What is a cesarean section (C-section)?

A cesarean section (C-section) is an operative procedure in which an incision is made into a woman's abdomen and uterus to give birth rather than having a vaginal delivery. As of 2013, C-sections represented 32.7% of births in the US, with 1,284,339 babies delivered via this method as opposed to 2,642,892 vaginal deliveries.¹

Women who have undergone a C-section with previous deliveries may be candidates for a vaginal birth after C-section (VBAC). However, this option is not recommended for all women and should be discussed with a health care provider.

C-sections may be planned in advance or unplanned due to a multitude of reasons.^2,3 Circumstances in which a C-section may be performed include:

Women who have previously had a C-section may be recommended by clinicians to have the procedure again at subsequent births.

• Multiple gestation pregnancy
• Failure to progress during labor
• Fetal emergency or concern
• Fetal hydrocephalus
• A baby in the breech or transverse position
• A large baby
• Maternal infections with viruses such as herpes and HIV
• Maternal conditions such as diabetes, high blood pressure or a fibroid obstructing the cervix
• Placental or umbilical cord abnormalities
• Previous history of C-section.

What are the risks of C-section?

As with any procedure or operation, there are risks to having a C-section. Maternal risks include wound infection, blood loss, blood clots, injury to organs such as the bowel or bladder, adverse reactions to medication or anesthesia and potential complications during future pregnancies.^2,3 Some women may also experience an infection of the lining of the uterus known as endometritis.³

Risks to the infant include surgical injury and breathing difficulties, such as transient tachypnea or respiratory distress syndrome.³

What types of anesthesia are used for C-sections?

There are various options for anesthesia during a C-section. Women can discuss these with a health care provider to see what option is best for them. Options include the use of general anesthesia, epidural block or spinal block. When general anesthesia is used, the patient will be put to sleep for the operation.^2,3

With an epidural or spinal block, only the lower half of the body will be numbed.² During an epidural block, numbing medication is injected into a space in the spine either with or without a tube that can deliver additional medication as needed.² In contrast, during a spinal block, the medication is injected into the spinal fluid.^2,3

Recovering from a C-section

Women who have a C-section can expect to remain in the hospital for around 2-4 days following the procedure.

Following a C-section, patients can expect to remain in the hospital for about 2-4 days, and to experience surgical site pain, cramping and bleeding with or without clots for approximately 4-6 weeks.² The severity of these symptoms differs from woman to woman. Any concern over the severity of these symptoms should be further discussed with a health care provider.

When returning home, there will be a certain level of activity restriction recommended by health care providers. It is routinely recommended that patients avoid strenuous exercise, placing anything in the vagina or having sex, until their health care provider says it is OK to resume normal activity - typically around 4-6 weeks after surgery.^2,3

During the recovery period, it is important to maintain hydration, take any medications as directed, rest as needed and provide support to the incision and abdomen with the use of a pregnancy belt or pillow.³

Symptoms to look out for following a C-section

It is important to report any concerning symptoms that could signify an infection or other complication to a health care provider. These symptoms could include fever, worsening pain, increased vaginal bleeding, redness, drainage or swelling of the surgical incision, breast pain with redness or fever, foul smelling vaginal discharge and pain with urination.^2,3

People should be sure to speak with a health care provider if they have any additional questions regarding a C-section when trying to decide if it is the right option for them.

References:

1. Centers for Disease Control and Prevention (CDC), Births - method of delivery, accessed 5 September 2015.
 
2. The American College of Obstetricians and Gynecologists, Cesarean birth (C-section), accessed 5 September 2015.
 
3. Mayo Clinic, C-section, accessed 5 September 2015.