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The Cesarean Section FAQ


It seems that everyone is aware that the cesarean section is the number one surgery these days. More babies are born abdominally than people lose gall bladders and tonsils. We are very grateful for the medical technology that has enabled us to save the lives of babies and mothers who would not have made it otherwise. However, as the cesarean rates rise to close to 25% nationally, and even higher in some places, we have to ask ourselves if all of the cesareans are necessary. The answer to that question is no.

This FAQ will deal partially with preventing the unnecessary cesarean, but mainly on the procedures, routines, not-so-routine, support, recovery and other aspects of cesareans, with a short section on Vaginal Birth After Cesarean (VBAC).

Feel free to write me and tell me what you like and don't like about this FAQ. I could use some more stories from people who have been there.


This FAQ contains the following topics:


Preventing the Unnecessary Cesarean

Why would I want to avoid a cesarean?

Cesarean section increase many of the risks to mothers and babies. When this risk is weighed against other circumstances, it can be the better choice, however, sometimes it is a choice of convenience, or a matter of lack of information.

Here are some places to check out for help with avoiding an UNNECESSARY cesarean:


Indications for a Cesarean

What are some reasons that would mean I would need a cesarean?

Prolapsed cord (where the cord comes down before the baby), placenta abruptio (where the placenta separates before the birth), placenta previa (where the placenta partially or completely covers the cervix), fetal malpresentation (transverse lie, breech (breech can sometimes be managed by External Version, exercises or a vaginal breech birth), or asynclitic position), cephalopelvic disproportion (CPD, meaning that the head is too large to fit through the pelvis. This can also be over diagnosed, it can be caused by maternal positioning either from restraint to bed, lack of mobility or anesthetics.), maternal medical conditions (active herpes lesion, severe hypertension, diabetes, etc. (please note that these conditions do not ALWAYS mean a cesarean.)), fetal distress (This is a hot topic with the recent studies indicating that continuous electronic fetal monitoring increases the cesarean rate and does not show a relative increase in better outcomes. Discuss with your care provider how they define fetal distress and what steps are used to remedy the situation before a cesarean.), maternal exhaustion, and repeat cesarean, these are the main reasons for cesareans.


Pain Relief During and After the Cesarean

What type of pain relief is offered before and after a cesarean?

If you have not already had a epidural or spinal anesthesia for labor, or this is a scheduled cesarean, and not an emergency cesarean, you will most likely be given a regional anesthetic (epidural or spinal). If there is a reason that you can't get regional anesthesia or it is an emergency you will be given a general anesthetic. You may be offered or want to watch for someone giving you a pre-operative sedative. If you are not particularly nervous about the cesarean, you may want to forego this medication. It can reach the baby and make it harder to start the baby breathing after a narcotic (usually), and it can make you groggy an unaware during the birth. After the birth your regional anesthesia will help you be pain free for a few hours, after which you will be prescribed some other type of pain medication (narcotic or otherwise).

See also: Planning Your Cesarean FAQ for more discussion of options.

Note: Some people have noted that there are major discrepancies between epidural and epidural. The feelings can range from total loss of sensation to being able to feel parts of your body. However, with spinal anesthesia there is a more uniform total loss of sensation. When you have already had the epidural, generally a different medication will be added to the catheter and the dosage increased.

Procedures for Cesarean

What is the procedure for a cesarean?

Some of these may go in a different order, and a few left out, but these are the basics:

  • A catheter inserted to collect urine
  • An intravenous line inserted
  • An antacid for your stomach acids
  • Monitoring leads (heart monitor, blood pressure)
  • Anesthesia
  • Anti-bacterial wash of the abdomen, and partial shaving of the pubic hair
  • Skin Incision (vertical or midline(most common))
  • Uterine Incision
  • Breaking the Bag of Waters
  • Disengage the baby from the pelvis
  • BIRTH!!!! (Accomplished by hand, forceps, or vacuum extractor)
  • Cord Clamping and cutting
  • Newborn Evaluation
  • Placenta removed and the uterus repaired
  • Skin Sutured (Usually the top layers will be stapled and removed within 2 weeks.)
  • You will be moved to the Recovery Room (If the baby is able s/he can go with you.)

How long will it be until my baby is born?

It is generally 5 minutes from the time that they make the initial incision until the baby is born. The rest of the surgery will take between 30 and 40 minutes, including repair.


Cesarean Primer for Partners

As her partner, how can I help her during a cesarean?

Most hospitals will allow you to go into the operating room with your partner, or if you feel unable to, she may be accompanied by one other person (some hospitals will allow two if one is the doula). Contrary to popular belief, most people do not faint in the operating room. The mother will provided a drape to block her view of the surgery, feel free to stay behind the curtain with her if you are worried. Just being there for her and telling her what is going will help her. Sometimes the doctor will allow you to cut the cord, carrying the baby to the nursery, and take pictures. Make sure that you ask about these particular things.

