A Cesarean section, or C-section, is a surgical method of delivering a baby. An obstetric surgeon makes an incision in the lower abdomen and another one into the uterus to access the fetus and deliver the baby. If specific medical conditions are identified during pregnancy, a C-section can be scheduled ahead of time. In other cases, a C-section may be done if it’s an emergency. Having a C-section can increase certain risks, but for some people this may be the safest way to deliver their baby.
Why would you need a scheduled C-section?
There are different reasons why someone might require a C-section delivery, but most are due to a vaginal delivery being the more dangerous (or only) option. For example, if baby is in a poor position for delivery (like sideways or bum-first) or is at risk of being stuck and is unable to be pushed through the pelvis and birth canal, a C-section would be a safer way of getting the baby out of the uterus.
Other situations that can lead to a scheduled C-section include:
- Macrosomia—when the baby’s head is larger than normal and can’t fit safely through the pelvis
- If you’ve had previous damage or surgery to the perineal, pelvic, rectal or anal areas
- In the presence of a Herpes simplex (genital herpes) or HIV infection
- When the placenta is in an abnormal position (like covering or partially covering the cervix)
- If you’re expecting multiples—most twins can be delivered vaginally, but in some cases may require a C-section (this is often the case for multiples greater than two)
Why would you need an emergency C-section?
A vaginal delivery is likely to be moved to an emergency (unscheduled) C-section if:
- The baby has an abnormal heart rate pattern
- The cervix is unable to open to allow the baby through during labor
- The umbilical cord prolapses—this is when the cord comes through the cervix before baby (if the cord becomes squeezed by contractions or by the baby, it could prevent blood flow and oxygen from reaching baby while they’re still in the uterus)
- The cord loops around the baby or gets caught
- The placenta separates from the uterine wall before the baby is delivered
What can I expect during a C-section?
In both a scheduled and emergency C-section, you’ll have an IV put into your arm to provide you with fluids and any necessary medications. Epidurals are commonly used to numb you from the chest down (these can also be used in vaginal deliveries), though if an emergency C-section is required and time is limited, a general anesthetic can be used. You’ll also have a catheter inserted into your urethra to collect any urine.
An oxygen mask can be applied to ensure you and the baby are getting enough oxygen before birth. Then a small curtain or drape is placed between the chest and abdomen—this can be opaque to block the view, or clear if a view is wanted.
The abdomen is cleaned, the incisions are made and the baby is lifted out. The umbilical cord is cut and the baby should start breathing real air for the first time. The medical team will assess the baby and, in many cases, mom can hold the baby shortly after the delivery (the same is true for a vaginal delivery). If there is any sign of distress, one medical team will continue to take care of the baby, while another doctor stiches up the incisions made during the surgery (to the birthing parent). This whole procedure can take between 15 to 45 minutes depending on how emergent it is to have the baby delivered.
What are the risks with having a C-section?
In general, a vaginal delivery is safer than a C-section, but that doesn’t mean a C-section can’t be done safely. With any type of surgery, however, there is a risk of bleeding and infection, and the same is true for C-sections. Prophylactic antibiotics are standard practice in most hospitals to decrease the chance of infection, while blood transfusions are often used in the case of any major bleeding (the highest risk being when the placenta is covering the cervix), and are twice as likely to be done if you have been diagnosed with anemia pre-delivery.
What does recovery from a C-section look like?
Most people who have a C-section stay admitted to hospital for a few days, but this could be longer depending on the health status of both mom and baby. Like other abdominal and pelvic surgeries, you’ll notice pain or discomfort at the incision area after the anesthetic has worn off, which can last from a few days to a couple weeks.
Since both the abdominal wall and the uterus are cut during the procedure, anything that puts pressure on those areas (including deep breaths, coughing, sneezing and certain movements) can cause pain or discomfort. The outer stiches in your skin should heal in about five to ten days, but those underneath in the muscle layer can take six to twelve weeks to fully heal.
Avoid strenuous activities and heavy lifting (your baby is the heaviest thing you should be lifting) during this time. Keep the outer incision sites clean and dry (your doctor or nurse will tell you when you no longer need to keep the areas covered). If you notice any redness, swelling or pus, contact your doctor.
Will I still have a vaginal bleed post-delivery with a C-section?
Regardless of if you have a vaginal or C-section delivery, you will experience vaginal bleeding, called lochia, after delivery, since the uterus needs to shed its inner lining after the baby is born. This type of bleed will resemble a menstrual flow but can last anywhere from a few days to a few weeks.
The heaviest flow tends to last about two weeks and should then taper off with pink spotting or white-yellowish discharge lasting up to six weeks after delivery. Avoid the use of tampons as this can increase the risk of an infection and instead opt for sanitary pads.
Can I have a vaginal delivery after a C-section?
A vaginal birth after Cesarean, or VBAC, is becoming more common and can be safely done in many cases. Most people who have had a previous C-section are candidates for a trial of labour. Your ability to have a VBAC is more likely if:
- Your have a low transverse (horizontal) incision (instead of a vertical or inverted “T” incision)
- Your pelvis can accommodate an average-sized baby passing through
- You are expecting a singleton and not multiple babies
- You’ve never experienced a uterine rupture
- You have no other contraindications for a vaginal birth, such as the placenta laying over the cervix, or a baby laying in a transverse (sideways) position
What's uterine rupture?
A rare but serious risk to VBAC is a uterine rupture which can cause a major bleed requiring a blood transfusion, and possibly a hysterectomy (complete and permanent removal of the uterus). A uterine rupture puts the baby at risk of a slow heart rate and decreased oxygen. The actual risk of this happening when attempting a VBAC is about 0.47 percent. Having an inverted T-shape or vertical scar from a previous C-section increases the risk of a rupture, as does having a medically induced labour (1.1 percent).
But there are also factors that can be protective against a uterine rupture, such as waiting more than two years between births and going into labor spontaneously (without an induction).
How many C-sections can you have?
There’s no set limit on how many times you can give birth via C-section, but one study in Turkey gathered data of 1,318 women who underwent a repeat C-section and compared outcomes between women who had undergone two or three C-sections to those who had undergone four or more. Those in the group who had four or more had a significantly greater rate of scar tissue and adhesions (46.7 percent vs. 23.8 percent), and a greater number of blood transfusions (0.3 vs. 0.1).
Make sure to talk to your obstetrician about your delivery options and review the benefits and risks for each.