What to Expect With a C-Section

Even if you don't want a c-section, even if you're fully convinced you wont need a c-section, you should read this post. Birth is not a sure thing and you never can tell what will happen. 

 

Fact: The World Health Organization has warned not to exceed a c-section rate of 15% - The USA has a rate of 30 - 32% as a whole (in some hospitals, you'll find its more like 60%), which means half or more of all c-sections aren't necessary. You'll find that the rates are higher in first-time mothers and that there is a low percentile of VBAC (vaginal birth after cesarean) births. If you've had an uncomplicated pregnancy, a c-section is more often than not, not medically necessary (though complications can and do arise in labor and delivery). This isn't to say that all c-sections are terrible things - many have saved the lives of mothers and their babies and prevented birth-related injuries.

What is a cesarean section? 
A cesarean section is major abdominal surgery. Your baby will be delivered via an incision in your abdomen. Most women are awake during the surgery.

What types of c-sections are there?

• Emergency: This is a Grade 1 - 3 c-section (see below).
• Planned (elective/scheduled): This is a Grade 4 c-section (see below).

How does a doctor determine if a c-section is needed?
Most times a doctor will assign a grade on a grading scale.

• Grade 1 is one that is done if there is an immediate threat to the baby or to the mother. Life threatening. Examples: baby's oxygen supply has been reduced and the baby is in distress. The c-section is usually done in a matter or 30 minutes.
• Grade 2 is where there is concern for the baby's or the mother's well-being. Not life threatening. This may be because your baby's heart rate is concerning early in labor and the chances of a vaginal delivery happening soon (in a short amount of time) are low.
• Grade 3 is done when there is no immediate concern for the mother or the baby, but an early delivery is advised. The baby or the mother may have some type of medical condition. Usually this is done due to a failed induction.
• Grade 4 is elective/planned. 1/3 of c-sections are a Grade 4 and the number is only increasing. Reasons include: breech baby, previous c-section, larger than average baby, or a mother's choice. Though these situations can be a cause for c-section, an attempt at a VBAC is also a reasonable choice. A few reasons why it would be encouraged to have an elective section are: if you've had multiple previous c-sections or a surgery to your uterus, the baby can't move from a horizontal position, the placenta isn't in the right position, any pelvic abnormalities in the birth canal, or a maternal medical condition.

Consent: Your doctor will need your consent prior to your c-section and should tell you what the risks and benefits are and why its being done.

Pre-Op: 

• You may be given something (a medication) that will help to dry out your mouth. 
• You will be given an ant-acid to reduce your stomach acid. 
• You may also be given a single dose of antibiotics to protect against any possible infections. 
• An IV will be put into your hand or arm for fluids and/or medications can be given if necessary. 
• Your pubic hair on your lower abdomen will be shaved down. 
• Once it is determined that you are pain free, a catheter will be inserted into your bladder. 
• Your abdomen will be cleaned with an antiseptic solution (Betadine) and sterile drapes will be placed over you/hung in front of you so that you can't see the surgery. You will be completely naked from your breasts, down. A sticky plastic drape is placed over your belly to stabilize your skin.

Your Anesthesiologist:  
You will meet the anesthesiologist who will make sure that you don't feel any pain during the surgery and will help you to manage your pain afterward. There will be an injection of medication into your spinal fluid in your back (a spinal block). If you've already had an epidural for pain in labor, you'll continue that. These drugs can cause nausea, vomiting, and/or uncontrollable shaking (while, I didn't have a c-section, I did have an epi, and I shook and shook for quite awhile).

The Surgery: 

• A 4 inch incision will be made (usually horizontally) on the abdomen (across the bikini line - though, occasionally an up-and-down incision below the belly button is made). 
• Your bladder will be pushed down and the front of your uterus will be opened so that your doctor can access the baby. 
• If your water wasn't previously broken, it will be now. 
• The surgeon will release the baby's head first, suction the nose and mouth, and then lift the baby out. You may feel some tugging if you've had an epidural, but you probably wont feel anything at all if you've had the spinal. You may experience some nausea and you may even vomit (there will be tugging on the peritoneum, which is the layer that coats your internal organs, which causes this reaction sometimes).
• Some women will be given general anesthesia; this means you'll be asleep. This can be due to your regional anesthesia not working, blood-clotting issues with the mother, an infection in the mother's bloodstream, or persistent fetal distress.
• Pre-op procedures will be the same as a regional anesthesia patient. 
• Once you're asleep the anesthesiologist inserts a tube into your mouth and down your throat (you may have a sore throat when you wake up). 
• You'll continue to receive pain killers and anti-nausea medicine while in surgery. 
• The procedure takes about an hour and then you are woken up about 5 - 10 minutes after the surgery is over. 
• You'll need pain relief after surgery.

  
The Delivery: 

• The cord will be cut and you'll get to see your baby (after the cord is cut, the placenta will be delivered). 
• They will then take the baby and do the initial check-ups (Apgar score), procedures, and more suctioning.
• Your uterus will then be closed up with a layer or two of stitches and then the surgeon will stitch up the abdomen wall. This can take about 30 minutes or more. They may use dissolvable stitches, stitches that will need to be removed, or staples (not as common). 
• Then either you or your partner will be able to hold the baby.
• You will be taken to the recovery room to be monitored.  

Complications? Like every surgery, there can be risks. Some of the risks for a c-section include: infection, blood loss, problems with the anesthesia, blood clots caused by reduced mobility after surgery, and bladder and bowel injuries. (More risks here: C-section Rates in America) 

Recovery: 

• You will be given antibiotics and/or pain meds at this point. 
• You'll be moved to the postpartum floor to recover. 
• Within 24 hours after delivery, your catheter will be removed and you'll be encouraged to get out of bed. 
• You will be given IV fluids for a day or two until you're eating on your own again. 
• Women usually go home 3 - 5 days after a c-section. 
• Your incision will be checked in 2 weeks. 
• Your incision may hurt constantly or intermittently for up to a year. 
• Your ability to birth vaginally may be questioned after this. 
• Recovering From a C-Sectoin - Healing Tips

FACT: A study at Yale University (from approx. 2003) found - 

• male doctors in university hospitals are 3 times more likely to deliver babies via c-section than female doctors.
• male doctors in private practices are 1 1/2 times more likely to deliver babies via c-section than female doctors.
• c-section rates have quadrupled over the past 20 years.

Cesarean Resources:

International Cesarean Awareness Network, Inc. 

1304 Kingsdale Avenue

Redondo Beach, CA 90278

Phone: 310-542-6400

Fax: 310-542-5368

Email: info@ican-online.org

Website: www.ican-online.org