Cesarean Delivery

Overview

A cesarean delivery, often called a C-section, is an operation in which a baby is born through incisions made in the lower abdomen and uterus. It may be planned ahead of time when a vaginal birth is expected to be unsafe, or performed unexpectedly when problems arise during labor.

Cesarean delivery is one of the most common surgeries performed worldwide and is generally very safe. Like any major operation, it carries some risks and requires a longer recovery than a vaginal birth, so it is usually recommended when the benefits to the mother or baby outweigh those of laboring vaginally.

Reasons It Is Done

A cesarean is recommended for a wide range of situations. Common reasons include:

• Labor that fails to progress or the cervix that stops opening
• Signs that the baby is not tolerating labor well (fetal distress)
• The baby is positioned feet- or bottom-first (breech) or sideways
• Problems with the placenta, such as placenta previa
• Carrying twins, triplets, or more
• Certain maternal health conditions or a large baby relative to the pelvis
• A previous cesarean or other uterine surgery

Some cesareans are planned, while others are decided urgently to protect the health of mother or baby.

What Happens During the Procedure

In most cesareans the mother is awake with the lower body numbed by a spinal or epidural block, so she can be present for the birth. General anesthesia is used in some emergencies.

• The abdomen is cleaned and a catheter is placed to drain the bladder.
• A horizontal incision is usually made low on the abdomen, followed by an incision in the uterus.
• The baby is delivered, the cord is clamped, and the placenta is removed.
• The uterus and abdomen are closed in layers, typically with dissolvable stitches or staples.

The operation itself usually takes under an hour, with the baby often born within the first several minutes.

Possible Risks

Cesarean delivery is generally safe, but as a major surgery it carries some risks for the mother, including:

• Infection of the incision or uterus
• Heavier bleeding than with a vaginal birth
• Blood clots in the legs or lungs
• Reaction to anesthesia
• Injury to nearby organs (uncommon)
• Risks in future pregnancies related to the uterine scar or placenta

Babies born by cesarean may occasionally have temporary breathing difficulties, especially when delivery is before the due date.

Planning and Preparation

When a cesarean is planned, it is usually scheduled close to the due date, often around 39 weeks, unless an earlier delivery is medically necessary. Preparation may include:

• Blood tests and a review of your medical history
• Instructions on when to stop eating and drinking before surgery
• Discussion of anesthesia options and pain control afterward
• An intravenous line, often antibiotics to lower infection risk, and a bladder catheter

For unplanned cesareans during labor, the care team moves quickly while still explaining the steps when time allows.

Recovery

Recovery from a cesarean takes longer than from a vaginal birth. Most people stay in the hospital for two to four days.

• Pain control: Soreness at the incision is expected and managed with medication.
• Activity: Walking soon after surgery helps reduce the risk of blood clots; heavy lifting and strenuous activity are limited for several weeks.
• Wound care: Keep the incision clean and dry and watch for signs of infection.
• Support: Help with the baby and household tasks is useful while you heal.

Full recovery typically takes about six weeks, though this varies from person to person. Many people who have had a cesarean can consider a vaginal birth in a later pregnancy, depending on their circumstances.

Self-Care After Surgery

• Rest when possible and avoid lifting anything heavier than your baby at first
• Support your abdomen with a pillow when coughing or laughing
• Stay hydrated and eat fiber to ease constipation
• Take pain medicine as directed and don't wait until pain is severe
• Attend your postpartum checkups
• Reach out for help if you feel persistently sad or overwhelmed

When to See a Doctor

Call your care team after a cesarean if you notice signs of a problem. Seek prompt or emergency care for:

• Fever, or redness, swelling, or drainage from the incision
• Heavy vaginal bleeding or large clots
• Severe abdominal pain that is worsening
• A red, swollen, painful leg, or chest pain or shortness of breath, which can signal a blood clot
• Feelings of hopelessness or thoughts of harming yourself or your baby

Sudden trouble breathing, chest pain, or heavy bleeding are medical emergencies that need immediate attention.

Related Topics

Frequently Asked Questions

References

1. Mayo Clinic. C-section.
2. American College of Obstetricians and Gynecologists (ACOG). Cesarean Birth.
3. MedlinePlus, U.S. National Library of Medicine. Cesarean delivery.
4. National Institute of Child Health and Human Development (NICHD). Cesarean Delivery.