Purpose

C-sections can be lifesaving surgeries that doctors usually perform in emergencies or circumstances where a baby would otherwise not be safely born. Since a C-section is a major surgery, the American College of Obstetricians and Gynecologists (ACOG) recommends that they be reserved for situations where they are medically necessary.

These situations can include:

• Labor fails to progress
• Compressed umbilical cord
• Abnormal fetal heart rate 
• Pregnancy of multiples
• Placenta previa (the placenta lies over the cervix)
• Placenta accreta (the placenta grows too deeply into the uterine wall)
• A fetus that is too big to be born vaginally
• A fetus in an unfavorable position (breech or transverse lie)
• HIV infection
• Active herpes infection
• Diabetes
• High blood pressure

According to ACOG, the drastic increase in the cesarean rate between 1996 and 2011 without concurrent decreases in maternal and neonatal morbidity and mortality indicates that C-sections were overused. While the World Health Organization does not recommend a target C-section rate, it is concerned with the rising rates of cesarean sections globally and recognizes that not all cesarean sections are performed for medical reasons.

C-sections by request are not a significant contributor to the high cesarean rate. In fact, only 2.5% of C-sections are performed based on the request of the pregnant person. In these situations, ACOG advises the following:

• Doctors should counsel pregnant people on the risks of the procedure.
• Doctors should advise pregnant people on other options, including available anesthesia for vaginal birth.
• If a person still desires elective surgery, it should occur at 39 weeks or later.
  

Risks

Like all medical procedures, a C-section comes with certain risks. Some risks are specific to the person giving birth, and some are to the baby.

Risks to the pregnant person include:

• Infection
• Blood loss
• Blood clots
• Injury to bowel or bladder
• Amniotic fluid embolism
• Reaction to anesthesia

Risks to the baby include:

• Altered immune development
• Increased likelihood of developing allergies and asthma
• Reduced gut microbiome diversity

The most significant risk of C-sections is the risk posed to future pregnancies. The more cesarean sections a person has, the greater their risk of complications.

 Risks to future pregnancies include:

• Need for future C-sections
• Uterine rupture
• Placenta problems
• Ectopic pregnancy, a pregnancy that happens outside the uterus
• Stillbirth
• Preterm birth, where a baby is born before 37 weeks of pregnancy

Procedure

An obstetrician usually performs a C-section in an operating room. The surgery itself usually takes around 45 minutes.
In most circumstances, your partner or support person may be allowed in the room with you. During the surgery, your doctor will cut through the abdomen and uterus to deliver the baby.

Before Surgery

Before the surgery, a nurse and anesthesiologist will prepare you for the surgery. Preparation may include:

• Placing an IV line in your arm or hand
• Washing the surgical site (your abdomen)
• Clipping your pubic hair
• Placing a catheter in your urethra, the tube that allows urine to pass out of the body

In addition, an anesthesiologist will administer anesthesia. Sometimes in an emergency, general anesthesia is used. Most of the time, however, an epidural or spinal block is preferred. This type of regional block allows the parent to be awake and alert for the birth of their baby. 

To administer an epidural, the anesthesiologist will ask you to sit very still while they inject the medication and insert a tube into a space in your lower spine. The line will allow the anesthesiologist to continue to administer more anesthetics as needed during the surgery.

During Surgery

During the procedure, your doctor will make an incision in the abdominal and uterine walls. The type of incision on the skin may be different than the incision on the uterus. The skin incision and uterine incision could be transverse, horizontal and placed beneath the belly button, or vertical.

The risk of uterine rupture with a vertical uterine incision is 8% to 10%, while the risk with a transverse incision is 1%.

After your doctor makes the incisions, they will deliver your baby. Then they will cut the umbilical cord and remove the placenta. Finally, they will close the incisions with stitches. Sometimes other closure techniques such as staples are used on the skin.

After Surgery

If you are awake for the surgery, you will likely be able to hold your baby right away. After your doctor completes the surgery, you will be moved to a recovery room, where they will monitor your vitals and check your abdomen regularly.
Soon after the surgery, a nurse will remove your catheter. You may feel pain around your incision, and your doctor can prescribe medications to help you feel comfortable as you recover.

Recovery

Hospital stays after a C-section are usually between two and four days. Remember that you are recovering not just from giving birth but also from a major surgery. Some things you may experience after a C-section include:

• Mild cramping
• Bleeding from the vagina for four to six weeks
• Passing clots
• Pain at the incision site

Even though you gave birth by C-section, it is still important to avoid placing anything in your vagina (and having sex) for several weeks to limit your chances of infection. Talk to your doctor for specific instructions. 

When to Call a Doctor

Seek medical attention right away if you notice any of the following:

• Severe pain
• Heavy vaginal bleeding
• Redness, swelling, or excessive pain at the incision site
• Discharge from incision
• Cough or trouble breathing
• Swelling in your lower leg
• Pain while urinating or difficulty holding urine
• Fever

Summary

A C-section, or cesarean section, involves making an incision in your abdomen to deliver your baby. It's typically reserved for situations where a C-section is medically necessary. Examples include labor not proceeding and when your health or your baby's health is at risk.

An epidural or spinal anesthesia is given during this procedure to provide regional anesthesia, so you can be awake after your baby is born. You may have to stay at the hospital for two to four days after the surgery.