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 What
is a cesarean section?
In this procedure, a doctor makes an incision in a
woman's abdomen and uterus and removes her baby through it.
At least 22 percent of American women give birth by cesarean
delivery, or c-section, these days, though the American
College of Obstetricians and Gynecologists is working to make
sure that fewer women end up having unnecessary c-sections.
Why might I need a cesarean delivery?
Doctors often don't decide to perform a c-section until
labor has begun, but that doesn't mean it's an emergency
procedure. Most commonly it's something the medical staff
simply couldn't anticipate until labor was underway.
A woman may have an unplanned surgical delivery for several
reasons, including:
• The cervix stops dilating (arrest of dilation) or the baby
stops progressing down the birth canal (arrest of descent in
labor) and appropriate attempts to stimulate uterine
contractions to get things moving again have failed.
• The baby's heart rate becomes irregular and the doctor
determines (if she is unable to correct the situation) that
the baby may not be able to withstand continued labor and a
subsequent vaginal delivery.
• The umbilical cord prolapses, or slips through the cervix,
where it becomes compressed, thus decreasing the baby's
oxygen supply.
• If there are signs that the placenta is starting to abrupt,
or separate from the uterine wall, a c-section is done
because the baby will be in danger.
Under what conditions would I have a planned c-section?
Sometimes it's clear that a woman will need a cesarean even
before she goes into labor. Some of the conditions that may
necessitate a planned c-section include:
• There is a maternal history of invasive uterine surgery, a
classical cesarian, or multiple cesarean sections. (See our
piece on having a vaginal birth after a previous cesarian.)
• The baby is in a breech (bottom first) or transverse
(sideways) position. (In some cases, a breech baby may still
be delivered vaginally.)
• There are three or more fetuses.
• The mother has placenta previa (when the placenta is
implanted so low in the uterus that it blocks the baby's exit
through the cervix).
• At the time of labor, the mother is having an outbreak of
genital herpes, which could be passed along to a baby
delivered vaginally.
• A mother's preeclampsia is rapidly worsening, making it
dangerous for her to delay delivery.
• The baby has a known fetal illness or abnormality that
would make a vaginal birth risky.
• The baby is expected to be very large, especially in the
case of a diabetic mother or if the mother had a previous
fetus of the same size or smaller who suffered serious trauma
during delivery.
What should I expect during a c-section?
Typically, your husband or partner can be with you during
most of the preparation, and for the birth. In the rare
instance that your c-section is a true emergency, your
partner may not be allowed to stay in the operating room with
you.
If the c-section is unplanned but not an emergency, the
obstetrician should explain why she has decided to do one,
and you will be asked to sign a consent form. The next thing
to expect is a visit from an anesthesiologist, who reviews
with you various pain-killing options. It's rare these days
to be given general anesthesia, which would knock you out
completely, except in emergency situations. More likely,
you'll be given an epidural or spinal block, which numb the
lower half of your body.
A catheter is inserted to drain urine during the procedure,
and an IV started. Anesthesia is administered and the staff
raises a screen so you won't have to see the incision being
made. If you'd like to witness the moment of birth, ask them
to lower it — slightly, so you see all but the most explicit
details. Your partner or husband, freshly attired in
operating room garb, may take a seat by your head.
Once the anesthesia takes effect, the doctor usually makes a
small horizontal incision in your skin above your pubic bone
(called a bikini cut), and then makes a second cut in the
lower section of your uterus. Then, it's time for your baby
to make his entrance. The doctor eases him out, lifting him
so you get a glimpse of him before he's handed off to be
cared for by a pediatrician or nurse. While the staff is
examining your baby, the doctor delivers the placenta.
After the examination, the pediatrician or nurse may hand
your baby over to your partner. He can hold him near you
while you're being stitched up, which can take about 30
minutes, since each layer of muscle and skin needs to be
closed.
When you're all stitched up you're moved to a stretcher or
bed. Then, finally, while being wheeled into the recovery
room, you can hold your baby. Once there, you should try to
breastfeed, if possible. You may find it more comfortable if
you both lie on your side and face each other.
Can I minimize my chances of having a cesarean birth?
Not all cesareans can — or should — be prevented. But there
are some ways that you may be able to reduce your chances of
having one, including:
• Staying healthy during pregnancy, eating well,
exercising, and getting plenty of rest, so that when labor
starts you'll be in optimal condition.
• Finding out whether your obstetrician's c-section rate is
unusually high, and, if so, switching to another
practitioner.
• Using a midwife; they tend to have lower c-section rates
than doctors.
• Asking a doula to attend your birth. Studies show that the
presence of a trained, supportive doula during delivery
reduces the incidence of cesarean deliveries.
• Maintaining an upright position as long as you can during
labor. Walking and standing may hasten the process, and even
sitting, rather than lying down, may help some, although
there's no hard evidence for this.
• Consulting The Silent Knife by Nancy Cohen for more
suggestions on avoiding a c-section.
I had my first child by cesarean. Can I deliver my next baby
vaginally?
Having a surgical delivery does not mean — as it once did
— that you'll have your future children by cesarean section
as well. In fact, about 70 percent of women who try to have a
vaginal birth after cesarean (VBAC) succeed. Horizontal
("low-transverse") uterine incisions have greatly reduced the
risk of uterine rupture. (While the risk of rupture is small,
it can have serious consequences, so any woman trying a VBAC
should plan to labor in a hospital where an obstetrician and
anesthesia are immediately available to perform an emergency
c-section if necessary.)
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