What is cesarean section?

A cesarean section, or C-section, is surgery to deliver your baby through a cut the doctor makes in your lower belly and uterus. This cut is also called an incision. In many cases, the doctor makes the cut just above the pubic hairline. In other cases, it runs from the belly button to the pubic hairline. Both cuts leave a scar. It most often fades with time.

The surgery may be done while you are awake but your belly is numb. This lets you be awake for the birth of your baby. Less often, women need general anesthesia. This means you are asleep during the surgery.

Most women go home about 3 days after the birth. You may feel better each day. But you will likely need about 6 weeks to fully recover. During the first few weeks you will need extra help with household chores. But you will be able to care for your baby. You can do things like breastfeed and change diapers.

A cesarean section can be done by a doctor who has specialized training, such as:

• An obstetrician.
• A perinatologist (maternal-fetal medicine specialist).
• A family medicine doctor with C-section training.
• A surgeon.

If your pregnancy care provider doesn't perform C-sections and thinks there's a chance you might need one, you will be referred to a cesarean-trained doctor ahead of time. Your family medicine doctor, certified nurse-midwife, or certified professional midwife can assist with the surgery and provide your follow-up care.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia, constipation, and blood clots.
• Avoid strenuous activities, such as bicycle riding, jogging, weightlifting, and aerobic exercise, for 6 weeks or until your doctor says it is okay.
• Until your doctor says it is okay, do not lift anything heavier than your baby.
• Do not do sit-ups or other exercises that strain the belly muscles for 6 weeks or until your doctor says it is okay.
• Hold a pillow over your incision when you cough or take deep breaths. This will support your belly and decrease your pain.
• You may shower as usual. Pat the incision dry when you are done.
• You will have some vaginal bleeding. Wear sanitary pads. Do not douche or use tampons until your doctor says it is okay.
• Ask your doctor when you can drive again.
• You will probably need to take at least 6 weeks off work. It depends on the type of work you do and how you feel.
• Ask your doctor when it is okay for you to have sex.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• Drink plenty of fluids (unless your doctor tells you not to).
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.
• If you are breastfeeding, limit alcohol. Alcohol can cause a lack of energy and other health problems for the baby when a breastfeeding woman drinks heavily. It can also get in the way of a mom's ability to feed her baby or to care for the child in other ways. There isn't a lot of research about exactly how much alcohol can harm a baby. Having no alcohol is the safest choice for your baby. If you choose to have a drink now and then, have only one drink, and limit the number of occasions that you have a drink. Wait to breastfeed at least 2 hours after you have a drink to reduce the amount of alcohol the baby may get in the milk.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also get instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

• If you have strips of tape on the incision, leave the tape on for a week or until it falls off.
• Wash the area daily with warm, soapy water, and pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.
• Keep the area clean and dry.

Other instructions

• If you breastfeed your baby, you may be more comfortable while you are healing if you don't rest your baby on your belly. Try tucking your baby under your arm, with your baby's body along the side you will be feeding on. Support your baby's upper body with your arm. With that hand you can control your baby's head to bring your baby's mouth to your breast. This is sometimes called the football hold.

Some women want to schedule a C-section because:

• They worry that their labor pain won't be controlled.
• They're concerned that labor will cause pelvic floor problems, such as incontinence.
• Their partner may be away at the due date (such as on a military deployment), so they want to have the baby sooner.
• They want to attend an important family event (such as a reunion).
• They want to be sure that their own doctor delivers the baby, rather than an on-call doctor. (In some cases, the doctor may suggest a C-section because of his or her schedule.)
• They may feel shy or embarrassed about people seeing them giving birth.

Talk to your doctor about your wishes and concerns. He or she may be able to help you feel more confident about vaginal birth. For example, your doctor could discuss the many ways to control pain during labor. Or the doctor may explain how often pelvic floor problems happen and what can be done to prevent them.

If you're still thinking of planning a C-section, talk to your doctor about reasons for and against a planned C-section.

Most mothers and babies do well after a C-section. But it's major surgery. It has more risks than a vaginal delivery. Because of these risks, experts feel that a C-section should only be done for medical reasons.

