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Giving birth by cesarean section
Reviewed by the BabyCenter Medical Advisory Board
Last updated: June 2014

In this article
What is a cesarean section?
Why would I have a planned c-section?
Why would I have an unplanned cesarean delivery?
What happens right before a c-section?
How is a c-section done?
What are the risks of having a c-section?
Video: C-section surgery
Photos: C-section scars

What is a cesarean section?
A cesarean section, or c-section, is the delivery of a baby through a surgical incision in the
mother's abdomen and uterus. In certain circumstances, a c-section is scheduled in advance. In
others, it's done in response to an unforeseen complication.
According to the U.S. Centers for Disease Control and Prevention, about 33 percent of American
women who gave birth in 2011 had a cesarean delivery. (The c-section rate in the United States
has risen nearly 60 percent since 1996.)

Why would I have a planned c-section?
Sometimes it's clear that a woman will need a cesarean even before she goes into labor. For
example, you may require a planned c-section if:
You've had a previous cesarean with a "classical" vertical uterine incision (this is relatively rare)
or more than one previous c-section. Both of these significantly increase the risk that your
uterus will rupture during a vaginal delivery.

If you've had only one previous c-section with a horizontal uterine incision, you may be a good
candidate for a vaginal birth after cesarean, or VBAC. (Note that the type of scar on your belly
may not match the one on your uterus.)
You've had some other kind of invasive uterine surgery, such as a myomectomy (the surgical
removal of fibroids).
You're carrying more than one baby. (Some twins can be delivered vaginally, but most of the
time higher-order multiples require a c-section.)
Your baby is expected to be very large (a condition known as macrosomia). This is particularly
true if you're diabetic or you had a previous baby of the same size or smaller who suffered
serious trauma during a vaginal birth.
Your baby is in a breech (bottom first) or transverse (sideways) position. (In some cases, such as
a twin pregnancy in which the first baby is head down but the second baby is breech, the breech
baby may be delivered vaginally.)
You have placenta previa (when the placenta is so low in the uterus that it covers the cervix).
You have an obstruction, such as a large fibroid, that would make a vaginal delivery difficult or
impossible.
The baby has a known malformation or abnormality that would make a vaginal birth risky, such
as some cases of open neural tube defects.
You're HIV-positive, and blood tests done near the end of pregnancy show that you have a high
viral load.
Why would I have an unplanned cesarean delivery?
You may need to have a c-section if problems arise that make continuing or inducing labor.
These include the following:
Your cervix stops dilating or your baby stops moving down the birth canal, and attempts to
stimulate contractions to get things moving again haven't worked.
Your baby's heart rate gives your practitioner cause for concern, and she decides that your baby
can't withstand continued labor or induction.
The umbilical cord slips through your cervix (a prolapsed cord). If that happens, your baby needs
to be delivered immediately because a prolapsed cord can cut off his oxygen supply.
Your placenta starts to separate from your uterine wall (placental abruption), which means your
baby won't get enough oxygen unless he's delivered right away.
You have a genital herpes outbreak when you go into labor or when your water breaks
(whichever happens first). Delivering your baby by c-section will help him avoid infection.

What happens right before a c-section?
First, your practitioner will explain why he believes a c-section is necessary, and you'll be asked
to sign a consent form. If your prenatal practitioner is a midwife, you'll be assigned an
obstetrician for the surgery who will make the final decision and get your consent.

Typically, your husband or partner can be with you during most of the preparation and for the
birth. In the rare instance that a c-section is such an emergency that there's no time for your
partner to change clothes or you need general anesthesia, which would knock you out
completely your partner might not be allowed to stay in the operating room with you.

An anesthesiologist will then come by to review various pain-management options. It's rare these
days to be given general anesthesia, except in the most extreme emergency situations or if you
can't have regional pain relief (like an epidural or spinal block) for some reason.

More likely, you'll be given an epidural or spinal block, which will numb the lower half of your
body but leave you awake and alert for the birth of your baby.

