What Is A Cesarean Section

Overview

A caesarean section, or C-section, is a surgical procedure used to deliver a baby through a cut made in the abdomen and uterus. It is a major surgery, that comes with several risks and is performed when a vaginal delivery is not possible or safe, for example when the health of the mother or baby is at risk.¹ Women who have previously undergone a C-section may require another one, yet the need for a first time C-section often becomes evident only once labour begins.²

In this article, we will cover the reasons for using caesarean sections, the surgical procedure, aftercare, potential risks for both mothers and babies and key considerations surrounding this childbirth method.

Why C-sections are carried out?

A caesarean, whether planned (elective) or performed in an emergency, becomes necessary if a vaginal birth poses significant risks. In situations where there is time for preparation, your midwife or doctor will discuss the pros and cons of a caesarean birth versus a vaginal delivery with you.

Planned caesareans are typically scheduled from the 39th week of pregnancy.

There are several reasons why a caesarean might be carried out, such as:

• The baby is in the breech position (feet first), positioned horizontally or sideways within the uterus. A C-section may be necessary if attempts to turn the baby gently by applying pressure to the abdomen are unsuccessful.
• Cases involving a low-lying placenta (placenta praevia) or pregnancy-related high blood pressure (pre-eclampsia).
• Infections, such as a first occurrence of genital herpes, late in pregnancy or untreated HIV.
• The baby is not receiving sufficient oxygen and nutrients, requiring immediate delivery to ensure the well-being of both mother and baby.
• Labour is not progressing or if excessive vaginal bleeding occurs.
• Certain health conditions, such as heart disease, where the risks associated with vaginal birth could exacerbate the condition.
• Factors like a large uterine fibroid, a pelvic fracture, or the expectancy of a baby with specific congenital anomalies might necessitate a C-section due to potential obstructions or complications during birth.
• Expecting twins or more, where vaginal delivery is possible in many instances, but a C-section offers a safer and more controlled birth process.
• For those with a history of a previous C-section. Attempting a vaginal birth after a previous C-section (VBAC) might not be recommended for everyone due to various factors. The type of uterine incision from the prior C-section and the risk of uterine rupture play crucial roles in determining whether a VBAC is a safe option for an individual.
• Cephalopelvic disproportion (CPD) occurs when either the pelvis is too small to safely allow an average-sized baby for delivery, or when the baby's head or body is too large to pass through the pelvis safely. 
• Instances of umbilical cord compression when the cord wraps around the baby's neck or body or becomes trapped between the baby's head and the pelvis. Umbilical cord prolapse, with the cord descending before the baby during labour, might also require a C-section.^1,3

Requesting a caesarean section for non-medical reasons

More and more women are choosing to undergo caesarean deliveries without clear medical reasons, like specific health conditions or previous caesareans. They believe planned caesareans are safer, pain-free and more convenient. However, research suggests risks for the mother include higher chances of serious health problems and emotional difficulties. Caesareans could also affect future pregnancies and the baby's health in both the short and long run.⁴ 

If the prospect of childbirth causes anxiety, seeking guidance from a healthcare professional for support during pregnancy and delivery is crucial. After careful consideration of risks and available support, individuals should have the option of a planned caesarean if they remain convinced it is the most suitable choice. In cases where their primary doctor is reluctant, they should assist in identifying another healthcare provider willing to provide support.³

Procedure details

What happens during a C-section?

A surgeon creates surgical openings in both the abdomen and uterus to facilitate the baby's delivery.

The abdominal incision is typically made horizontally near the pubic hairline or, in some cases, vertically from just below the navel to just above the pubic bone.

Following this, the uterine incision is performed, commonly horizontally across the lower part of the uterus (known as a low transverse incision). However, alternative uterine incisions might be necessary based on the baby's position or any complications, such as placenta previa or preterm delivery.

Subsequently, the baby is delivered through these incisions. The medical professional clears the baby's mouth and nose of fluids, clamps and cuts the umbilical cord, removes the placenta from the uterus and closes the incisions using sutures.

If you have received regional anaesthesia, instead of general (whole body) anaesthesia, you are likely to have the opportunity to hold the baby shortly after delivery.²

After the procedure

Following a C-section, expect a 2 to 3 day hospital stay. Your healthcare provider will discuss pain relief options with you.²

As the anaesthesia wears off, you will be encouraged to drink fluids and walk to prevent complications like constipation and blood clots. Your incision will be monitored for signs of infection, and the bladder catheter will be removed as soon as practical.

You can start breastfeeding as soon as you are comfortable, even in the delivery room. Ask for guidance on positioning from nurses or lactation consultants to avoid pain from incisions. Medications for post-surgical pain will be chosen with breastfeeding in mind.²

When you get back home

During C-section recovery, expect discomfort and tiredness. Follow these steps to promote healing:

• Rest and keep necessities nearby. Avoid lifting over 25 pounds for a few weeks.
• Use recommended pain relief, like ibuprofen or acetaminophen, which are safe for breastfeeding.
• Abstain from sex for at least six weeks.
• If taking pain medications, wait 1 to 2 weeks before driving to prevent discomfort.
• Monitor your C-section incision for signs and symptoms of infection. Contact your healthcare provider if:
  • The incision appears red, swollen or discharges fluid
  • You develop a fever
  • You experience heavy bleeding
  • Your pain gets worse² 

Risks/benefits

What are the benefits of C-sections?

The most significant advantage of a C-section is that it is safer for you and your baby in some instances. For example, if the baby's heart rate falls to unsafe levels, an emergency C-section is considered the safest option to prevent further decline.¹

What are the risks associated with a C-section?

Some potential issues of a C-section for mothers may include:

• Adverse drug reactions to the medications used during surgery
• Bleeding
• Injury to the bowel or bladder
• Abnormal separation of the placenta, particularly in women with previous caesarean delivery
• Uterine infection
• Incision (wound) infection
• Urinary tract infections or difficulty urinating
• Delayed return of bowel function
• Blood clots

After having a C-section, the uterine incision used impacts one’s ability to have a vaginal birth in future pregnancies.

It is important to address any concerns with your healthcare provider before the procedure if possible.⁵

Risks to babies may include:

• Breathing problems. Babies born by scheduled C-sections are more likely to experience respiratory issues, such as transient tachypnea, than infants born vaginally.^.6,7
• Surgical injury. Although rare, accidental nicks to the baby's skin may happen during surgery.² 

Although at times necessary for your and your baby's health, a C-section might not align with your birth plan, leading to unexpected emotions. Be assured, most providers prioritise vaginal delivery and only choose a C-section if it is the best option for you or your baby's health. After a C-section, rest and accepting assistance are crucial for a smoother recovery.¹

Summary

A caesarean section, commonly known as a C-section, is a surgical procedure for childbirth. It is an alternative to vaginal delivery when this is not possible or too dangerous. While this method poses certain risks compared to vaginal delivery and necessitates a longer recovery, it is a vital option in cases of breech positioning, maternal health issues, or labour complications. The process involves incisions to safely deliver the baby, followed by post-operative care to manage pain, monitor incisions and gradually reintroduce physical activities to facilitate recovery. Although associated with potential risks for both the mother and the baby, C-sections remain a crucial option in specific situations, requiring thorough consideration and medical guidance.