In ancient times, cesarean sections were performed only on dead or dying women. And in most cases, there was no hope of saving the baby. Rather, the rudimentary operation was performed so that mother and child could be buried separately.
It’s hard to believe C-sections have evolved from a procedure of last resort to the nation’s most commonly performed surgery—and a lifesaving one at that. Over the centuries, doctors learned that a successful cesarean is all in the timing. Intervening before the mother is near death and the fetus is in severe distress can spare both lives.
A C-section might be chosen as the safest—or only—way to deliver a baby for many reasons. One of the most common is cephalopelvic disproportion, which means the baby is too big to pass safely through the mother’s pelvis. Breech presentation, in which a baby’s buttocks or feet are positioned downward, is another reason.
Cesareans are also performed when there’s a problem with the placenta. Placenta previa is a condition in which the placenta positions itself beneath the baby, covering part or all of the cervix and making a vaginal delivery impossible. In some cases, the placenta separates from the baby before delivery, cutting off oxygen and nourishment, a condition called placenta abruptio.
A cesarean may also be safest if the mother has diabetes, high blood pressure, heart disease, genital herpes or kidney disease. And many moms opt for repeat C-sections rather than attempt a vaginal delivery in future pregnancies.
C-section scenarios range from planned to calm to frenetic, depending on the reason for the procedure. If the cesarean is scheduled, you’ll know the birth date of your child well in advance. In a nonemergency but unexpected C-section, you’ll likely have time to weigh the pros and cons of local versus general anesthesia. But in an emergency situation, everything will happen so fast there will be little time for any discussion. In any case, these preparatory steps will probably take place:
- A urinary catheter will be inserted to collect urine and keep the bladder empty.
- An IV line will be inserted to administer fluids or medications.
- You’ll be given an antacid to neutralize stomach acids.
- A blood-pressure cuff will be wrapped around your upper arm and monitoring devices will be applied to your chest to monitor your blood pressure and heart activity.
- Your pubic area and abdomen will be shaved, and you’ll be scrubbed with an antiseptic wash.
In the operating room, you may be given supplementary oxygen. And if you haven’t yet received an epidural or spinal anesthetic, both of which are local anesthetics, you will be asked to lie on your side so the anesthesiologist can administer the anesthesia. The advantage of local anesthesia, which is used in about 80 percent of cesarean deliveries, is that Mom can be awake during the procedure and Dad can be present during delivery. (In an emergency C-section, general anesthesia is usually used and dads are not allowed in the operating room.) The attendants will arrange sterile drapes around your abdomen to block your view as the incisions are being made. (Ask the attendants to lower the drapes when the baby is about to be delivered so you’ll have a first peek.)
The surgeon will then make a 6”-long incision through the abdomen—most likely it will be along the bikini line, just above the pubic-hair line. If a doctor needs to work quickly, he or she may instead make a vertical incision from below the navel to just above the pubic bone.
After the first incision has been made, the doctor will make the smaller uterine incision. The type of uterine incision will depend on the baby’s position and the urgency of the situation. Most commonly used today is the low transverse incision, a horizontal cut made along the lower part of the uterus. This type forms a strong scar that can withstand the stress of a vaginal delivery in future labors. The low transverse incision surpasses in popularity the classical incision, a vertical cut made high in the uterus. Because it poses a high risk of bleeding and is likely to rupture during future labors, the classical incision is now reserved for emergency situations. Finally, doctors may also opt for a low vertical incision, performed low on the uterus, if the baby is in an awkward position.
Expect to feel some pulling and tugging but no pain while the baby is eased out. Believe it or not, just five minutes or so will have passed from the first incision to catching a glimpse of your newborn. After the baby is born, the doctor will remove the placenta, check your uterus and repair the incisions. In the meantime, the staff will attend to the baby and you may then be able to hold your infant while the procedure is finished.
You’ll probably feel fatigued, gassy and sore after the cesarean. Like all new mothers you’ll also feel after-birth pains, uterine contractions that help control bleeding and help the uterus resume its original shape. But postoperative medication will ease your discomfort, minimize the risk of infection and prepare you to care for Baby. You can start breastfeeding as soon as you feel comfortable, perhaps within three hours of giving birth. And within eight hours of surgery, you’ll be able to take short walks. Although you’ll be home within a matter of days, your body will take six weeks to heal fully. Devote that time to nurturing your baby—and yourself.