C-Sections Explained

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When I was pregnant, having a cesarean section was the last thing I wanted. But I had no choice: When my baby’s heart rate slowed and I had failed to progress after 17 hours of labor, I was whisked into the operating room. My experience isn’t unusual – 30 percent of all babies in the United States are delivered by C-section – the most ever, according to the National Center for Health Statistics. Whether you have a scheduled C-section or an emergency one, educating yourself will make the experience easier. Check out the expert advice below.

What are the most common reasons I’d need a C-section?
According to Dr. Yoram Sorokin, director of obstetrics and maternal-fetal health at Wayne State University’s School of Medicine in Detroit, Mich., your doctor may schedule you for the surgery if you’re carrying multiples, or if your baby is breech, very large, or has been diagnosed in utero with a birth defect or a placental abnormality. C-sections are also preferred if you’ve had pregnancy complications, such as severe preeclampsia, or if you’ve had a previous C-section. You might need to undergo an emergency C-section if, during labor, your baby shows signs of distress (such as elevated heart rate), your labor fails to progress, or if you are running a fever.

Does the surgery pose any major risks to my health?
It carries the same risks associated with any significant surgery: internal bleeding that may require a blood transfusion; surgical injuries to the bowel, bladder, and other internal organs; blood clots; or uterine damage or infection.

Is a C-section safer for my baby than a vaginal birth?
“If there is real failure to progress with labor, or if the baby’s heart rate is a cause for concern, then it’s safer to have a C-section,” says Dr. Elena M. Kamel, an associate professor of clinical obstetrics and gynecology at Northwestern University in Chicago, Ill. Still, there are certain risks. Babies who are born by C-section have a higher incidence of respiratory problems, possibly because they don’t pass through the birth canal and miss out on the squeezing action that helps clear their lungs of amniotic fluid, says Kamel.

Does the surgery or the recovery hurt?
Although you’re usually awake during a C-section, spinal anesthesia will ensure you’ll be completely numb and pain-free from the chest down. Expect to be sore after surgery; you may be given an IV narcotic pain reliever for 24 hours. You’ll likely be in the hospital for three days, and you’ll have to take it easy for several weeks while your incision heals.

Is a C-section automatic if you’re having multiples?
It depends on how the babies are positioned in your uterus. “If the first baby’s head is positioned down toward the vagina, you could try a vaginal delivery with twins or triplets,” says Dr. John Larsen, an obstetrician-gynecologist at George Washington University’s School of Medicine in Washington, D.C.

Is vaginal birth after C-section (VBAC) safe?
The biggest danger doctors worry about during a VBAC is uterine rupture – a potentially life-threatening tear in the uterus. A 2001 study found the risk of rupture during VBAC to be higher than previously thought; so fewer doctors are now performing VBACs. If your doctor offers it, evaluate your risk factors before making a decision, says Larsen. Women who aren’t induced, have had only one C-section and are at least 18 months past their previous delivery have the lowest risk of rupture. With a VBAC, there’s also a small chance (five to 10 babies per 10,000 each year) of brain damage or death to the baby.

What kind of recovery can I expect after a C-section?
A C-section requires a longer recovery time than a vaginal birth. Typically, you’re in the hospital for three days instead of two and then lying low, doing minimal activity for several weeks while your incision heals, although you needn’t be bedridden. “Modern incisions are sewn up in such as way that there’s no danger that normal activity at home is going to pull them apart,” says Larsen. You can walk up and down the stairs and clean the house (even vacuum if you like), but to minimize muscle soreness, “don’t lift and strain,” he advises. At the six-week to two-month mark, you can go back to work. “By three months post-surgery, you should be good as new, and you can resume more rigorous activities such as playing tennis,” he says.

How Its Done
After your lower abdominal area is cleaned and shaved, you’re given IV fluids and spinal anesthesia to numb you from the chest down. A drape is set up in front of your chest so that you won’t see anything. The doctor makes a 4-inch horizontal incision just above your pubic bone, and then another incision into the uterine muscle itself.

“Then we extend that opening either with scissors or our fingers and pull the baby out,” says Dr. Michele R. Lauria, a maternal-fetal medicine specialist at Dartmouth-Hitchcock Medical Center in New Hampshire.

The placenta is removed then, too. To close the incision, some doctors sew up the uterus while it’s in the abdomen, while others pull the uterus out. Moms usually get to hold the baby within an hour of delivery.