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Understanding Cesarean Birth

When most women find out they are expecting their first baby, the last thing they are thinking about is whether or not they will have to have a cesarean birth or C-section.  Once the birth gets closer, there are lots of questions about everything, including the possibility of having a C-section.  

And for women who have already delivered by C-section, they want to know if they can deliver their next child naturally.  Because of these questions and recent developments surrounding cesarean births, we decided to explore a topic that women care about and need to know, whether expecting their first baby or their third.      

So let’s start with the basics:  A cesarean birth is when the baby is delivered through an incision in the mother’s abdomen and uterus.  This is usually done for a number of medical reasons:

Multiple pregnancyIf a women is pregnant with twins, a cesarean may have to be performed because they are going to be born too early or are not in good positions in the uterus.

Failure of labor to progress – Sometimes contractions may not open the cervix wide enough for the baby to be born.

Concern for the baby – For instance, the umbilical cord could be compressed or fetal monitoring could detect an abnormal heart rate.

Problems with the placenta

A large baby

Breech presentation A baby’s buttocks or feet would be born first.

Maternal infections – Such as human immunodeficiency virus or herpes. 

Maternal medical conditions – Such as diabetes or high blood pressure.

  

How is a cesarean performed?  An incision is made through your skin and the wall of the abdomen.  The incision may be transverse (horizontal, known as bikini cut) or vertical.    Another incision will be made in your uterus.  The baby will be delivered through the incisions, the umbilical cord cut and the placenta removed.  Then, the uterus will be closed with stitches that will dissolve and stitches or staples are used to close your abdominal skin.  

You will be given either general anesthesia or an epidural block which numbs the lower half of your body.  If you have an epidural and are awake for the surgery, you can hold your baby right away.   At Calvert Memorial, you are taken to your room to recover and your blood pressure, pulse rate, breathing rate, amount of bleeding and abdomen will be checked regularly.  You should be able to begin breastfeeding right away.  

If you have general anesthesia, you will recover in the hospital’s Post Anesthesia Recovery Unit and you will be reunited with your baby normally within two hours.  Your husband/significant other is allowed in the operating room with you if you have a C-section by epidural but not if you have general anesthesia.  

A C-section is major surgery and the recovery is longer and more extensive than if you have a vaginal delivery.  With a section, you usually stay in the hospital three to five days.  You will be sore from an abdominal incision and have limited physical activity for two weeks.  The hospital stay for a vaginal delivery is two days.    

  

One of the most-asked questions is: If I have had a C-section, will I always have to have one?  Not necessarily.  You and your doctor will decide whether you are eligible for a VBAC (Vaginal Birth after Cesarean).  The decision is based on a number of factors:  the type of incision you had in the first C-section, the number of previous C-sections or whether you have any conditions that could make a vaginal delivery risky.        

How many C-sections can you have?  There is not a specific number of how many C-sections are safe.  Research does show that with each repeat C-section, the chances for complications are increased.  Again, you and your doctor will discuss what is best for you.   Both vaginal and cesarean deliveries have risks and benefits. 

Another question asked is: Can I schedule a C-section or induction to get the doctor I want or when it works out best for me and my family?  No.  For over 30 years, the American College of Obstetricians and Gynecologists has recommended that obstetric providers not induce labor or perform cesarean sections before 39 weeks (full term) without a medical reason.

Early elective deliveries have been shown to increase harm to infants, increase costs and worsen medical outcomes.  And now The Joint Commission, the Centers for Medicare and Medicaid Services and various other health and safety organizations use the rate of elective deliveries before 39 weeks of gestation as an indicator of quality. 

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