C-section

Answer 1

Definition

A C-section, also called a cesarean section, is the delivery of a baby through a surgical opening in the lower belly area.

Alternative Names

Abdominal delivery; Abdominal birth; Cesarean section

Description

A C-section delivery is performed when a vaginal birth is not possible or is not safe for the mother or child.

Surgery is usually done while the woman is awake but numbed from the chest to the feet. This is done by giving her epidural or spinal anesthesia.

The surgeon make a cut across the belly just above the pubic area. The uterus and amniotic sac are opened, and the baby is delivered.

The health care team clears the baby's mouth and nose of fluids, and the umbilical cord is clamped and cut. The pediatrician or nurse makes sure that the infant's breathing is normal and that the baby is stable.

The mother is awake, and she can hear and see her baby. The father or another support person is often able to be with the mother during the delivery.

Indications

The decision to have a C-section delivery can depend on the obstetrician, the delivery location, and the woman's past deliveries or medical history. Some reasons for having C-section instead of vaginal delivery are:

Reasons related to the baby:

• Abnormal heart rate in the baby
• Abnormal position of the baby in the uterus such as crosswise (transverse) or feet-first (breech)
• Developmental problems such as hydrocephalus or spina bifida
• Multiple babies in the uterus (triplet and some twin pregnancies)

Reasons related to the mother:

• Active genital herpes infection
• Large uterine fibroids low in the uterus near the cervix
• HIV infection in the mother
• Previous uterine surgery, including myomectomy and previous C-sections
• Severe illness in the mother, including Heart disease, toxemia, preeclampsia or eclampsia

Problems with labor or delivery:

• Baby's head is too large to pass through mother's pelvis (cephalopelvic disproportion)
• Prolonged or arrested labor
• Very large baby (macrosomia)

Problems with the placenta or umbilical cord:

• Placenta attaches in abnormal location (placenta previa)
• Placenta prematurely separated from uterine wall (placenta abruptio)
• Umbilical cord comes through the cervix before the baby (umbilical cord prolapse)

Risks

A C-section is a safe procedure. The rate of serious complications is extremely 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
• Injury to the baby

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

All surgeries carry risks. Risks due to anesthesia may include:

• Reactions to medications
• Problems breathing

Risks related to surgery in general may include:

• Bleeding
• Blood clots in the leg or pelvic veins
• Infection

Expectations after surgery

Most mothers and infants recover well, with few problems.

Women who have C-section deliveries can have a normal vaginal delivery with later pregnancies, depending on the type of C-section performed and the reason the C-section was performed.

Many women who attempt a vaginal birth after cesarean (VBAC) delivery are successful. However, there is a small risk of uterine rupture associated with VBAC attempts, which can endanger the mother and the baby. It is important to discuss the benefits and risks of VBAC with your obstetric health care provider.

Convalescence

The average hospital stay after C-section is 2 to 4 days. Recovery takes longer than it would from a natural birth. Walking is encouraged the day of surgery to speed recovery. Pain can be managed with medications taken by mouth.

References

Landon MB. Cesarean delivery. In: Gabbe SG, Niebyl JR, Simpson JL, ed. Obstetrics: Normal and Problem Pregnancies. 5th ed. New York, NY: Churchill Livingstone; 2007: Chap.19.

Answer 2

Definition

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

Alternative Names

Abdominal delivery; Abdominal birth; Cesarean section

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

The surgeon make a cut across the belly just above the pubic area. The womb (uterus) and amniotic sac are opened, and the baby is delivered.

The health care team clears the baby's mouth and nose of fluids, and the umbilical cord is cut. The pediatrician or nurse makes sure that the infant's breathing is normal and that the baby is stable.

The mother is awake, and she can hear and see her baby. The father or another support person is often able to be with the mother during the delivery.

Indications

The decision to have a C-section delivery depends on:

• Your doctor
• Where you are having the baby
• Previous childbirth
• Your medical history

Some reasons for having C-section instead of vaginal delivery include:

Problems with the baby:

• Abnormal heart rate in the baby
• Abnormal position of the baby in the womb, such as crosswise (transverse) or feet-first (breech)
• Developmental problems such as hydrocephalus or spina bifida
• Multiple pregnancy (triplets, and sometimes, twins)

Health problems and medical history in the mother:

• Active genital herpes infection
• Large uterine fibroids near the cervix
• HIV infection in the mother
• Previous C-section
• Previous uterine surgery
• Severe illness in the mother, including heart disease, preeclampsia or eclampsia

Problems with labor or delivery:

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

Problems with the placenta or umbilical cord:

• Placenta covers all or part of the opening to the birth canal (placenta previa)
• Placenta prematurely separated from uterine wall (placenta abruptio)
• Umbilical cord comes through the opening of the birth canal before the baby (umbilical cord prolapse)

Risks

A C-section is a safe procedure. The rate of serious complications is extremely 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
• Injury to the baby

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).

All surgeries carry risks. Risks due to anesthesia may include:

• Reactions to medications
• Problems breathing

Risks related to surgery in general may include:

• Bleeding
• Blood clots in the leg or pelvic veins
• Infection

Expectations after surgery

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 usually successful. However, there is a small risk of uterine rupture, which can harm the mother and the baby. It is important to discuss the benefits and risks of VBAC with your health care provider.

Convalescence

The average hospital stay after C-section is 2 - 4 days. Recovery takes longer than it would from a vaginal birth. You should walk around after the C-section to speed recovery. Pain medication taken by mouth can help ease any pain.

References

Landon MB. Cesarean delivery. In: Gabbe SG, Niebyl JR, Simpson JL, ed. Obstetrics: Normal and Problem Pregnancies. 5th ed. New York, NY: Churchill Livingstone; 2007: Chap.19.

Cunningham FG, Leveno KJ, Bloom SL, et al. Cesarean delivery and peripartum hysterectomy. In: Cunnigham FG, Leveno KL, Bloom SL, et al, eds. Williams Obstetrics. 23rd ed. New York, NY: McGraw-Hill; 2010:chap 25.

Reviewed By

Review Date: 09/12/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.