Cesarean Delivery (C-Section)

A cesarean section, often called a C-section, is a surgery that delivers a baby via incisions in the abdomen and uterus. It's used when a pregnant woman can't or chooses not to deliver a baby through vaginal birth. It is sometimes also spelled "caesarian" section.

A C-section is usually performed when a doctor thinks vaginal delivery might be too dangerous for the baby, the mother or both. In some cases, your doctor will recommend a C-section long before labor begins. In other cases, a C-section only becomes necessary because of complications that happen during labor.

Reasons that a C-section might be recommended include:

Abnormal fetal heartbeat: your doctor might be concerned a vaginal birth wouldn't be safe for the baby.

Your baby is in an abnormal position: if the baby is in a breech position -- his or her feet or buttocks are entering the birth canal before the head — a C-section might be the safest way to deliver.

A problem with placenta or umbilical cord: if the placenta covers your cervix opening, or part of the umbilical cord moves through the cervix ahead of the baby

Stalled labor: If your labor seems to stalland your cervix isn't opening

Large baby: if your baby is too large to easily deliver through vaginal birth

You're carrying twins, or more: there are more often complications with multiples, including the lead baby being in an abnormal position

Health concerns with mother: including diabetes, high blood pressure, heart issues or an active genital herpes outbreak

You've had a C-section before: In some cases, mothers can deliver vaginally after a previous C-section. In other cases, doctors may believe it's safer to have another C-section.

C-section rates vary by country. In the United States, about 32 percent of the 3.9 million births in 2017 were by C-section.

Women sometimes request C-sections to have a planned delivery or to avoid labor and its possible complications. Doctors sometimes perform them in those cases. But often, they'll recommend against a C-section if the woman plans on multiple births in her life. Repeated C-sections can have medical complications, including an increased risk of problems with the placenta.

If you're having a planned C-section, your doctor might recommend a blood test to provide more information about your blood type in case you need a transfusion during surgery, which is rare. You might also speak with the anesthesiologist for your surgery about any medical conditions that might be important.

Depending on the type of anesthesia your medical team plans to use, you might be asked to not eat or drink anything for about eight hours before the surgery.

Even if you're planning a vaginal birth, you should talk to your doctor about the details of C-sections, in case one becomes necessary during labor.

The medical team will cleanse your abdomen and place a catheter (a small tube) into your bladder to collect urine. The team will also place an intravenous (IV) line into a vein in your hand or arm, which allows the team to administer fluids or medicine during the surgery.

In most cases, you'll be given regional anesthesia, which will numb the lower part of your body while you remain awake. In some cases, general anesthesia might be necessary, which will put you to sleep.

In a C-section, the surgeon makes an incision into the lower part of your abdomen, near the pubic hairline, then cuts into the uterus. The surgeon may use a vertical cut — called a longitudinal cut — from the navel to the pubic hairline, or the cut might be horizontal — called transverse — across the public hairline. Transverse is more common. It generally heals well and increases the chance for a vaginal birth in future pregnancies.

The baby is delivered through the openings in the uterus and abdomen.

Your surgeon will use sutures to close the incision in your uterus, and more sutures or surgical staples to close the incision in your abdomen. A bandage will then be applied to the area.

Hospital stays after the surgery are usually two to four days. You'll need help at home for several days afterward, because you'll likely have pain and fatigue for several days.

You can take pain relievers, but only those recommended by your doctor. Aspirin and other medications can increase the chance of bleeding.

You'll schedule a follow-up visit to your doctor about two or three weeks after the procedure.

You'll need to avoid sex for six weeks after the surgery.

As with any surgery, there are risks, and this surgery involves two people, of course.

Possible risks to your baby:

Breathing problems: babies born via C-section have a greater chance of developing abnormally fast breathing during the first few days after birth.

Surgical cut: While rare, the baby's skin can get nicked during the surgery.

Possible risks to the mother:

Infection of the incision area or the lining of the uterus.
Hemorrhaging: the surgery can cause heavy bleeding during and after the birth.
Adverse reactions to anesthesia
Blood clots: the procedure increases your risk of blood clots, especially in your legs or pelvic area. Your medical team will encourage you to walk as soon as possible after the surgery to lower this risk.

You'll want to contact your doctor if you have any of these symptoms after the surgery:

• Your incision area is unusually red, swollen or leaking a fluid
• A fever
• Heavy bleeding
• Pain in your legs
• Overall pain that is getting worse

C-sections are generally more expensive. Vaginal birth costs, including total hospital bills and other charges and with prenatal care and post-natal care, average about $20,000 nationally. The national average cost of a C-section, with prenatal and post-natal care, is about $25,000. In some areas, those costs — and the difference in costs — are higher.

Your health insurance maternity coverage will often cover much of the cost. But copays can still amount to thousands of dollars.

Sources:
https://www.acog.org/Patients/FAQs/Cesarean-Birth
https://www.mayoclinic.org/tests-procedures/c-section/about/pac-20393655
https://www.stanfordchildrens.org/en/topic/default?id=cesarean-delivery-92-P07768