After a C-section, you'll be watched closely to make sure that you don't develop problems. You'll likely get pain medicine and be encouraged to walk around a little.

Most women go home in 3 to 5 days. But it may take 4 weeks or longer to fully recover. Before you go home, a nurse will tell you how to care for yourself. In general:

• You'll need to take it easy while the incision heals. Avoid heavy lifting, intense exercise, and sit-ups. Ask family members or friends for help with housework, cooking, and shopping.
• You'll have pain in your lower belly. You may need pain medicine for 1 to 2 weeks.
• You can expect some vaginal bleeding for several weeks. (Use sanitary pads, not tampons.)

A cesarean section, or C-section, is surgery to deliver your baby through a cut that the doctor makes in your lower belly and uterus. The cut is called an incision.

You may have some pain in your lower belly and need pain medicine for 1 to 2 weeks. You can expect some vaginal bleeding for several weeks. You will probably need about 6 weeks to fully recover.

It's important to take it easy while the incision heals. Avoid heavy lifting, strenuous activities, and exercises that strain the belly muscles while you recover. Ask a family member or friend for help with housework, cooking, and shopping.

In most cases, doctors do a C-section because of problems during labor. For example:

• Labor is slow and hard or stops completely.
• Your baby shows signs of distress, such as a very fast or slow heart rate.
• There's a problem with the placenta or umbilical cord.
• Your baby is too big to be delivered vaginally.

When doctors know about a problem ahead of time, they may schedule a C-section. You may have a planned C-section if:

• Your baby isn't in a head-down position close to your due date.
• You have a health problem that could be made worse by the stress of labor.
• You have an infection that you could pass to your baby during a vaginal birth.
• You're carrying more than one baby.
• You had a C-section before, and you have the same problems this time. Or your doctor thinks labor might cause your scar to tear.

Before a C-section, a needle called an I.V. is put in one of your veins. The I.V. gives fluids and medicine (if needed) during the surgery. You will then get medicine (spinal or epidural anesthesia) to numb your belly and legs. Fast-acting general anesthesia, which makes you sleep during the surgery, is only used in an emergency.

After the anesthesia is working, the doctor makes the incision. Usually it's made low across the belly, just above the pubic hair line. This may be called a "bikini cut." Sometimes the incision is made from the navel down to the pubic area. The doctor lifts the baby out. Then the doctor removes the placenta and closes the incision with stitches.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• You will be kept comfortable and safe by your anesthesia provider. The anesthesia may make you sleep. Or it may just numb the area being worked on.
• The surgery will take about 1 hour.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Most mothers and babies do well after a C-section. But it's major surgery. It carries more risk than a normal vaginal delivery.

After a C-section, the most common problems for the mother are:

• Infection.
• Heavy blood loss.
• A blood clot in the legs or lungs.
• Nausea, vomiting, and severe headache. These can be related to the anesthesia.
• Bowel problems, such as constipation.
• Injury to another organ (such as the bladder). This can occur during surgery.
• Maternal death. This is very rare. About 2 in 100,000 cesareans result in maternal death.

After a C-section, the most common problems for the baby are:

• Injury during the delivery.
• Need for special care in the neonatal intensive care unit (NICU).
• Immature lungs and breathing problems, if the due date has been miscalculated or if the baby is delivered before 39 weeks of gestation.

Long-term risks of C-section

Women who have a uterine C-section scar have slightly higher long-term risks with future pregnancies. These risks can increase with each C-section. They include:

• Breaking open of the incision scar during a later pregnancy or labor. This is called uterine rupture.
• The growth of the placenta low in the uterus, blocking the cervix. This is called placenta previa.
• Problems when the placenta grows deeper into the uterine wall than normal. These problems are called placenta accreta, placenta increta, and placenta percreta. They can lead to severe bleeding after childbirth. And sometimes they require a hysterectomy.

A cesarean section is the delivery of a baby through a cut (incision) in the mother's belly and uterus. It's often called a C-section. Sometimes a C-section is needed for the safety of the mother or baby.