6 things to know about having a c-section

According to the latest statistics, around 32 percent of all births in the United States are C-sections, for a variety of reasons ranging from the parent’s personal preference to the position of the fetus, to saving the life of both parent and baby.

We spoke with Reut Bardach, MD, an OBGYN with Medical City of Trinity in Trinity, Florida, to find out what you need to know about this surgery, in which delivery occurs via an incision in the abdomen and uterus.

If you have a C-section, you will probably be awake and alert during the procedure—though each case is different. Most often, the body is numbed below the waist using regional anesthesia (which affects a part or region of the body), such as an epidural, spinal block, or both.

A spinal block is a one-time injection of a narcotic pain medicine, such as fentanyl, or anesthetic into the spinal fluid. An epidural is also administered in the pregnant person’s back, but it's done using a catheter tube that remains in place, so more anesthetic can be given as needed. Although you shouldn’t feel any pain once you’ve been given the anesthetic, you may feel some pressure.

In the case of an emergency C-section, it may be necessary for the doctor to administer general anesthesia, which brings on a sleep-like state so you won’t feel the pain.

Once anesthesia—local or general—is administered, your surgeon will make an incision on the lower part of your abdomen, through which the baby will be delivered.

Though patient or surgeon may sometimes schedule a C-section out of personal preference, C-sections are typically performed when a vaginal birth is deemed high-risk. These scenarios may include:

• The fetus is in a breech position, or feet first
• The pregnant person has had previous C-sections
• Twins, triplets, or more are expected

The pregnant person has diabetes (high blood sugar levels), preeclampsia (high blood pressure, protein in the urine, vision changes and fluid retention, which can cause serious complications for the parent and fetus), HIV (human immunodeficiency virus, which weakens the immune system), or an active case of genital herpes (a viral infection that causes sores when active).

Complications during an attempted vaginal delivery can also lead to an emergency C-section. According to Dr. Bardach, "Common reasons for an unplanned cesarean section include excessive bleeding during vaginal delivery, cord [entanglement, when umbilical cord loops around a part of the fetus] or placental abruption [separation of the placenta from the wall of the uterus]."

C-sections may also be performed if labor does not progress or the fetus’s heartrate is slow, a sign of distress.

Most obstetricians perform hundreds or thousands of these surgeries, making them routine. But like any major surgery, C-sections do come with some risks.   "Although it definitely poses some risk of complication, most surgeons are very comfortable and confident performing C-sections, so they generally run smoothly," Bardach says.

"The first risk in an abdominal surgery, and especially in C-sections, is bleeding," Bardach says. "By the mere fact that we're using scalpels, there's going to be some blood loss involved."

There are some other risks to the pregnant person, including infection, damage to surrounding organs and blood clots. Although unlikely, it's possible for the baby to have surgery-related injuries, such as small cuts. Babies born via C-section are also at an increased risk of developing a breathing issue known as transient tachypnea, in which the baby experiences rapid breathing in the days following delivery.

But in general, cesarean deliveries pose a very low risk to parent and child. "My personal philosophy is that having a vaginal delivery is safer," Bardach says. "Our bodies are designed to have babies vaginally, but both options have their own benefits."

As with any surgery that involves incisions,  a C-section will leave you with a scar, though the placement depends on many factors, such as the position of the fetus. The most common type of incision is called a "bikini incision" and it is done horizontally, just above the pubic hairline, in an area often covered by a swimsuit or underwear. In some cases, mainly when a large incision is needed or the baby must be removed quickly, the surgeon may make a vertical incision just below the belly button. A vertical incision can also be made higher up, particularly if the fetus is lying sideways in the uterus. Whether the first incision is vertical or horizontal, a second incision is then made in the uterine wall, and the baby is delivered through these two openings. If you’ve had a C-section in the past, that will also help your surgeon determine where to make the new incision.

Regardless of the position of the incision, it is usually around 4-6 inches long, big enough for the baby’s head and body to squeeze through.

Your medical team will give you instructions for how to care for the incision after surgery, and the amount of scarring can depend on many things, including genetics. Over time, the scar will fade and become smaller. If it bothers you, there are several treatment options to help minimize the appearance, including creams, injections and laser therapy.

Just because you’ve had a C-section for one delivery does not necessarily mean you will need to have another C-section if you have more children in the future. According to recent data, more than 13 percent of people who have had a C-section were able to have a successful vaginal birth after cesarean delivery (known as a VBAC) with at least one future pregnancy. If you’re interested in attempting a VBAC, discuss the risks with your doctor—your chance of success depend upon the reasons you had the C-section in the first place and if there were any complications. It may also depend on the type of incision you had—those with a prior vertical incision are more likely to need a second cesarean. C-sections increase the risk for placental complications, which might lead to an additional procedure.

Recovering from a C-section takes time and rest—it is, after all, major abdominal surgery. "Postoperatively a lot of people need assistance, and having supportive family and friends is a huge benefit," Bardach says.

It generally takes longer to recover from a C-section than a vaginal delivery, and you will likely stay in the hospital one or two days longer. For days, and even weeks, after the procedure, you might feel tired, sore near the incision, constipated or full of gas, and you may have difficulty getting out of bed or lifting your baby.

To help with healing, rest when possible, drink plenty of fluids, avoid sex until your doctor gives you the okay (usually at your six-week checkup), and take medication as recommended by your doctor to manage pain when needed. Walking as you are able may also relieve discomfort and help prevent blood clots. Using a pillow to support your abdomen when you sneeze, cough or laugh may also be helpful to relieve pressure in this area. Most people are back to their typical activities between six and eight weeks after delivery.

There are no restrictions on breastfeeding, and you can begin as soon as you feel up to it. If you’re uncomfortable breastfeeding because of your incision, feel pain while nursing, or have issues with milk supply, ask a nurse, doula (a professional trained to support a parent before, during, and after childbirth), or lactation consultant to help you find solutions. If you have questions about support during recovery and breastfeeding and whether your insurance covers, ask your HCP.

Taking care of yourself is crucial at this time, and if you decide that breastfeeding isn’t right for you as you recover, supplementing or bottle feeding are healthy options.