C sections (Cesarean sections)

Over 25% of births in United States are c-sections (cesarean sections) now. You have a one in four chance of having your baby via cesarean during your labor and childbirth and should learn the risks of cesarean sections and why you might need one.

A cesarean is a surgical birth. An incision will be cut into your abdomen at the top of your pubic hair. C-sections (cesarean section) generally take about an hour to an hour fifteen from the first incision to the end of the repair work. The baby is usually born within five to fifteen minutes after the first incision.

If possible, you will be awake for the procedure, and you will be given an epidural or a spinal for pain relief. Epidural or spinal medicine is better for you and the baby than general anesthesia. However, if your epidural does not work properly or you need an emergency c-section you will receive general anesthesia.

There is a quite a bit of postoperative pain and you will probably require pain medicine for a week or more after the birth. Breastfeeding may be a challenge and you should talk to your nurse about good breastfeeding positions with your incision.

• Failure to progress or prolonged labor. Women that have to have a c-section (cesarean section) for failure to progress often have no idea why they had a cesarean, or what went wrong during their labor. Failure to progress occurs when dilation stops progressing. You also may require a cesarean if your membranes have been ruptured for over 24-36 hours or if you develop a fever.
• Malpresentation or Malposition. Malpresentation occurs when how the baby lies within the uterus makes a vaginal birth unfavorable. Examples include breech presentations, transverse lies (when your baby is sideways), face or brow presentations. A malposition may include occiput posterior position (OP) or asynclitism (when the baby’s head is not tilted to fit through the pelvis).
• If the baby’s head does not fit through the pelvis. This is called Cephalo-pelvic disproportion (CPD). CPD can rarely be diagnosed and is a very rare condition. It cannot be diagnosed because as pregnancy continues, the joints and ligaments of the pelvis loosen to create even more room for the baby to move downward. In addition, using positions for delivery that increase the pelvic outlet can help the baby’s head fit through the pelvis.
• Fetal distress is a big reason for a cesarean. Doctors can see your baby is in fetal distress by monitoring the baby’s heat rate on the fetal heart monitor. If your baby’s heart beat decreases for a certain amount of time (called a deceleration) your baby could be getting less oxygen, causing damage to the brain and other fetal organs.
• Fetal problems are another reason for a cesarean. Babies with certain birth defects may be helped by having a cesarean.
• You will need a cesarean if your baby’s cord prolapses. This means that your baby’s cord falls through the cervix in front of your baby’s head. The cord then gets compressed either by your baby’s head or body, cutting off oxygen to your baby. This is an extremely serious, though rare, condition and if this occurs, you will have an emergency cesarean.
• Placenta previa is another reason for a cesarean. Placenta previa occurs when the placenta either partially or completely covers the cervix.
• Placental abruption is when the placenta prematurely separates from the uterine wall. This can cut off oxygen to your baby or cause hemorrhage. Depending on when and how much the placenta separates determines how quickly you need the cesarean.
• If you have a maternal disease or condition, you may need a cesarean. Heart disease, uterine fibroids, herpes sores or HIV are examples of these.
• If you had a cesarean previously, you may need another one. However, you can talk to your doctor about trying to have a VBAC (vaginal birth after cesarean).

There are many risks associated with a cesarean section birth. Possible complications include:

• Increased risk for infection and the need for antibiotics. If you are breastfeeding, antibotics have been linked with thrush.
• More blood loss and an increased risk of hemorrhage.
• Longer hospitalization than with a vaginal birth.
• Postoperative pain that lasts weeks or months and makes caring for yourself, your baby and other children difficult.
• Possible complications with anesthesia and medications for pain relief after the cesarean.
• Risk of problems from scar tissue or adhesions inside the abdomen.
• Possible injury to other organs during the procedure.
• Risks of blood clots in the legs and pelvic area.
• Increased risk of breathing and temperature problems for the new baby, especially if there was no labor before the cesarean.
• Higher rate of subsequent infertility.
• Increased risk of placenta previa or retained placenta in future pregnancies.
• Increased likelihood of another cesarean for the next birth.

If you need to have a scheduled c-section (cesarean sections) you can still make the birth as special as possible. Ask your doctor if you can have a support person with you to support you and your baby. Talk to you doctor about having music playing or the lights dimmed around your head. If possible, ask to see your baby as soon as possible after the birth and see if your baby can stay with you during the repair work.

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