Cesarean Delivery

By Nancy Bowers

(Cesarean Section, C-section, Cesarean Birth)

Procedure Overview

What is a cesarean delivery?

Cesarean delivery (also called a cesarean section or C-section) is the surgical delivery of a baby by an incision through the mother's abdomen and uterus. This procedure is performed when it is determined to be a safer method than a vaginal delivery for the mother, baby, or both.

In a cesarean delivery, an incision is made in the skin and into the uterus at the lower part of the mother’s abdomen. The incision in the skin may be vertical (longitudinal) or transverse (horizontal), and the incision in the uterus may be vertical or transverse.

A transverse incision extends across the pubic hairline, whereas, a vertical incision extends from the navel to the pubic hairline. A transverse uterine incision is used most often, because it heals well and there is less bleeding. Transverse uterine incisions also increase the chance for vaginal birth in a future pregnancy. However, the type of incision is determined by conditions of the mother and the fetus.

Reasons for the Procedure

If a woman is unable to deliver vaginally, the fetus is delivered surgically by performing a cesarean delivery. Some cesarean deliveries are planned and scheduled accordingly, while others may be performed as a result of complications that occur during labor.

There are several conditions which may make a cesarean delivery more likely. These include, but are not limited to, the following:

  • abnormal fetal heart rate - The fetal heart rate during labor is a good indicator of how well the fetus is handling the contractions of labor. The heart rate is usually monitored electronically during labor, with the normal range varying between 120 to 160 beats per minute. If the fetal heart rate indicates a problem, immediate action can be taken, such as giving the mother oxygen, increasing fluids, and changing the mother's position. A cesarean delivery may be necessary.

  • abnormal position of the fetus during birth - The normal position for the fetus during birth is head-down, facing the mother's back. However, sometimes a fetus is not in the right position, making delivery more difficult through the birth canal.

  • labor that fails to progress or does not progress normally

  • baby is too large to be delivered vaginally

  • placental complications (e.g., placenta previa, in which the placenta blocks the cervix and presents the risk of becoming detached prematurely from the fetus)

  • certain maternal medical conditions (e.g., diabetes, high blood pressure, or human immunodeficiency virus [HIV] infection)

  • active herpes lesions in the mother’s vagina or cervix

  • twins or other multiples

  • previous cesarean delivery

There may be other reasons for your physician to recommend a cesarean delivery.

Risks of the Procedure

As with any surgical procedure, complications may occur. Some possible complications of a cesarean delivery may include, but are not limited to, the following:

  • bleeding

  • abnormal separation of the placenta, especially in women with previous cesarean delivery

  • injury to the bladder or bowel

  • infection in the uterus

  • wound infection

  • difficulty urinating and/or urinary tract infection

  • delayed return of bowel function

  • blood clots

A woman may or may not be able to have a vaginal birth with a future pregnancy, called a vaginal birth after cesarean (VBAC). Depending on the type of uterine incision used for the cesarean birth, the scar may not be strong enough to hold together during labor contractions.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Before the Procedure

  • Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

  • You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear. If you want to have a tubal ligation (a permanent method of birth control in which the fallopian tubes are cut, cauterized, or banded to prevent the egg from being transported to the uterus) as part of your surgery, you must sign a consent form for this procedure.

  • You will be asked when you last had anything to eat or drink. If your cesarean delivery is a planned procedure and requires general, spinal, or epidural anesthesia, you will be asked to fast for eight hours before the procedure, generally after midnight.

  • Notify your physician if you are sensitive to or are allergic to any medications, latex, iodine, tape, and anesthetic agents (local and general).

  • Notify your physician of all medications (prescription and over-the-counter) and herbal supplements that you are taking.

  • Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.

  • You may be given medication to decrease the acid in your stomach and to help dry the secretions in your mouth and breathing passages.

  • The area around the surgical site may be shaved.

  • Plan to have someone stay with you after a cesarean delivery. You may have pain in the first few days and will need help with the baby.

  • Based upon your medical condition, your physician may request other specific preparation.