Patient education: Cesarean birth (The Basics)

What is cesarean birth? — Cesarean birth means having surgery to give birth to your baby (figure 1). If you have a cesarean birth, you will be given anesthesia so you won't feel pain. Then, the doctor will make an incision (cut) in your belly and remove the baby from your uterus. This surgery is sometimes called a "c-section."

About 1 in 3 babies in the US is born by cesarean. Most babies come out through the vagina. This is called "vaginal birth."

Will I know in advance if I need a cesarean? — You might. The most common reasons to have a cesarean birth before you go into labor are:

●You had a baby by cesarean in the past.

●The baby is not coming out head-first.

●The baby is very large.

●You have an infection, such as herpes or HIV – These can spread to the baby during a vaginal birth.

●You have a condition called "placenta previa" – The placenta is the organ that brings the baby nutrients and oxygen and carries away waste. In placenta previa, this organ blocks the way to the vagina.

●The baby has a problem, and the doctor believes that labor and vaginal birth might not be safe because of it.

Some people choose to have a cesarean birth even if they don't need to. Talk to your doctor if you think that you want to have your baby this way. Surgery has real risks.

When should planned cesarean births happen? — In most cases, you should wait until the 39^th week of pregnancy or later. (A normal pregnancy lasts about 40 weeks.) But it might need to be scheduled before 39 weeks if you or the baby has a problem.

Why do some people need to have a cesarean birth after labor begins? — A common reason is that labor doesn't move along like it should. This can happen if:

●The baby is in an odd position, like the head is sideways or chin-first.

●The baby is too big.

●Your pelvis is too small (the pelvis is the set of bones around your hips and vagina).

Other reasons for a cesarean birth include:

●The baby's life is in danger, for example, because their heart rate is too slow.

●Your life is in danger, for example, because you are bleeding too much.

If my labor is moving slowly, will I need to have a cesarean birth? — Not necessarily. First, your doctor or nurse might use a medicine called oxytocin (brand name: Pitocin). The medicine should make your contractions stronger. If that doesn't help within a few hours, your doctor might suggest a cesarean birth.

How is the surgery done? — Here are the main steps:

●First, you will get anesthesia to keep you from feeling what happens during the surgery. There are 2 kinds of anesthesia. With regional anesthesia, you stay awake. With general anesthesia, you are asleep.

●Next, the doctor will make an incision on your lower belly. There are 2 ways of making the incision:

•Most of the time, the incision goes across your belly, from 1 side to the other, an inch or 2 above your pubic hair.

•If you are bleeding a lot or if your baby is in danger, the incision might go up and down. This kind of incision is sometimes the fastest way to get the baby out.

●After opening your belly, the doctor will make an opening in your uterus and remove the baby. Then, the doctor will cut the umbilical cord and take out the placenta.

●Finally, the doctor will close your uterus and belly with stitches and possibly staples.

How long does it take to heal after the surgery? — Within a few hours, you will be able to move around, and eat and drink. Most people go home after 3 days, but will have some pain. It can take 6 to 8 weeks to heal completely. If you plan to return to work, you can most likely do so after this time.

Are there risks of having a cesarean birth? — Yes. Although most people and their babies do well after a cesarean birth, there are risks.

Compared with a vaginal birth, cesarean birth is more likely to cause:

●Harm to the bladder, blood vessels, intestines, and other nearby organs

●Infection

●Blood clots that can block blood vessels and cause trouble breathing

●A longer time to heal after the birth

●Problems with the placenta and uterus in later pregnancies

●Trouble breathing for the newborn (this usually lasts for just a short time)

Your doctor can help you decide if the risks of surgery are worth taking for you.

What symptoms might I have while I'm healing? — For the first few weeks, it is common to have:

●Mild cramps in your belly

●Light bleeding and yellowish fluids coming out of your vagina

●Pain where the incision was made

Call your doctor if:

●You have a fever higher than 100.4°F (38°C).

●Your pain gets worse.

●Your vaginal bleeding gets heavier.

●The incision in your belly gets more sore or red, or is bleeding or leaking fluid.

If I have a cesarean birth, will all of my future births have to be cesarean? — Not anymore. Today, many people have a "trial of labor" after their previous cesarean birth. This is called a "TOLAC." A vaginal birth after a cesarean is called a "VBAC."

If the cut in your uterus in the first cesarean birth went from side to side (instead of up to down), you have a good chance of being able to have a vaginal birth with your next baby. Ask your doctor if a trial of labor is possible for you.

More on this topic

Patient education: Anesthesia for cesarean birth (The Basics)
Patient education: Amniocentesis (The Basics)
Patient education: Labor and childbirth (The Basics)
Patient education: Shoulder dystocia (The Basics)
Patient education: Vaginal birth after a cesarean (The Basics)
Patient education: Having twins (The Basics)
Patient education: Breech pregnancy (The Basics)
Patient education: Using an abdominal binder (The Basics)
Patient education: When your baby is measuring large during pregnancy (The Basics)
Patient education: Cesarean birth – Discharge instructions (The Basics)

Patient education: Amniocentesis (Beyond the Basics)
Patient education: C-section (cesarean delivery) (Beyond the Basics)