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). Surgery is performed with an incision made in the pregnant person's abdomen and uterus, so the baby can be taken directly from the uterus instead of traveling through the birth canal.

About one in three deliveries were via C-section in 2020. C-sections are the most performed surgeries in the US.

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

When Are C-Sections Necessary?

There are many reasons why you may need to have a C-section. A healthcare provider may recommend a C-section while you're in labor or beforehand. Some reasons why a healthcare provider may recommend a C-section prior to labor include:

  • If you have a disease such as heart disease or HIV
  • If the baby is in a breech position (feet or butt down)
  • Placenta previa, a condition in which the placenta fully or partially blocks the opening to the cervix
  • Placental abruption, which is when the placenta separates from the uterus
  • If the fetus has certain chromosomal abnormalities
  • If you're having twins or triplets

If your healthcare provider recommends a C-section while you're in labor, it could be because the following occurs:

  • Your cervix stopped dilating, which is something called arrest of dilation
  • The fetus is in distress
  • Arrest of descent, which is when the cervix is dilated but the baby isn't coming down
  • Maternal exhaustion

If you get pregnant and have had more than two babies delivered via C-section, you will be scheduled for a repeat procedure. If you've had one or two prior cesareans, then you may be a candidate for a trial of labor after cesarean (TOLAC), which is an attempt to have a vaginal birth after cesarean, commonly known as a VBAC.

Hospitals and healthcare providers have different policies about TOLAC eligibility based on factors such as availability of anesthesia and whether there will be enough staff available for a patient's needs. Larger teaching hospitals are more likely to offer VBAC than small community hospitals.

What To Expect When You Have a C-Section

While a pregnant person is under 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, said Michael Cackovic, MD, an ob-gyn at the Ohio State University Wexner Medical Center.

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 through the vagina. Of note, many people report feeling a lot of 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. 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) after the baby has been delivered.

After, the incisions in your uterus, fascia, and skin are stitched up. Most will 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 or more. The more complicated the surgery is, the longer it can take.

Finally, recovery from a C-section takes four to eight weeks.

Risks

C-sections are generally safe for both the mother and baby, but there are risks of complications associated with the procedure. regardless if it's planned or unplanned. These complications include:

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.

Because of the potential of short-term and long-term complications associated with C-sections, the American College of Obstetricians and Gynecologists says they're usually done when the benefits of surgery outweigh the risks. The decision should be considered carefully and discussed with an ob-gyn, it notes.

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

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Sources
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