If you've already had an epidural for pain relief during labor, it will often be used for your c-
section as well. Before the surgery, you'll get extra medication to ensure that you're completely
numb. (You may still feel some pressure or a tugging sensation at some point during the
surgery.)

A catheter is then inserted into your urethra to drain urine during the procedure, and an IV is
started (for fluids and medications) if you don't have one already. The top section of your pubic
hair may be shaved, and you're moved into an operating room.
You may be given an antacid medication to drink before the surgery as a precautionary measure.
If an emergency arises, you may need general anesthesia, which puts you at risk for vomiting
while you're unconscious and inhaling your stomach contents into your lungs. The antacid
neutralizes your stomach acid so it won't damage your lung tissue.
You'll probably be given antibiotics through your IV to help prevent infection after the operation.
(Some practitioners give antibiotics after the surgery, but the newest recommendations require
giving them before the surgery.)
Anesthesia will be administered, and a screen will be raised above your waist so you won't have
to see the incision being made. (If you'd like to witness the moment of birth, ask a nurse to lower
the screen slightly so you can see the baby but not much else.) Your partner, freshly attired in
operating room garb, may take a seat by your head.

How is a c-section done?
Once the anesthesia has taken effect, your belly will be swabbed with an antiseptic, and the
doctor will most likely make a small, horizontal incision in the skin above your pubic bone
(sometimes called a "bikini cut").

The doctor will cut through the underlying tissue, slowly working her way down to your uterus.
When she reaches your abdominal muscles, she'll separate them (usually manually rather than
cutting through them) and spread them to expose what's underneath.

When the doctor reaches your uterus, she'll probably make a horizontal cut in the lower section
of it. This is called a low-transverse uterine incision.

In rare circumstances, the doctor will opt for a vertical or "classical" uterine incision. This might
be the case if your baby is very premature and the lower part of your uterus is not yet thinned out
enough to cut. (If you have a classical incision, it's unlikely that you'll be able to attempt a
vaginal delivery with your next pregnancy.)

Then the doctor will reach in and pull out your baby. Once the cord is cut, you'll have a chance
to see the baby briefly before he's handed off to a pediatrician or nurse. While the staff is
examining your newborn, the doctor will deliver your placenta and then begin the process of
closing you up.
After your baby has been examined, the pediatrician or nurse may hand him to your partner, who
can hold him right next to you so you can admire, nuzzle, and kiss him while you're being
stitched up, layer-by-layer.
The stitches used for your uterus will dissolve in the body. The final layer the skin may be
closed with stitches or staples, which are usually removed three days to a week later (or your
doctor may choose to use stitches that dissolve on their own). Closing your uterus and belly will
take a lot longer than opening you up, usually about 30 minutes.

After the surgery is complete, you'll be wheeled into a recovery room, where you'll be closely
monitored for a few hours. If your baby is fine, he'll be with you in the recovery room and you
can finally hold him. You'll receive fluids through your IV until you can eat and drink.

If you plan to breastfeed, give it a try now. You may find nursing more comfortable if you and
your newborn lie on your sides facing each other.

You can expect to stay in the hospital for about three days. Your doctor will talk with you about
your pain medication. Most use a patient-controlled anesthesia, through your IV, followed by
pain pills as necessary when you're able to eat and drink.
For the full scoop on what happens after a cesarean, see our article on recovering from a c-
section.

What are the risks of having a c-section?
A c-section is major abdominal surgery, so it's riskier than a vaginal delivery. Moms who have c-
sections are more likely to have an infection, excessive bleeding, blood clots, more postpartum
pain, a longer hospital stay, and a significantly longer recovery. Injuries to the bladder or bowel,
although very rare, are also more common.
Studies have found that babies born by elective c-section before 39 weeks are more likely to
have breathing problems than babies who are delivered vaginally or by emergency c-section.

In addition, if you plan to have more children, each c-section increases your future risk of these
complications as well as placenta previa and placenta accreta.
That said, not all c-sections can or should be prevented. In some situations, a c-section is
necessary for the well-being of the mother, the baby, or both. Ask your practitioner exactly why
he is recommending a c-section. Talk about the possible risks and advantages for you and your
baby in your particular situation.