One-third of pregnant women in the U.S. will deliver by Cesarean section, also known as C-section. The procedure, which takes about an hour, is second only to cataract removal for the most regularly performed surgery in the country. But while C-sections may be common, that doesn’t mean they are simple, or free from misconceptions.
For about 15 years, C-section rates continually rose in the U.S. But in the past four years, the rates have dropped, primarily due to a concerted effort to promote vaginal birth, says Dr. Ghea Adeboyejo, a TopLine MD Obstetrician and Gynecologist practicing in Plantation, Florida. “There is definitely a movement to give every woman (for whom it would be a healthy choice for her and her baby) a chance to have a vaginal delivery,” Dr. Abeboyejo says. The reason for this advocacy: C-sections, while a very safe form of surgery, is surgery nonetheless, exposing women to risks like infection, and complications like adhesions (scar tissue causing blockage or pain).
One of the most common cases where a C-section may be preplanned is when the woman’s prior delivery was through Cesarean. Attempting a vaginal birth after C-section (known as VBAC) can open up the previous incision during delivery, causing a uterine rupture. Although rare — Dr. Adeboyejo puts it at less than one percent — uterine rupture is a serious complication. Another reason to preplan a C-section is when problems are identified during the pregnancy with the placenta, like Placenta praevia, where the placenta is covering the opening to the cervix, blocking the baby’s exit and making vaginal delivery too risky.
Unplanned C-sections, the ones that aren’t identified until the woman is in labor, can be the harder ones for expecting parents who have spent nine months carefully crafting their vaginal birth plan. Reasons to switch to a Cesarean delivery vary. A typical reason is that the baby is not in a head-down position, but rather breech or transverse. This puts the baby at risk of not getting enough oxygen during delivery, among other complications. Another reason is that the mother’s cervix, for whatever reason, does not fully open to 10 centimeters. Doctors also keep a close watch on the baby’s fetal heart rate monitor and will advocate for a C-section if there’s an indication that the baby is experiencing abnormal levels of stress during the labor.
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If a C-section is determined to provide a bigger benefit than a vaginal delivery, the mother will have an IV placed in her hand for fluids and medications, and a catheter to handle urine, which will remain for another day or so. She will not be put to sleep for the operation. Dr. Abeboyejo says the vast majority of C-sections are done under regional anesthesia, using either an epidural block or a spinal block to numb the lower half of the woman’s body. In surgery, the obstetrician will make a horizontal incision into the abdominal wall at a point just below the bikini line so it’s not visible in underwear or a bathing suit. After that, the obstetrician will make a second horizontal incision, this time through the uterine wall. The second incision also serves to rupture the protective amniotic sac surrounding the baby.
The doctor then removes the baby from the uterus, cuts the umbilical cord, and removes the placenta. If all goes as planned, the baby is given to the mother for skin-on-skin contact. The obstetrician stitches up the cut in her uterine wall with dissolvable stitches. The abdominal wall and overlying skin are closed with stitches or staples. The mother is then taken to the maternity ward, where she’ll spend 2 to 4 days. The total recovery time for a standard C-section is 4-6 weeks.
Dr. Abeboyejo says it’s important to understand that many of the same elements that expecting parents were looking forward to with a vaginal birth can still happen with a Cesarean section. There can be family in the room, the father still can cut the umbilical cord, mom will still hear her baby’s first cry, there are still photos, there’s still skin-on-skin contact immediately following delivery, and it doesn’t impact breast feeding. “Remember to enjoy your day, whether the delivery happens through your Plan A or Plan B,” she says. “Going home with a healthy baby and a healthy mom is always the number one priority.”