C-section

Abdominal delivery; Abdominal birth; Cesarean birth; Pregnancy - cesarean

A C-section is the delivery of a baby by making an opening in the mother's lower belly area. It is also called a cesarean delivery.

Description

A C-section delivery is done when it is not possible or safe for the mother to deliver the baby through the vagina.

The procedure is most often done while the woman is awake. The body is numbed from the chest to the feet using epidural or spinal anesthesia.

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1. The surgeon makes a cut across the belly just above the pubic area.

2. The womb (uterus) and amniotic sac are opened.

3. The baby is delivered through this opening.

The health care team clears fluids from the baby's mouth and nose. The umbilical cord is cut. The health care provider will make sure that the infant's breathing is normal and other vital signs are stable.

The mother is awake during the procedure so she will be able to hear and see her baby. In many cases, the woman is able to have a support person with her during the delivery.

The surgery takes about 1 hour.

Why the Procedure Is Performed

There are many reasons why a woman may need to have a C-section instead of a vaginal delivery. The decision will depend on your provider, where you are having the baby, your previous deliveries, and your medical history.

Problems with the baby may include:

Abnormal heart rate
Abnormal position in the womb, such as crosswise (transverse) or feet-first (breech)
Abnormal position
During labor and delivery, your baby must pass through your pelvic bones to reach the vaginal opening. The goal is to find the easiest way out. Cer...
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Developmental problems, such as hydrocephalus or spina bifida
Multiple pregnancy (twins, triplets, or more)

Health problems in the mother may include:

Active genital herpes infection
Large uterine fibroids near the cervix
HIV infection in the mother
Past C-section
Past surgery on the uterus
Severe illness, such as heart disease, preeclampsia or eclampsia
Preeclampsia
Preeclampsia is high blood pressure and signs of liver or kidney damage that occur in women after the 20th week of pregnancy. While it is rare, pree...
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Eclampsia
Eclampsia is the new onset of seizures or coma in a pregnant woman with preeclampsia. These seizures are not related to an existing brain condition....
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Problems at the time of labor or delivery may include:

Baby's head is too large to pass through the birth canal
Labor that takes too long or stops
Very large baby
Infection or fever during labor

Problems with the placenta or umbilical cord may include:

Placenta covers all or part of the opening to the birth canal (placenta previa)
Placenta previa
Placenta previa is a problem of pregnancy in which the placenta grows in the lowest part of the womb (uterus) and covers all or part of the opening t...
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Placenta separates from the uterine wall (placenta abruptio)
Placenta abruptio
The placenta is the organ that supplies nutrients and oxygen to the baby during pregnancy. Placental abruption occurs when the placenta detaches fro...

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Umbilical cord comes through the opening of the birth canal before the baby (umbilical cord prolapse)

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Risks

A C-section is a safe procedure. The rate of serious complications is very low. However, certain risks are higher after C-section than after vaginal delivery. These include:

Infection of the bladder or uterus
Injury to the urinary tract
Higher average blood loss

Most of the time, a blood transfusion is not needed, but risk of transfusion is higher.

A C-section may also cause problems in future pregnancies. This includes a higher risk for:

Placenta previa
Placenta growing into the muscle of the uterus and has trouble separating after the baby is born (placenta accreta)
Uterine rupture

These conditions can lead to severe bleeding (hemorrhage), which may require blood transfusions or removal of the uterus (hysterectomy).

After the Procedure

Most women will remain in the hospital for 2 to 3 days after a C-section. Take advantage of the time to bond with your baby, get some rest, and receive some help with breastfeeding and caring for your baby.

Recovery takes longer than it would from a vaginal birth. You should walk around after the C-section to speed recovery. Pain medicines taken by mouth can help ease discomfort.

Recovery after a C-section at home is slower than after a vaginal delivery. You may have bleeding from your vagina for up to 6 weeks. You will need to learn to care for your wound.

Outlook (Prognosis)

Most mothers and infants do well after a C-section.

Women who have a C-section may have a vaginal delivery if another pregnancy occurs, depending on:

The type of C-section done
Why the C-section was done

Vaginal birth after cesarean (VBAC) delivery is very often successful. Not all hospitals or providers offer the option of VBAC. There is a small risk of uterine rupture, which can harm the mother and the baby. Discuss the benefits and risks of VBAC with your provider.

Open References

References

Berghella V, Mackeen AD, Jauniaux ERM. Cesarean delivery. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 19.

