C-Section Surgery: What Happens During and When It’s Necessary

Childbirth either happens vaginally or via a Cesarean section, also known as a C-section. An obstetrician performs a C-section by an incision in the abdomen and uterus. They deliver the newborn directly from the uterus instead of through the birth canal.

Obstetricians may perform C-sections when a vaginal delivery isn't going as anticipated. Other times, people know ahead of time that they will need one.

Here's what to know about when someone might need a C-section and how obstetricians perform the surgery.

When Are C-Sections Necessary?

There are several possible reasons why you may need a C-section. A healthcare provider may recommend a C-section if you're in labor or still pregnant in cases such as:

• You have a disease like heart disease or human immunodeficiency virus (HIV).
• The fetus is in a breech position, with the feet or butt facing downward instead of the head.
• You have placenta previa, which happens when the placenta fully or partially blocks the opening to the cervix.
• You have placental abruption, which happens when the placenta separates from the uterus.
• The fetus has a known congenital abnormality.
• You're having twins or triplets.

Other times, a healthcare provider recommends a C-section while you're in labor in cases such as:

• Your cervix has stopped dilating.
• The fetus is in distress.
• The cervix is dilated, but the fetus isn't coming down the birth canal.
• You're too tired to keep pushing, also known as maternal exhaustion.

Also, a healthcare provider will likely schedule people who've already had two or more C-sections for another with future pregnancies.

If you've previously had only one or two C-sections, you may be a candidate for a trial of labor after cesarean (TOLAC). An obstetrician or midwife will discuss if you are an appropriate candidate for a TOLAC. A vaginal birth after a C-section occurs once you have delivered vaginally.

Hospitals and healthcare providers have different policies about who is eligible for a TOLAC. Generally, large teaching hospitals are better equipped to handle TOLACs and VBACs than small hospitals.

What to Expect When You Have a C-Section

Commonly, an anesthesiologist gives an epidural or spinal anesthesia before the C-section. The medications used in those forms of regional anesthesia numb the body from the waist down. So, you can be awake for the birth of your newborn. Healthcare providers rarely administer general anesthesia if you require an emergency C-section.

The idea that the obstetrician takes out your organs and places them on the operating table is a myth, Michael Cackovic, MD, an OB-GYN at the Ohio State University Wexner Medical Center, told Health. Realistically, the obstetrician will cut through the skin and layers of connective tissue in your abdominal area. Then, they will move aside the organs surrounding the uterus, like the bladder and intestines.

The obstetrician will then manually separate the rectus abdominus muscles, the vertical muscles that run along your abdomen. From there, they make a vertical or horizontal incision on your uterus.

The obstetrician gently lifts the head through the incision and, at times, applies pressure on the uterus to facilitate delivery. The movement is similar to how the fetus travels through the vagina. Many people report feeling pressure and tugging as the newborn is born. 

"While pain receptors are blocked with anesthesia, they deal with pain only, not the sensations of pressure. That can be anxiety-provoking or feel weird for the woman," said Dr. Cackovic.

After the surgery, the obstetrician stitches up the incisions in your uterus, fascia, and skin. Most people will have a horizontal scar on their bikini lines. Sometimes, the scar runs up and down underneath the belly button. 

The surgery takes about 25 to 30 minutes, added Dr. Cackovic. But sometimes, a C-section can last up to an hour or more, depending on how complicated the surgery is.

Once the obstetrician delivers your newborn, you should be able to hold them right away. But if you had general anesthesia, you would have to wake up and become alert before holding your newborn.

Recovery

After the obstetrician stitches you up, you will move to a recovery room. There, healthcare providers will monitor your vital signs and pain level.

You may stay in the hospital for two to four days after a C-section. The length of your stay depends on several factors, including how your in-hospital recovery is going.

Risks

C-sections are generally safe for both the parent and newborn. But there are risks of complications associated with the procedure, regardless of if it's planned, which include:

• Bleeding
• Bladder or bowel injuries
• Infections
• Issues with urinating and urinary tract infection (UTI)
• Blood clots
• Adverse reactions to medications

Repeat C-sections come with potential complications, as well. For example, a person might have a placenta accreta, which happens when the placenta remains attached to the uterine wall after delivery. Placenta accreta may cause severe bleeding.

Ideally, a healthcare provider can diagnose placenta accreta during a prenatal ultrasound, but in some cases, they cannot.

So, the American College of Obstetricians and Gynecologists advises that healthcare providers only perform C-sections if the benefits outweigh the risks. An OB-GYN should carefully discuss the decision with you.

Going Home After a C-Section

Once you are home, you will need to take it easy for a few weeks until you heal. It may take up to eight weeks to return to your normal self. You'll likely experience some symptoms during your recovery, most of which also occur after a vaginal delivery. Those symptoms include:

• Mild cramping
• Bleeding from the vagina for four to six weeks
• Passing clots
• Pain at the incision site

If you're bleeding, the blood will slowly become less red and then pink. Later, the blood will become a yellow or white color. Bleeding and discharge after delivery is called lochia.

You must clean the incision site by washing it gently with mild soap and water. You can take showers but should avoid taking a bath or swimming pools until a healthcare provider tells you it's OK.

After four to eight weeks, you should be able to resume most of your regular activities. But before then, you should not place anything inside your vagina, such as tampons, or have sex. 

Other things to keep in mind after C-section include:

• Do not lift anything heavier than your baby.
• Rest when you need to.
• Avoid heavy housecleaning, jogging, exercising, or any other strenuous activity.

Over time, you can gradually increase your activity level until you are back to normal.

A Quick Review

There are many reasons that it may not be possible to give birth vaginally, so you may need a C-section. With a C-section, an obstetrician makes an incision through the abdomen and into the uterus to deliver the newborn. It can take several weeks to recover after having a C-section.

Talk with a healthcare provider if you have questions or concerns about having a C-section. They can tell you what to expect if you end up needing one.