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By Jenilee Matz, M.P.H., Staff Writer
Delivery by cesarean section (c-section) has been around for ages. Today, c-sections are more common than ever. They are done when it's the safest way for the baby to be born. But some women wonder if they can have a c-section even when it's not medically needed. Find answers to your c-section questions here.
What is a c-section?
A c-section is the delivery of a baby through an incision in the mother's abdomen and uterus. It is a major surgery. This is done instead of delivering the baby through the mother's vagina.
Why would I need a c-section?
Doctors usually advise a c-section when it's medically safer than a vaginal delivery for the mother, baby or both.
You may need a c-section if:
- Labor does not progress normally
- You're pregnant with multiples. Sometimes twins may be able to be delivered vaginally.
- There are problems with the placenta. It may block the cervix (placenta previa) or separate from the uterine wall (placenta abruption).
- You have HIV, herpes or another infection and want to lower the risk of passing it on to the baby.
- The baby is in a feet-first position (breech) or is too big to pass through the birth canal safely.
- The baby is experiencing fetal distress.
- You have gestational diabetes or preeclampsia.
- You've had a previous c-section. Though many women are able to have a vaginal birth after having a c-section (VBAC), there is an increased risk of uterine rupture.
Can I request to have a c-section?
Some women may ask to have a c-section when it's not medically necessary. Reasons for an elective c-section are personal. A woman may fear the pain of a vaginal birth. Or, she may want to guarantee that her doctor is the one to deliver her baby. But there are many options available to help with the pain of childbirth. Discuss these options with your doctor. Also discuss concerns you may have about another doctor being present for delivery. It might help to meet the covering doctor ahead of time. Ultimately you want what is safest for both you and your baby.
C-sections by request are not usually performed until week 39 of pregnancy or later. This is to help assure that the baby's lungs are fully developed. There is still an increased risk that the baby will be born prematurely, because it is not always possible to be sure of the baby's age.
Though all births are risky, vaginal birth is usually the safer option for both mom and baby when a c-section is not medically needed. Only you and your doctor can decide if a c-section by request is right for you.
What are the risks?
C-sections are generally safe. But, the risk of complications is greater from a c-section, which is major surgery, than a vaginal delivery. Possible problems for the mother include:
- Infection of the uterus, bladder, other pelvic organs or incision site on the abdomen
- Injuries to the bladder or bowel
- Blood clots
- Pain from incisions
- A bad reaction to the anesthesia
- Very rarely the mother may die
Babies born by c-section tend to have more breathing problems than babies who are born vaginally, even if they are delivered at full term.
How is the procedure performed?
First, you will be given anesthesia, usually a spinal. A spinal numbs everything from your waist down. You will likely be awake during the birth. (General anesthesia that completely sedates the mother is usually only used in emergency situations.) A catheter will be placed into your bladder.
The actual surgery usually lasts about an hour. The baby will be delivered during the first part of surgery. The incision in the abdomen will be made in one of two ways:
- Transverse - a low horizontal incision, also called "bikini-line" incision
- Vertical - in the lower abdomen below the belly button
The incision into the uterus will usually be transverse. This type of incision tends to heal more quickly. A vertical incision may be needed in certain cases.
During the second part of surgery, the placenta will be removed from the uterus. Both incisions are then stitched closed.
What is recovery like?
You may need to stay in bed for a short time. When you are ready, a nurse will help you walk the first few times you get out of bed. The catheter will be removed soon after surgery. Most women spend two to four days in the hospital to recover. You may need to stay longer depending on the reason you had a c-section. You can still hold and breast-feed your baby during this time.
It will take weeks to fully heal from the surgery. Expect the following during the recovery process:
- Soreness and pain in your abdomen and at the incision site
- Abdominal cramping, especially if you breast-feed
- Vaginal discharge that lasts four to six weeks after delivery
Call your doctor if:
- You have heavy bleeding
- You get a fever
- The pain gets worse
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External Sources
 | Landon MB. Cesarean delivery. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics: Normal and Problem Pregnancies. 5th edition. Philadelphia, PA: Churchill Livingstone Elsevier; 2007. . Accessed June 24, 2009
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| March of Dimes. C-section: medical reasons. . Accessed June 24, 2009
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| American College of Obstetricians and Gynecologists. Cesarean birth. . Accessed June 24, 2009
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| Doan-Wiggins L. Emergency childbirth. In: Roberts JR, Hedges JR, Chanmugam AS, et al, eds. Roberts: Clinical Procedures in Emergency Medicine. 4th edition. Philadelphia, PA: Saunders; 2004. . Accessed June 24, 2009
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| National Women's Health Information Center. Labor and birth. . Accessed June 24, 2009
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This article was reviewed and updated
08-01-2009.
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