Hull AD, Resnik R, Silver RM. Placenta previa and accreta, vasa previa, subchorionic hemorrhage, and abruptio placentae. In: Lockwood CJ, Copel JA, Dugoff L, et al, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 43.

Cesarean section
Animation

Cesarean section - illustration
1. The uterus is exposed through the abdominal wall, and an incision is made in the uterine covering. 2. The muscles of the uterus are separated, producing a hole for the delivery of the infant. 3. The infant is delivered through the opening in the uterine wall, after which, the uterus is stitched closed.
Cesarean section
illustration
C-Section - Series
Presentation

<strong>C-Section - Series</strong><p>In a normal pregnancy, the baby is positioned head down in the uterus.</p>

<strong>Indications</strong><p>Sometimes the baby is in a position, like breech (buttocks-first) or transverse (cross-wise), that makes a vaginal birth risky. Other times certain medical conditions, such as placenta previa (placenta is attached too low, blocking the baby's exit) or placenta abruptio (placenta is partially or completely detached, threatening the baby's oxygen and nutrient supply), make vaginal birth nearly impossible. A Cesarean section delivery is performed if a vaginal birth is not safe or possible for the mother or the baby.</p>

<strong>Procedure, part 1</strong><p>Many doctors prefer using general anesthesia, which renders the patient unconscious, for emergency C-sections because it can be administered quickly and takes effect almost immediately. When the C-section is planned, the doctor may order regional anesthetics (a spinal or an epidural), which numbs only the lower portion of the body.</p>

<strong>Procedure, part 2</strong><p>After the anesthesia takes effect, the surgeon makes an abdominal incision. In non-emergency C-sections, the surgeon usually makes a horizontal incision (a bikini cut) across the abdomen, just above the pubic area. In an emergency situation, the surgeon may prefer a vertical cut, from below the navel to just above the pubic area. A vertical cut allows quicker access to the baby.</p>

<strong>Procedure, part 3</strong><p>Next, the surgeon opens the uterus with either a horizontal or vertical incision, regardless the direction of the skin/abdominal incision. A vertical incision on the uterus causes less bleeding and better access to the fetus, but renders the mother unable to attempt a vaginal delivery (must have another repeat C-section) in the future. If you end up with a horizontal incision, you will have the option of either going through a trial of labor (TOL) or electing a repeat c-section. The reason for the differences between the two is that patients with vertical uterine incisions have a much higher chance of rupturing the uterus (8% to 10%) in the future pregnancies, compared to only 1% in those with horizontal incisions.</p>

<strong>Procedure, part 4</strong><p>Finally, the surgeon cuts through the amniotic sac enclosing the baby. He then allows the amniotic fluid to escape.</p>

<strong>Procedure, part 5</strong><p>The surgeon reaches into the uterus and lifts the baby's head. An assistant pushes down on the mother's upper uterus to help guide the baby out.</p>

<strong>Procedure, part 6</strong><p>The surgeon will clamp and cut the umbilical cord.</p>

<strong>Aftercare</strong><p>A typical hospital stay after C-section delivery is two to three days. Usually, the doctor encourages the mother to get up and move around soon after surgery to aid healing and to prevent complications. For the first few weeks, the abdominal incision will be sore. The scar will lighten as it heals.</p>

Cesarean section - illustration
There are many reasons to deliver a baby by Cesarean section, such as abnormal position of the baby, or abnormalities of the placenta and umbilical cord.
Cesarean section
illustration

Cesarean section
Animation

Cesarean section - illustration
1. The uterus is exposed through the abdominal wall, and an incision is made in the uterine covering. 2. The muscles of the uterus are separated, producing a hole for the delivery of the infant. 3. The infant is delivered through the opening in the uterine wall, after which, the uterus is stitched closed.
Cesarean section
illustration
C-Section - Series
Presentation

Cesarean section - illustration
There are many reasons to deliver a baby by Cesarean section, such as abnormal position of the baby, or abnormalities of the placenta and umbilical cord.
Cesarean section
illustration

A Closer Look

Talking to your MD

Self Care

After a C-section - in the hospital

Tests for C-section

Review Date: 4/16/2024

Reviewed By: John D. Jacobson, MD, Professor Emeritus, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Health Library

C-section

Description

Why the Procedure Is Performed

Abnormal position

Preeclampsia

Eclampsia

Placenta previa

Placenta abruptio

Risks

After the Procedure

Most women will remain in the hospital

Recovery after a C-section at home

Outlook (Prognosis)