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Giving Birth by Cesarean Section

October 7th, 2008

Almost one-third of women will have a Cesarean birth. Here's how to prepare for a C-section.

by: Nancy Ripton

C-section Births

  • 25 to 30 percent of women have a Cesarean birth.
  • Breech birth, placenta previa and placenta abruption are the most common reasons for an elective C-section.
  • A spinal nerve block is typically administered before a Cesarean–it's stronger than an epidural and takes away every sensation, except for some tugging.
  • Shivering and shaking is common during, and immediately following, a Cesarean birth.
  • You can walk around and take a shower 24 hours after having a C-section.

"The most predictable thing about C-sections–and childbirth in general–is that they're unpredictable," says Dr. William Camann, associate professor of anesthesia at Harvard Medical School. An estimated 25 to 30 percent of pregnant women will have a Cesarean or C-section birth, where the baby is delivered through a surgical incision in the mother's abdomen and uterus. Here's how to prepare yourself in case your baby arrives via Cesarean:

Reasons for a C-section Birth
"Every woman should prepare herself for a C-section before she goes into labor," says Dr. Camann. Many C-sections are planned in advance for reasons such as breech birth, placenta previa (placenta blocks the cervix opening) and placenta abruption (the placenta starts to give way from the uterine wall), but the majority of Cesareans are non-elective. Regardless of your birthing plan, you should be prepared for the possibility of a Cesarean birth.

C-section Risks

Although a Cesarean birth is a major surgery, it is a very common procedure and usually there are no complications. There are, however, a few risks women should be aware of:

  • A wound infection can occur five to 10 percent of the time.
  • There's a very small risk of blood clots or a hole in the bladder.
  • There are potential problems for subsequent pregnancies. For example, placenta previa is more common in women who have had a prior C-section.
  • There's a chance of scar tissue build up on the uterus after a Cesarean birth. This isn't typically a problem with women who have one or two C-sections, but if you're planning on having a large family, the scare tissue can build up and, in severe cases, the mother may have to have her uterus removed after giving birth.

What to Expect with a Cesarean birth

You will get an IV: In fact, most hospital labors require an IV. "It's a great way to keep mom hydrated and we can deliver anti-nausea and pain medication through the IV," says Dr. Mary Marnach, an ob/gyn at the Mayo Clinic.

It won't hurt, but you will feel something: Except for extreme cases of emergency C-sections, you will be awake during the procedure. Typically, a single spinal injection is delivered by the anesthesiologist to numb the area from midchest downward. "It's a nerve block, so very little medication gets into the blood stream," says Dr. Camann. "You won't be sleepy and the baby gets very little effect." It is stronger than an epidural and takes away every sensation, except for some tugging. With an epidural you can still move your legs, but with a spinal you will not be able to move anything.

Assume the position: You will be lying on your back with your arms extended out to the side so your body looks like a cross. Monitors are attached to your wrists and a blue sheet is put up mid-chest level so you can't see what is happening during the surgery.

Uneasy feelings: You may be hit with a wave of nausea and/or your body may start to shake and become cold. This is a result of low blood pressure–a very common side effect of anesthesia. "A doctor will monitor your blood pressure every minute and, if it drops, will give you medicine to correct the symptoms promptly," says Dr. Camann.

Catheters: After the spinal, the nurse will insert a catheter because you won't be able to walk until the next morning.

Color shock: C-section babies sometimes need a little help getting the fluid out of their airway and they can appear bluer in color than other newborns. Don't worry, their color will return to normal in a few minutes.

After effects: You will be sent to a recovery room for about an hour to monitor your progress and possibly have your wound redressed. Your baby will be with you the whole time and skin-to-skin contact and breastfeeding are encouraged.

During this time shivering and shaking is very common. The IV fluids are colder than body temperature so they can make you feel cold. Also, small pieces of amniotic fluid can seep into the blood stream during surgery and cause shivering or shaking. "It's harmless and will pass in a few minutes to a few hours," says Dr. Camann.

C-section Recovery

All women recover at different rates, but generally speaking:

Your catheter will be removed: The morning after surgery

You can walk around and take a shower: 24 hours after surgery

You'll be able to walk comfortably: two weeks after surgery

You can stop taking pain medication: one to two weeks after surgery

You'll be able to resume cardiovascular exercise and strength training: six weeks post surgery.

To boost your rate of recovery and lower the risk of infection, it's important to get up and move as soon as possible after your surgery. Too much bed rest can lead to blood clots. It also helps to have exercised throughout pregnancy and to eat right pre- and post-surgery. "You'll heal better with a nutritious diet," says Dr. Marnach.
Meet our Experts:
Dr. William Camann is a member of the Just the Facts, Baby expert panel. He is the director of obstetric anesthesia at the Brigham and Women's Hospital in Boston, an associate professor of anesthesia at Harvard Medical School, and past-president of the Society for Obstetric Anesthesia and Perinatology. An internationally recognized authority on obstetric anesthesia and pain control during childbirth, Dr. Camann is the co-author of Easy Labor, Every Woman's Guide to Choosing Less Pain and More Joy During Childbirth (Random House/Ballantine Books, 2006).
Dr. Mary Marnach is an ob/gyn at the Mayo Clinic in Rochester New York.

c-section, cesarean, section, birth, risks, childbirth, anesthesia, breech birth, placenta previa, placenta abruption, surgery, pregnancy, labor