Caesarean section

C-section: When is it the best option?

Sometimes a C-section is safer for mother or baby than is a vaginal delivery. Here's why a C-section might be needed…

Caesarean birth — also known as a C-section — is the birth of a baby through an incision in the mother's abdomen. Although C-sections are sometimes planned due to pregnancy complications or previous C-sections, most first-time C-sections are planned efectively.

Why a C-section might be needed

Sometimes a C-section is safer for mother or baby than is a vaginal delivery. Your health care provider may recommend a C-section if:

Your labor isn't progressing. Arested labor is the most common reason for a C-section. Perhaps your cervix isn't opening enough despite strong contractions. Or your baby's head may simply be too big to pass through the birth canal.
Your baby's heartbeat suggests reduced oxygen supply. If your baby isn't getting enough oxygen or your health care provider is concerned about changes in your baby's heartbeat, he or she may recommend a C-section.
Your baby is in an abnormal position. Babies whose feet or buttocks enter the birth canal before the head are in the breech position. If your health care provider isn't able to move the baby into a more favourable position before labor begins, you may need a C-section to reduce the risk of complications. A C-section is also needed if your baby is lying horizontally across your uterus.
Your baby's head is in the wrong position. If your baby enters the birth canal chin up or with the top of the forehead or face leading the way, he or she may not fit through your pelvis. A C-section may be the safest way to deliver the baby.
You're carrying twins, triplets or other multiples. When you're carrying multiple babies, it's common for one or more of the babies to be in an abnormal position. In this case, Caesarean birth is often safer than vaginal birth — especially for the second baby.
There's a problem with your placenta. If the placenta detaches from your uterus before labor begins (placental abruption) or the placenta covers the opening of your cervix (placenta previa), C-section is often the safest option.
There's a problem with the umbilical cord. A C-section may be recommended if a loop of umbilical cord slips through your cervix ahead of your baby or if the cord is compressed by the uterus during contractions.
Your baby is very large. Some babies are simply too big to safely deliver vaginally.
You have a health problem. If you have a condition such as diabetes, heart disease, lung disease or high blood pressure, your health care provider may induce labor early to reduce the risk of pregnancy-related complications. If the induction isn't successful, you may need a C-section.

In other cases, a C-section may be recommended if you have an active genital herpes infection or another condition your baby might acquire while passing through your birth canal.

Your baby has a health problem. A C-section may be safer for babies with certain developmental problems, such as failure of the spine to close properly (spina bifida) or excess fluid in the brain (hydrocephalus).
You've had a previous C-section. Depending on the type of incision and various other factors, you may be able to attempt a vaginal delivery after a previous C-section. In some cases, however, your health care provider may recommend a repeat C-section.

Manage anxiety about C-sections

Getting the unexpected news that you need a C-section can be stressful, both for you and your partner. In an instant, your expectations about giving birth abruptly change. In case of emergency, your health care provider may not have time to explain the procedure and answer your questions.

Discuss the possibility of a C-section with your health care provider well before your due date. Ask questions, share your concerns and review the circumstances that might make a C-section the best option. Remind yourself that your health and your baby's health are more important than is the method of delivery. Look forward to a complete recovery and a joyful start with your new baby.

Preparation. Before the C-section, your abdomen will be cleansed. A tube (catheter) will be placed in your bladder, and intravenous (IV) lines to provide fluid and medication will be placed in a vein in your hand or arm.
Anaesthesia. Regional anaesthesia — which numbs only the lower part of your body — is most common. With epidural anaesthesia, pain medication is injected into your lower back just outside the sac that surrounds your spinal cord. With a spinal block, the medication is injected directly into the sac surrounding your spinal cord. You'll be able to hear and see the baby right after delivery.

In an emergency, general anaesthesia may be needed. With this type of anaesthesia, you won't be able to see, feel or hear anything during the birth.

Although you won't be able to hold your baby until after surgery, you'll likely be able to see your baby right away.