"...be prepared to see you wife/partner treated with an apparent lack of dignity. I was taken away to be prepped and Dennis was left in the birthing center labor room. When they ushered him into the operating room I was spreadeagled on the table, buck naked, with betadine wash all over my belly. It looked to him like I'd been crucified. Plus there were all these people there, which generally would *not* be the case when I'm naked. To them it was just business, but to him it was his wife and baby." -Penny H.


Emergency Cesarean

What is an emergency Cesarean?

Basically, an emergency cesarean would be one that meant a matter of minutes was all that remained before the serious threat of loss of life or damage became imminent. Generally, this would be a placenta abruptio, a prolapsed cord, etc. General anesthesia is usually used, in combination with a vertical incision (for the matter of time), and your partner is generally not allowed to accompany you.


Recovery

What will my recovery be like?

Everyone's recovery will be different, depending on your age, body type, and general health. However, some basics of recovery will be to remember that you have just had major abdominal surgery as well as given birth to a new baby. You may be plagued with gas pains from being opened, incisional pain, uterine contractions (your uterus will still need to work to get back to it's original shape). You may be extremely tired from medications, labor (if you had one), or just in general. Your staples will usually be removed about 4-7 days postpartum. Try to take everything easy. Do as little as possible, although walking as soon as possible is very helpful in your recovery. The rule of thumb is to not lift anything heavier than your baby. When you get home, take the steps only once a day (if at all). Make a nest on the couch and nap there during the day. Get as much help as you can with your cleaning, food preparations, and other children.

You can start doing breathing exercises the first day in the hospital, someone will show you how. Then each day you can gradually find small exercises to do to get back into shape. Do not return to your previous exercise routine without permission of your care provider. Overdoing it will only slow your recovery.

By the end of six weeks, some people say they are feeling pretty good, although still dealing with some pain and sleeplessness. After this period you can usually resume most activities (Some doctors will allow you to drive after about 2 weeks, others request that you wait the entire 6.).
Read: After a Cesarean

"Do get up as soon as they'll let you, even though it hurts like hell the first time you get out of bed. Also, I found one of those big elastic belly supports really helpful when I got home. I didn't use it for long, but for those first few days, it really made laying on my side and rolling over in bed much less painful." -France W.


Breastfeeding after a Cesarean

Can I still breastfeed if I had a cesarean?

Certainly you can. It may take some more effort on your part, but do not hesitate to ask for help. Your hospital should have a lactation consultant on hand to help you get started. Start breastfeeding as soon as possible, for some this will be in the recovery room, for others you may have to pump for a sickly baby or to encourage your milk supply. There are different positions that will be helpful to you in breastfeeding after a cesarean, like the football hold, or any other position that keeps the baby off of your incision.

For more help try:

"My son Aaron was born via emergency C-section. I was under general anesthetic and was therefore unable to breastfeed "Immediately" after he was born. After I was out of recovery and allowed to hold him (3 hours later), the doctors told me to wait and not try to breastfeed him because of how tiring it would be on me, and I needed my rest, etc., etc. They suggested waiting until the next day to attempt the first feeding. I was so drugged up (morphine, demerol) that I didn't protest. However when I was a little more aware a few hours later, I insisted on having my baby and successfully breastfed him. So, my advice would be to breastfeed when you feel up to it, not when you doctor says you should or shouldn't. It's your baby and you choice." -Angie J.


Vaginal Birth After a Cesarean

I had one cesarean (or more!), will I have to have another cesarean?

Recent studies have shown that there was an over 80% success rate for VBACs. Finding a care provider who is supportive and being educated are still the keys to preventing an unnecessary cesarean, even if it is a repeat cesarean.

One of the biggest fears of having a woman labor after having had a previous cesarean was the fear that her scar would tear. That is very unlikely, especially with the mid-line (bikini-cut) incisions that are the most popular today. Talk to your care provider about any fears you have and read books, talk to others who have experienced VBAC.


Recommended Reading

Where should I look for information?

These books can be ordered at your local book store or ordered through the Bookstore Online.

Talk to childbirth educators, doulas, lactation consultants, Le Leche members, or anyone else who deals with birthing women for information.


Emotions and Feelings

What are some feelings that I may have after the cesarean?

Many people say that they feel a range of emotions. They can be happy that their baby is there safely, disappointed that they did not achieve their "dream" birth, mad at the circumstances or some people, disconnected from the baby, or just relieved to get it over with.

It is important to remember that all new mothers go through emotional changes as the baby is born. This can be from the hormones, the situation, etc. However, in mothers who also are recovering from a major surgery, these can be more pronounced.

"Here's an important point: women who have not seen the baby come out of them may feel disconnected from it! This happened to me - it can be avoided by having them drop the drape after the incision to see the birth. I even got to be the first to say, "It's a boy!"" - Sabrina C.



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