What Happens During a C-Section?

There's a lot that goes on during the most performed surgery in the US.

When it comes to pregnancy, there are two major types of delivery: vaginal and Cesarean-section (C-section). A C-section is a surgical procedure where a baby is delivered through incisions in a mother's uterus, per the American College of Obstetrics and Gynecology (ACOG). Additionally, about one in three deliveries are via C-section—and a C-section is the most performed surgery in the US per the National Library of Medicine (NLM).

Although some individuals might expect to have a C-section, the majority of C-section births occur if something goes wrong during the process of delivery. Should you find yourself needing a C-section to deliver your baby, here's what to expect.

When Are C-Sections Necessary?

One of the most common reasons for a C-section is what's called "arrest disorder," or when the cervix stops dilating and the woman has a C-section to get the baby out, said Michael Cackovic, MD, an ob-gyn at the Ohio State University Wexner Medical Center.

A C-section may be recommended out of medical necessity, but the decision to do one may also be rushed out of convenience for the doctor, hospital, or patient, Dr. Cackovic added. Other reasons why a C-section may be performed include certain chromosomal abnormalities of the fetus or if the baby is in breech position (feet or butt down).

If you get pregnant again after you've had one C-section, you'll typically be scheduled for a repeat procedure. While some doctors are comfortable performing vaginal births after cesarean section (or VBACs), many times another C-section is done because of the "small, but real risk" of uterine rupture, Dr. Cackovic said, who added that this happens in less than 1% of cases.

What To Expect When You Have a C-Section

While a woman is under general anesthesia, a doctor will cut through the skin and fascia (connective tissue layers in your abdomen area) to reach the peritoneal cavity.

The organs surrounding the uterus, like the bladder and intestines, are moved aside during a C-section delivery but not removed. The idea that your organs are taken out and basically put on the operating table next to you is an urban legend, Dr. Cackovic said.

Because there's already a natural separation of the rectus abdominis muscles (the vertical muscles that run along your abdomen), no cuts to these muscles need to be made. Instead, the doctor separates them manually. From there, they make a vertical or horizontal incision on your uterus.

The doctor then puts pressure on the uterus and the baby is squeezed through this incision, similar to how the baby would come out through the vagina. Of note, many women report feeling a lot of the pressure and tugging from the doctor squeezing the baby out. "While pain receptors are blocked with general anesthesia, they deal with pain only—not the sensations of pressure. This is something that can be anxiety-provoking or feel weird for the woman," Dr. Cackovic said.

Some doctors will remove the uterus and repair it (which is called uterine exteriorization), according to a September 2020 International Journal of Environmental Research and Public Health study, after the baby has been delivered. However, uterine exteriorization often triggers nausea and vomiting. For the woman's comfort, a doctor can stitch the uterus up on the inside, Dr. Cackovic said.

After, the incisions in your uterus, fascia, and skin are stitched up. Most women get a "bikini cut," meaning the C-section scar is horizontal at the bikini line, but it may also be up and down underneath the belly button. The surgery takes 25 to 30 minutes, Dr. Cackovic said—but sometimes a C-section can last up to an hour.

Finally, recovery from a C-section takes four to six weeks. "You need to recover from the changes that occurred during the 40 weeks of pregnancy, birth, and major abdominal surgery," Dr. Cackovic said.

The Risks of Having C-Sections

Regardless of if you have a planned or unplanned C-section, there can be complications associated with having this procedure. According to the American Pregnancy Association, complications might consist of:

  • Organ injuries
  • Infections
  • Extended hospital stays or recovery time
  • Medication reactions
  • Adhesions (scar tissue forms and causes blockages or pain)
  • Hemorrhages

Repeat C-sections come with potential complications as well. For example, an individual might experience placenta accreta, where the placenta remains attached to the uterine wall after delivery. This is something that can cause severe bleeding—so there's been a push in the medical community to reduce the rate of first-time C-sections, Dr. Cackovic said.

Ultimately, you'll want to talk with your healthcare provider if you have questions or concerns about having a C-section. They'll let you know why a C-section is the recommended option for your situation and what you might specifically expect for your delivery process.

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