The Straight Truth: What Really Happens During a C-Section?
“We are going to have to deliver the baby by C-Section.”
When a pregnant mom-to-be hears those words from her doctor or healthcare provider, she undoubtedly faces many fears and uncertainties. Will the baby be OK? Is it dangerous? How will she manage the pain and recovery? What about the scar?
A Caesarean Section (C-Section) birth can be a lifesaving surgical procedure when certain complications arise during pregnancy and labor. But a recent study has shown that the use of C-Section delivery has grown dramatically worldwide in the last decades. Some nations have shown drastic increases in use of C-Section birth, with the highest rate worldwide in Brazil, where C-Sections account for 56.4% of all live births. In the United States, Canada, and the majority of Western Europe, C-sections consistently account for about 25-30% of all births.
The reasons for the dramatic rise in use of C-Section delivery are complicated. Many children are now being delivered via elective C-Section, especially if they or their mothers are facing certain health complications. Mothers who have an active genital herpes infection or HIV will be delivered surgically to reduce the risk of transmission to the baby during vaginal delivery. Many women are delaying childbearing until later years, when they are more likely to develop pregnancy complications such as gestational diabetes, heart disease, or pre-eclampsia, making labor and vaginal delivery risky for her health. Babies who present in a breech position and who are unable to be turned are almost always delivered by C-Section to prevent injury to the baby. Doctors are facing higher rates of lawsuits for birth injuries. Doctors also may also decide to deliver a baby via C-Section if a woman’s labor fails to start or progress, if the baby is in distress during labor, or in the emergency cases of a prolapsed umbilical cord or uterine rupture.
So, what really happens during a C-Section?
If your healthcare provider believes a C-Section is necessary, you will be asked to sign a consent form. If you have been laboring with a nurse midwife, you will be assigned to an OB/GYN who will oversee and perform your delivery. In almost all cases, your partner or a chosen support person will be allowed to be in the operating room for the birth.
An anesthesiologist will meet with you to discuss pain management options during the procedure. Most commonly, women will be offered either an epidural or a spinal block for the surgery. The anesthesiologist will explain the difference in these two methods to you. The differences in the effects of these two choices are minimal when used for C-Section, so trust your anesthesiologist’s opinion here, and rest assured that if they use the method with which they are most comfortable, you will have the best results. The anesthesiologist will also be present during the delivery and seated right by your head. His or her job is to ensure that you have no pain, and to ensure that you are comfortable, so communication before and during the surgery can greatly improve your experience.
You will be prepped for surgery, which often includes shaving your lower abdomen and pubic hair. This is to ensure a sterile surgical field and help decrease the risk of infection. You will have an IV placed if you don’t already have one, and a catheter to drain your bladder, because all of those IV fluids have to go someplace, and you won’t be getting up out of bed for a while afterward! You may be given an antacid to drink to neutralize your stomach acid, in the rare case that an emergency arises and you should require general anesthesia.
Antibiotics and fluids will be administered through your IV prior to surgery to help prevent any infections. Your partner or support person will be given a set of surgical scrubs, hair net, mask, and shoe covers to wear in the operating room, to keep the environment sterile. The woman herself will not be required to wear a mask or any protective clothing of any kind.
During a C-Section:
When it is time to begin, you will be transferred into the surgical suite (operating room). Most hospitals will allow you to walk in and get up onto the operating table on your own. It will be surprisingly cold in this room. You will either sit on the edge of the operating table or lay on your side as anesthesia is administered. The anesthesia is not necessarily pleasant, but quick and generally painless, if a little uncomfortable. Some women do report feeling an “electric shock” sensation in their legs as the medicine is inserted, but it is generally well tolerated.
Your nurses will help you to lay on your back on the table, and because the table is narrow, you will have straps attached to help keep you from falling off. Generally, your arms will be positioned out to your side, and strapped to arm boards, as well. Your partner or birthing support person will be seated on a stool near your head where they can observe the birth and help to support you and keep you calm. Sticky EKG electrodes will be placed on your chest to monitor your heart rate during the operation and recovery, and you will be given oxygen. Your nurses will remove your hospital gown and replace it with a sterile drape that covers all but your stomach. Your abdomen and pelvic areas will be scrubbed with an iodine solution to remove any bacteria that could cause infection. Once these preparations have been completed, your physician will be present in the room, most likely with a second physician to assist. There will also be several nurses and surgical techs present in the room to attend to you and your baby.
