Every pregnant woman hopes for a short labor and delivery with no complications — manageable contractions, some pushing, then a beautiful baby — but it doesn’t always work out that way.
These days, almost 30% of all babies in the United States are delivered via cesarean section (C-section). In fact, there’s a lot of debate and concern about their increasing number, with some health professionals wondering how many are medically necessary. Federal officials have even set a goal of reducing the cesarean rate to 15% by the year 2010.
Still, many C-sections are justified and unavoidable. Even if you’re envisioning a traditional vaginal birth, it may help to ease some fears to learn why and how C-sections are performed, just in case everything doesn’t go as planned.
What Is a C-Section?
A C-section is the surgical delivery of a baby that involves making incisions in the mother’s abdominal wall and uterus. Generally considered safe, C-sections do have more risks than vaginal births. There’s far less chance of infection and severe bleeding with a vaginal delivery than with a C-section. Plus, you can come home sooner and recover quicker after a vaginal delivery.
C-sections are worth avoiding, if possible. However, these common surgical deliveries can help women with high-risk pregnancies avoid dangerous delivery-room complications and can save the life of the mother and/or baby in emergency situations.
Who Performs It?
C-sections are done by obstetricians (doctors who care for pregnant women before, during, and after birth) and some family physicians. Although more and more women are choosing midwives to deliver their babies, midwives of any licensing degree cannot perform C-sections.
Why It’s Needed
Some C-sections are scheduled if the doctor is aware of certain factors that would make a vaginal birth risky. That means some women know ahead of time that they will be delivering via C-section and are able to schedule their baby’s “birth day” well in advance. This allows them to prepare themselves emotionally and mentally for the birth — which can help to lessen the feelings of disappointment that many mothers who are unable to deliver vaginally experience.
So what determines if a woman is scheduled for a C-section? A doctor may schedule one if:
- the baby is in breech (feet- or bottom-first) or transverse (sideways) position in the womb (although some babies can be turned before labor begins or delivered vaginally using forceps and anesthesia)
- the baby has certain birth defects (such as spina bifida)
- the mother has problems with the placenta, such as placenta previa (when the placenta sits too low in the uterus and covers the cervix)
- the mother has a medical condition that could make a vaginal delivery risky for herself or the baby (such as HIV or an active case of genital herpes)
- some multiple pregnancies
- the mother previously had surgery on her uterus or a C-section (although many such women can safely have a vaginal birth after a C-section, called a VBAC)
Some C-sections are unexpected emergency deliveries performed when complications arise with the mother and/or baby during pregnancy or labor. An emergency C-section might be required if:
- labor stops or isn’t progressing as it should (and medications aren’t helping)
- the placenta separates from the uterine wall too soon (called placental abruption)
- the baby’s shoulders are stuck in the birth canal
- the umbilical cord becomes pinched (which could affect the baby’s oxygen supply) or enters the birth canal before the baby (called umbilical cord prolapse)
- the baby is in fetal distress — the heart rate drops, doesn’t change at all, or is too fast or too slow
- the baby’s head or entire body is too big to fit through the birth canal (which is rare)
Of course, each woman’s pregnancy is different. If your doctor has recommended a C-section and it’s not an emergency, you can ask for a second opinion. In the end, you most often need to rely on the judgment of the doctors.
The thought of having surgery can be unnerving for any woman. Here’s a quick look at what usually happens during a scheduled C-section, according to the American College of Obstetricians and Gynecologists (ACOG).
Your labor coach can be right by your side, clad in a surgical mask and gown, during the entire delivery (although partners may not be allowed to stay during emergency C-sections). Before the procedure begins, an anesthesiologist will discuss your options.
To prepare for the delivery, you’ll probably have:
- various monitors in place to keep an eye on your heart rate, breathing, and blood pressure
- your mouth and nose covered with an oxygen mask or a tube placed in your nostrils to give you oxygen
- a catheter (a thin tube) inserted into your bladder through your urethra (which may be uncomfortable when it is placed, but should not be painful)
- an IV in your arm or hand
- your belly washed and any hair between the bellybutton and pubic bone shaved
- a privacy screen put around your belly
After being given anesthesia, the doctor makes an incision on the skin of the abdomen — either vertically (from the bellybutton down to the pubic hair line) or horizontally (1-2 inches above the pubic hairline, sometimes called “the bikini cut”).
The doctor then gently parts the abdominal muscles to get to the uterus, where he or she will make another incision in the uterus itself. This incision can also be vertical or horizontal. Doctors usually use a horizontal incision, also called transverse, which heals better and makes a VBAC much more possible.
Once the uterine incision is made, the baby is gently pulled out. The doctor suctions the baby’s mouth and nose, then clamps and cuts the umbilical cord. As with a vaginal birth, you should be able to see your baby right away. Then, the little one is handed over to the nurses and a pediatrician or other doctor who will be taking care of your newborn for a few minutes (or longer, if there are concerns).
The obstetrician then removes the placenta from the uterus, closes the uterus with dissolvable stitches, and closes the abdominal incision with stitches or surgical staples that are usually removed, painlessly, a few days later.
If the baby is OK, you can hold and/or nurse your newborn in the recovery room by lying on your side (since holding your baby will put too much pressure on your abdomen).
to be continued…