section. Very rarely, an emergency cesarean becomes necessary if there is a prolonged or severe drop in fetal heart rate, cord prolapse, placental complications, or uterine rupture.
What happens during a cesarean birth?
What can you expect from a non-emergency cesarean, whether planned or unplanned?
First, you will be asked to remove your jewelry and potentially be given an antacid to reduce stomach acid. If you don’t already have an IV, you will be hooked up to one. You will then be walked or wheeled into the operating room, which will be cold, bright, and bustling. Expect a whole bunch of people, including the surgical staff and medical teams to support you and baby. Once you’re in the operating room, you will receive spinal anesthesia to numb your body from the chest down. Your arms will be placed on boards beside you.
Your partner or support person will be asked to stay behind at first while you are prepped. They will join you about 15-25 minutes later, after you’re settled in, and will typically sit in a chair next to you at the head of the operating table.
In addition to the spinal anesthesia, you will also receive a urinary catheter. This is because while you’re numb, you won’t be able to feel the sensation of having to pee, nor will you be able to get up to go.
The medical team will hang a drape across your chest. Traditionally the drape is opaque, like a bedsheet, but you can ask for a clear drape if you would like to see your baby being born.
Some birthing parents experience discomfort due to the anesthesia, including shortness of breath, nausea, and vomiting. Unfortunately, these side effects are relatively common, but they usually resolve quickly.
When it’s time for the procedure, the surgeon will make a horizontal incision about 5-6 inches long just above your pubic bone and below your belly button. Once the incision is made, the doctor will separate your abdominal muscles and make another incision in the uterus. Finally, the doctor will rupture your amniotic sac.
As the surgical team moves through these steps, you might feel pressure, pulling, and tugging, especially during the finale — when the doctor pulls out the baby and your baby is born!
Once baby is out, the cord is clamped and cut and baby is passed off to the pediatric provider. Baby will be assessed on a warmer for a few minutes, and if all is well, can be brought to you for skin-to-skin time or snuggled into your partner’s arms. Note that some providers will do delayed cord-cutting in cesarean birth, so ask your doctor if that’s important to you.
Finally, the placenta is manually removed through the incision. The surgeon then uses dissolvable stitches for the incision in the uterus and stitches, glue, or staples for the external incision. While many people worry about the scar, it’s perfectly hidden by underwear or a bathing suit bottom — and even if or when it’s not, it’s a badge of honor.
In the case of an emergency cesarean, some of these preparation steps may be skipped to keep the birthing parent and baby safe. In very rare situations, there may not be time for spinal anesthesia, so general anesthesia may be used instead.
What is a gentle cesarean?
Even if you were hoping to avoid a cesarean, you can still get the most out of your birth experience. For example, some providers offer a gentle cesarean, which is intended to mimic the experience of vaginal labor and birth as much as possible while still performing the necessary surgical procedure to bring baby into the world.
A gentle cesarean is a cesarean birth performed with dimmed lighting, limited talking, and/or background music of your choice. A doula or midwife may be able to be in the operating room, and the baby may be removed more slowly than during a traditional C-section.
A gentle cesarean may also include:
• Using a clear drape to see and watch baby being born (your pregnancy bump usually blocks the site of the actual incision)
• Baby being handed to you directly after birth for skin-to-skin contact
• Breastfeeding initiated in the operating room right after birth
• Delayed umbilical cord-cutting
• Birth support person cutting the umbilical cord
• Baby staying with you in the operating room for the remainder of the operation (while sewing up the incision, etc.)
Ask your doctor about their approach to gentle cesareans, as it can vary by hospital and care provider.
What is recovery like after a cesarean birth?
Recovering from a cesarean birth is similar to recovering from a vaginal birth in many ways. There are, however, a few key differences.
After a C-section, you will likely stay at the hospital a bit longer, for an average of 2-4 nights. How long you remain at the hospital depends on how you’re managing pain, moving around, and using the bathroom. To determine if you’re ready to go home, your medical team may ask if you’ve passed gas. This may sound a little awkward, but they’re simply looking for clues that your digestive system is moving the way it should after the abdominal surgery.
Moving within the limits of your body is key to recovery after a cesarean birth. Even short walks around the hospital unit or, once you’re home, to the mailbox or down the street can keep your digestive system working the way that it’s supposed to. Deep breathing and coughing can help as well, clearing the lungs and lowering the risk of pneumonia post-surgery.
Many people report pain in their muscles and tissues after a cesarean birth, especially when laughing, coughing, or standing up. Pressing a folded blanket or pillow against your abdomen when standing up can make it less painful.
You may also experience shoulder or neck pain. Interestingly, this is often trapped gas. When bowels become sluggish after surgery, gas presses on the diaphragm which triggers a nerve and extends pain to your shoulders. These sensations typically disappear within a few days. If you feel neck or shoulder pain for much longer than that, or it becomes particularly painful, ask a nurse about anti-gas medication, or if at home, call your doctor.
Most people have to wait about 24 hours before showering after a C-section so that the incision can heal before removing the dressing. When you’ve received the all-clear to shower, simply rinse the incision with warm water and mild soap and pat it dry.
Once you’re home, it’s important to monitor your incision for signs of infection. If you see any of the signs below, contact your physician right away.
• Foul-smelling secretions
Remember, after a cesarean, your body is recovering from significant surgery. Take it easy. Drink plenty of water, eat a well-balanced diet, and rest when you can. Wear loose, comfortable clothes that don’t rub your incision. No lifting anything heavier than your baby, no driving for two weeks, and no baths until your incision is healed. You will likely see your doctor about two weeks after the birth, who can clear you for these activities and more.
Can I deliver vaginally after having a C-section?
Potentially! In many cases, it is possible to deliver vaginally following a cesarean birth. If that is your preference with the next baby, the first step is TOLAC or Trial of Labor After Cesarean. If that goes well, you can try for a VBAC, a Vaginal Birth After Cesarean.
Studies show that 60-80% of people who TOLAC end up with a vaginal birth. Discuss your options with your doctor to see if a VBAC could be right for you.
Final words on C-sections
Although a cesarean birth may not be your first choice, knowing what to expect means you’ll be prepared and empowered if the time comes. For more information on cesarean births and the entire childbirth process, check out our Childbirth 101 course.
About our Expert
Ashley Derderian Sousa is a board-certified lactation consultant and registered nurse with nearly ten years of experience in labor, delivery, and postpartum units. Through approachable methods and open and honest philosophy, she believes each journey to becoming a parent is a personal one that should be met with self-compassion. She is currently completing a Masters of Health Education.