You may at any point feel strong waves of nausea, as your body reacts to a sudden drop in blood pressure. This is a normal and expected reaction to the anesthesia and the delivery of the baby. Communicate with the anesthesiologist, and medications can be administered to counteract the nausea almost immediately. Also, if during the operation you are experiencing anxiety about what is going on, the anesthesiologist can administer medications to calm your nerves without totally knocking you out.
A screen will be raised at your waist level to preserve the sterile surgical field--and so you don’t have to see the incision being made--and the doctor will begin. In most cases, the doctor will make a small, horizontal incision in the skin, immediately above your pubic bone. This incision is generally right above the hairline, and nearly invisible and covered by bikini underwear once it is healed. The doctor will continue working through several layers of tissue. You can expect to hear some technical talk between the doctors and the nurses during this time, and hear or smell occasional use of cauterization to reduce bleeding. The abdominal muscles are generally separated, rather than cut, to expose the uterus.
Once the doctor reaches the uterus, a horizontal incision will generally be made in the lower portion of the uterus. This method is generally considered safest for future pregnancies and vaginal deliveries. The amniotic sac will be pierced, and you will hear a lot of suctioning as the fluid is released. The doctor will reach inside the incision at this point and cradle the baby’s head, while pressing softly on the top part of the uterus near the baby’s bottom to ease them out gently. Many women report feeling a “tugging” sensation or pressure during this part of the delivery, but it is not painful. Once the baby has been delivered, the umbilical cord will be clamped, and the baby will be suctioned to help remove amniotic fluid from his or her lungs that would normally be squeezed out during a vaginal delivery. The doctor will raise the baby high enough that you and your partner can catch a glimpse before getting cleaned up a bit. The baby will be handed off to the pediatric team while your doctor sets about the task of delivering the placenta and closing your incisions. This entire process happens fast, in fact, most babies are born within about 10 minutes from the time of the first incision.
Pitocin will most likely be administered through the IV to bring on uterine contractions to minimize bleeding and help to deliver the placenta. Excess blood and fluids will be suctioned out, and your doctor may perform a quick inspection of the uterus, before beginning to close. The uterus and inner tissue layers will be closed with dissolvable sutures, and the outermost layer of skin will be closed with staples, regular sutures, or steri-strips, or a combination of all three. Depending on the preference of your surgeon and your individual needs, one or more wound drains may be left in place for the first 24-48 hours to ensure proper healing.
Following the delivery:
It will generally take about 30 minutes for the doctor to close your incisions following the delivery, during which time you or your partner will be allowed to hold the baby. Some hospitals are even moving to allow first attempts at breastfeeding during this time, if the mother is feeling up to it.
You and the baby will be moved together into post-op recovery where your vital signs will be monitored for the first couple of hours, and you will have time to bond and breastfeed. You can expect to feel sleepy during this time, so if you are too exhausted to nurse right away, don’t worry. The nurses will monitor you for excess bleeding and other potential complications while you are in recovery.
Once you have stabilized following delivery, you will be moved to a room on the postpartum floor. Nurses will work with you to show you how to position yourself and the baby for breastfeeding. Six to eight hours following surgery, your catheter will be removed, and you will be encouraged to get up out of bed and attempt walking short distances with assistance. It is normal to feel a bit unsteady the first few times you are up, but the rule here is, the sooner you can get up and moving, the better.
You will continue to receive IV fluids during your 3-5 day stay in the hospital, and your diet will gradually be increased from liquids to solids. Pain medications will be offered to control your pain in the incision area. Especially if you and your doctor determine that narcotic pain medications are in your best interest, be sure to take in plenty of fluids and consider asking for a stool softener, as those first few times getting things moving can be quite difficult.
Recovery from a C-Section can be a bit difficult, especially in the first few days after returning home. Your body is recovering from a major surgery, and so it will be important that you rest as much as possible. Allow others to help you with household tasks, cooking, and caring for older children. When possible, have someone bring the baby to you for feeding and diaper changes. Be sure that you are watching your incision for signs of infection, and report any changes to your OB/GYN for follow up. You will be placed on restricted activity for the first few weeks following a C-Section, including no driving, and no lifting anything other than the baby, while your incisions heal. Generally, normal activity can be resumed six to eight weeks following the baby’s birth.
Women who deliver their babies via C-Section may be more vulnerable to troubling feelings of disappointment in their birth experience. It is rarely the way that they had envisioned their child would be born. Of course, having a C-Section birth or a vaginal birth has no bearing on your ability to be a great mom. If you continue to feel disappointment about your experience and that your child wasn’t delivered vaginally, it may be a good idea to speak with a therapist or your caregiver. In the scheme of things, what matters most is that both baby and mom are healthy. Any delivery that brings a healthy baby into the world and into your arms is a perfect delivery.