Recovery in the hospital

After a C-section, most mothers and babies stay in the hospital for about three days. To control pain as the anaesthesia wears off, you may use a pump that allows you to adjust the dose of intravenous pain medication as needed. Later, oral pain relievers are usually adequate.

Soon after the C-section, you'll be encouraged to walk — with assistance. Getting up and moving around can speed your recovery and help prevent constipation and potentially dangerous blood clots. The catheter and IVs will likely be removed within 12 to 24 hours of the C-section.

While you're in the hospital, your health care team will monitor your incision for signs of infection. They'll also monitor your appetite, fluid intake, and bladder and bowel function.

Breast-feeding after a C-section

IVs and discomfort near the incision can make breast-feeding somewhat awkward. With help, however, you'll be able to start breast-feeding soon after the C-section. Ask your nurse or the hospital's lactation consultant to teach you how to position yourself and support your baby so that you're comfortable.

Your health care team will select medications for your post-surgical pain with breast-feeding in mind. Continuing to take the medication shouldn't interfere with breast-feeding. In fact, trying to breast-feed when you're in pain may only make the whole process more difficult. If you're in pain, you can't relax — and your baby needs you to be calm and low-key when he or she is learning to breast-feed.

Going home

It usually takes about four to six weeks for a C-section incision to heal. Fatigue and discomfort are likely. While you're recovering:

If you're disappointed that you had a C-section rather than a vaginal birth, remind yourself that your health and your baby's health are more important than the method of delivery. Although it takes longer to recover from a C-section than from a vaginal birth, the end result is the same — and the adventure of caring for your baby is likely to overshadow it all.

Abdominal incision. The doctor will make an incision through your abdominal wall. It's usually done horizontally near the pubic hairline. If a large incision is needed or the baby must be delivered very quickly, a vertical incision may be made from just below the navel to just above the pubic bone.
Uterine incision. The uterine incision is usually made horizontally across the lower portion of the uterus (low transverse incision). Other types of uterine incisions may be used depending on the baby's position or other pregnancy complications.
Delivery. If you have epidural or spinal anaesthesia, you'll likely feel some movement as the baby is pulled from your uterus — but you won't feel pain. The doctor will clear your baby's mouth and nose of fluids, and clamp and cut the umbilical cord. The placenta will be removed from your uterus, and the incisions will be closed layer by layer.
- Take it easy. Give yourself time to rest. Keep everything that you and your baby might need within reach. Until your six-week checkup, don't lift anything heavier than your baby.
- Support your abdomen. Use good posture when you stand and walk. Hold your abdomen near the incision during sudden movements, such as coughing, sneezing or laughing. Use pillows or rolled up towels for extra support while breast-feeding.
- Limit company. Too many visitors in the first few weeks will keep you from getting the rest you need to recover and care for your baby.
- Drink up. Extra fluids can help replace those lost during delivery and breast-feeding, as well as prevent constipation. Remember to empty your bladder frequently to reduce the risk of urinary tract infections.
- Avoid sex. Many doctors recommend waiting six weeks before resuming intercourse. But don't give up on intimacy. Spend time with your partner, even if it's just a few minutes in the morning or after the baby goes to sleep at night.
- Don't drive. Until you can handle the sudden movements driving might require, let someone else drive. When you think you're ready to drive, practice sudden moves in the driveway to make sure you won't be slowed by discomfort near your incision. Before you drive anywhere with the baby on your own, make sure you can comfortably manage the baby's car seat or infant carrier.
- Take medication as needed. Your doctor may recommend medication for pain relief. If you're constipated or bowel movements are painful, your doctor may recommend an over-the-counter stool softener or a mild laxative, such as milk of magnesia.
- Know when to contact your doctor. Promptly report any signs of infection — such as severe pain in your abdomen; redness, swelling and discharge at your incision site; or flu-like symptoms accompanied by pain in one breast — to your doctor. Postpartum depression may be a concern as well. If your mood is consistently low, you find little joy in life or you have trouble summoning the energy to start a new day, seek help promptly.