When the decision to have a cesarean is made before labor, it is often called a planned or scheduled cesarean. The decision might also happen in labor. This might be because the labor is taking too long, the parent or baby is not tolerating labor well, or other issues (see above). This is typically called an unplanned cesarean. In a few cases, it will be a true emergency and the surgery may happen very quickly, as in the case of placental abruption, severe bleeding, or fetal distress. Knowing what to expect may help you feel more comfortable with the procedure. Here is a picture essay, with a step-by-step explanation of a C-section birth.
Step by Step C-Section Procedure
PreparationAnesthesiaInitial incisionFollow-up incisionsSuctioning of amniotic fluidsDelivery of the baby’s headDelivery of the baby’s shoulders and bodyBirth of the babyCutting of the umbilical cordDelivery of the placentaClosing the incisionRecovery
While your anesthesia is being administered, the room will be busy as the nurses and doctors prepare the room with instruments and the warmer for the baby. Anesthesia can take about 20 to 30 minutes to administer. The powerful numbing will happen quickly and effectively. Sometimes, your arms will be strapped down in a T-position away from your sides. This is done to prevent you from accidentally interfering with the surgery. You may also have a catheter placed. There will be a drape placed at your abdomen to keep you from seeing directly into the incision. However, you will be able to see the doctors, and most importantly, the baby when they are delivered. A vertical incision is usually only used in emergencies or complicated cases where better access to the baby is needed quickly. The drawbacks of a vertical incision are that a VBAC is not possible in later pregnancies due to the risk of uterine rupture and the scar is more visible. On the plus side, this type of incision usually results in less bleeding for the mother. Also, note that there is no need to shave beforehand. Hospital staff will do this if it is necessary, and it might not be. The doctor will use a variety of instruments during the procedure as they go through each layer of the body. You may also hear whirring noises from a machine used to cauterize (burn) small blood vessels to prevent excess bleeding. Sometimes, there are strange smells, caused by disinfectants and cauterizing, which is a burning smell. Although you may feel pressure, you should not feel pain. The anesthesiologist is usually positioned right by your head in order to monitor your pain and general well-being. Alert them if you feel any pain. They will also often keep you informed about everything that is happening during the procedure and can answer any of your questions. Once the head is out, your doctor will suction the baby’s nose and mouth for fluids. In a vaginal birth, these are squeezed out by the constriction of labor. In a cesarean birth, the baby needs some extra help getting rid of these fluids. If meconium (the baby’s first bowel movement) is present there may be extra suctioning required. The doctor will check for umbilical cord entanglement or other complications as the body is born. You may also have the assistant surgeon pressing on the upper part of your abdomen to assist in the birth. If your baby goes to the warmer, it is usually in the same room as the surgery. Here, your baby will be suctioned again to ensure that they have help clearing the amniotic fluid. Your baby may also have some basic care like weighing, measuring, cleaning, and vitamin K. For example, lights may be dimmed, music may be played, the drape that normally obscures the mom’s view of the operation may be clear, and once the baby’s head is out of the abdomen, the rest of the body is brought out slower (this can help to squeeze out fluid from the baby’s lungs), and skin-to-skin contact with your baby immediately after the birth is prioritized. During this time you can usually have your baby with you to breastfeed or hold. However, don’t feel pressure to begin breastfeeding immediately, you can start any time in the first hours after your baby is born—a small delay won’t cause any harm. Simply enjoying your baby however works best for you is fine. It may also be possible for your support person to hold the baby close to your face if you are unable to hold your baby. There are advantages to both methods—staples are faster (saving around seven minutes), while stitches decrease rates of wound separation and infection and usually yield a finer scar. The type of wound closing used will depend on physician preference and the specifics of your particular surgery. In a planned procedure, you can discuss the options with your doctor. Once closed, the wound will be covered with a bandage. There you will spend the remainder of your hospital stay, which is usually two to four days. Stitches or staples come out in around 5 days to a week after surgery. Your doctor will let you know once it’s safe for you to bathe. During the first few weeks of recovery, aim not to pick up anything heavier than your baby to avoid strain on your wound. However, walking and getting up out of bed is encouraged to promote healing.
