- A multiple pregnancy [twins, triplets, etc] – if the babies are being born too early, not in a good position, or if there are problems a c-section will be necessary
- Failure of labor to progress
- Concern for the baby – if the umbilical cord becomes pinched or fetal monitoring detects a problem
- Issues with the placenta
- A large baby
- Breech presentation
- Maternal infection
- HIV or Herpes in the mother
- Maternal medical conditions – diabetes, high blood pressure
Cesarean incisions are performed one of two ways – either vertical along the pubic hair line or vertical under the belly button. The incision will be made through the skin, the wall of the abdomen, the muscles if they haven’t separated. There will be an incision in the wall of the uterus, and it will be vertical or horizontal as well. The baby will be delivered through the incision, the umbilical cord will be cut, and then the placenta will be removed. The uterus will then be stitched up with disposable stitches. Stitches or staples will be used to close the skin.
Before a cesarean, a nurse will prep you for surgery by giving you an IV, to get fluids and medication during the procedure, your abdomen will be washed and your pubic hair may be trimmed or clipped. You will be given medication to prevent infection and a catheter will be placed to drain your bladder. If your bladder is drained, it will decrease the chance of injury during the cesarean.
You will have either general anesthesia or epidural block to reduce pain during the procedure. If general anesthesia is used, you will be asleep during the cesarean. If an epidural block is used, only half of your body will be numbed in order for your to stay awake during the delivery. You will get an injection in the space in your spine on your back, they may insert a small tube so that more of the drug can be given if needed. It is administered similar to an epidural.
If a previous birth was a cesarean, there is a chance you will have to have a repeat cesarean. You man be able to try for a VBAC or vaginal birth after cesarean depending on factors including the incision of the previous cesarean, number of prior cesareans, conditions that make vaginal delivery risky or the hospital where you are delivering.
If you have a cesarean, and were given a spinal block then you may be able to hold your baby immediately. You will be taken to a recovery room and you will be monitored. If you are planning on breastfeeding, let your health care provider know, so they can help you breastfeed as early as possible. You may need to stay in bed longer than with a vaginal delivery, and will need help to get out of bed. Your catheter will be removed soon after surgery.
With any surgery, there are risks and complications that can arise. The complications occur in a small number of people and usually can be easily treated:
- Blood loss
- Blood clots in legs
- Injury to the bowel or bladder
- Reaction to medications or anesthesia
You should expect to stay in the hospital for at least 2-4 days depending on the reason for your cesarean and is often case-by-case. Once you go home, you will need to heal for a few weeks after the surgery. You should limit activities and avoid placing anything in your vagina or having sexual intercourse. Your health care provider can provide you with a prescription for pain, and a heating pad can be helpful. You should contact your health care provider if you have a fever, heavy bleeding, or the pain worsens. There are a few things you should expect after the delivery:
- Cramping, that is worse if you are breastfeeding
- Bleeding and discharge for 4-6 weeks
- Bleeding with clots and cramps
- Pain at the incision site