What is a cesarean section?

A cesarean (C-section) is the surgical delivery of a baby by incision through a mother's abdomen and uterus. The procedure's name is believed to have come from a set of Roman laws, Lex Caesare, which mandated surgical removal of the fetus from a woman dying in late pregnancy as an attempt to save the child.

Why would I need a cesarean?

Doctors perform a C-section when they deem it safer than vaginal delivery for mother, baby or both. The most common single reason for performing a C-section is dystocia, a catchall term that describes a slow or difficult labor. Examples of a difficult labor include abnormalities of the mother's birth canal, such as a small pelvis; abnormalities in the position of the fetus, including breech position or large fetal size; and abnormalities in the forces of labor, including infrequent or weak uterine contractions.

Are there medical conditions that would necessitate a cesarean?

Yes. Certain medical conditions in either the mother or fetus are more likely to necessitate a C-section. Some examples are maternal diabetes, pregnancy-induced hypertension, and erythoblastosis fetalis, which is a blood disease related to the Rh factor in the mother. It is also recommended that some, but not all, mothers infected with genital herpes or HIV (human immunodeficiency virus), which causes AIDS (acquired immunodeficiency syndrome), deliver by C-section to avoid infecting their babies.

What other conditions would warrant a cesarean?

The procedure may also be required when the following conditions are present:

• Fetal malpresentation (breech, transverse)
• Placenta previa - when the placenta covers the cervical opening, blocking the infant from passing through the birth canal
• Abruptio placentae - when the placenta prematurely separates from the uterine wall and hemorrhage may occur
• Fetal distress- this can usually be monitored during delivery
• Cord prolapse - when the umbilical cord is pushed out ahead of the infant, compressing the cord and cutting off blood flow
• Pelvic tumors, which obstruct the birth canal and weaken the uterine wall
• Presence of weak uterine scars from previous surgery or cesarean
• Certain malformations of fetus

How is the procedure performed?

The procedure is performed by a team consisting of an obstetrician, anesthesiologist, nurses, and may include a specialist in disorders of newborns (neonatologist) or someone who can resuscitate the baby if necessary. There are two main types of cesarean operations:

• Low-transverse - a horizontal incision in the lower uterus
• Classical - a vertical incision in the main body of the uterus

What kind of anesthesia is used during a cesarean section?

There are three major anesthetic techniques for cesarean birth:

• Spinal anesthesia, in which an anesthetic is injected into the central canal of the spinal cord, may be used, although it carries a slight risk of headache, sometimes severe, after delivery.
• Lumbar epidural anesthesia involves the injection of an anesthetic into the space that surrounds the spinal cord (epidural space) in the lower back. Both the lumbar epidural and spinal are considered regional anesthesia because they deaden pain in only part of the body without putting the patient to sleep.
• General anesthesia, which renders the patient unconscious, is often used in an emergency situation and with women who object to spinal or epidural approach.
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What are the risks to the mother in cesarean childbirth?

Cesarean childbirth is safe, but because major surgery is involved, the chance of infection and complication is greater after the operation than with a vaginal delivery. C-sections also result in more overall pain and a longer hospital stay. Although maternal death during childbirth is extremely rare, cesareans carry a higher risk of death compared to a vaginal delivery.

Are there risks to the infant?

Infants delivered with elective cesarean surgery appear to have a greater risk of respiratory distress syndrome (RDS), particularly if the surgery is performed before the onset of labor. RDS, a condition in which the infant's lungs are not fully mature, may result if an error is made in estimating the age of the developing fetus.

Is it safe to have a vaginal birth after a previous cesarean section?

In the absence of contraindications, a woman with one previous cesarean delivery with a low incision may be considered a candidate for a vaginal birth after cesarean. Success rates for vaginal birth after cesarean range from 60 percent to 80 percent.

What kind of recovery period should I expect?

In most instances, you will stay in the hospital for three to five days following a cesarean. Once the anesthesia wears off, you will require pain medication. At times, medication is added to the epidural and provides immediate relief from incision pain. Other times, pain medication is administered through your intravenous catheter or by injection. You may need to request this medication.

Within 24 hours after delivery, you will get out of bed. You will need help sitting, standing and walking at first. You will be permitted to eat a light diet within a day or so, and your urinary catheter will also be removed. Your incision will have staples or stitches in place. These may be removed before you leave the hospital, or later when you return to see your doctor. Vaginal bleeding occurs after delivery, even when a cesarean has been performed. The bleeding or discharge will initially be bright red, but will change to pink and disappear over several weeks.

As with any type of abdominal surgery, there will be restrictions on physical activity and exercise. Your doctor will let you know when it is safe to drive and what type of activity is permitted.