There’s more than one way to give birth to a baby. There is vaginal delivery, of course, and then there are cesarean sections, or C-sections, which account for nearly one-third of U.S. births. This surgical delivery of a baby from the mother’s uterus is a common and safe procedure, but it comes with more risks and a tougher recovery than vaginal birth.
That’s why it’s important to ask why if your OB-GYN suggests a scheduled C-section. You’ll want to understand the need for the procedure and how it will work before bringing your little one into the world.
First, a note: Most C-sections are not planned and happen as a result of labor not progressing as it should, says Brian Brimmage, MD, an obstetrician who delivers babies at UNC REX Healthcare. This might be because the woman’s cervix isn’t dilating to the full 10 centimeters needed to deliver the baby, the woman has been pushing for a long time and the baby won’t fit through her pelvis, the baby’s heart rate has dropped, or for other reasons that require a quick medical response.
“The top priority is to come out at the end with a healthy mom and a healthy baby,” Dr. Brimmage says. “We recommend a C-section when we do not think that vaginal delivery would be safe for mom or baby.”
Keep these four questions in mind if your doctor suggests a scheduled C-section.
1. Why do I need a scheduled C-section?
The most common reason for a scheduled C-section is that a woman has had one or more C-sections before. For first-time moms, the most common reason is that the baby is not in the head-down position for birth, Dr. Brimmage says. The baby might be breech (bottom or feet down) or transverse (sideways). Attempting to deliver a baby who is not head-down can result in a potentially dangerous situation where the baby’s head gets stuck after the rest of the body is delivered. This can rapidly become life-threatening for the baby, so doctors almost never recommend vaginally delivering a baby breech.
As the pregnancy nears the 40th week, health care providers can attempt to turn the baby with a manual procedure called external cephalic version (ECV) that involves pushing on the mom’s abdomen, but it doesn’t always work.
Twins and other multiples are often born via C-section, either because of the position of the babies or because the mom requests it, Dr. Brimmage says.
“Interestingly, though, in certain situations with twins, it is possible to deliver the second twin breech if the first twin delivers head-first. If a woman is carrying twins, she can talk to her obstetrician about this option,” he says.
If you’ve had a C-section in the past, your doctor may recommend scheduling another one. But if you want to try laboring and attempt a vaginal birth after cesarean, or VBAC, that might be possible.
“For someone who has had one C-section before, usually they can try to have a vaginal delivery if they want to,” Dr. Brimmage says. “If they don’t want to, they can choose to have a scheduled repeat C-section.”
For women who have had two or more C-sections, vaginal birth becomes less of an option outside of a limited number of hospitals (mostly large academic centers). The concern is the small but not insignificant risk of uterine rupture, which is when the scar on the uterus tears open during labor. This risk increases with the number of C-sections a woman has had.
2. How many C-sections do you perform each year?
It’s important to have a doctor who performs C-sections often; this will be true of nearly all OB-GYNs who deliver babies.
Like any surgery, C-sections come with three main types of risk: bleeding, infection and damage to surrounding organs or structures. As with any type of surgery, the more of them a doctor performs, the lower the risk of complications, in general. Another piece of good news is that a pregnant woman has about 50 percent more blood than normal in her body, so she’s well-prepared to handle blood loss, and IV antibiotics given before surgery reduce the risk of infection to about 3 to 5 percent, Dr. Brimmage says.
As for the surgery causing damage to other parts of the body, the risk is less than 1 percent.
3. What date should we choose?
Most scheduled C-sections occur at 39 weeks’ gestation, Dr. Brimmage says. While a baby is considered full-term starting at 37 weeks and ready for life outside the womb, babies benefit from staying inside the womb until 39 weeks when possible.
At 39 weeks, you’re less likely to deliver a baby who will need treatment in the neonatal intensive care unit, Dr. Brimmage says.
“However, if a woman goes into labor or her water breaks before her scheduled date at 39 weeks, as long as she is past 37 weeks we would not try to stop labor and would instead go ahead with her C-section then,” he says.
There are exceptions to the 39-week rule, of course, including conditions such as placenta previa, which is when the placenta covers the cervix and poses a bleeding risk. In that case, a C-section might be scheduled as early as 36 or 37 weeks, Dr. Brimmage says.
4. What should I expect during and after my C-section?
C-sections are like any surgery in that “the more you know about it going in, the less nervous or scared you’ll be about what’s going to happen,” Dr. Brimmage says.
The vast majority of women don’t experience pain during a C-section, though they will feel pressure or a pushing sensation. Most women receive spinal anesthesia, which the anesthesiologist administers immediately before surgery, and this makes everything from your upper abdomen down to your toes go numb. Your OB-GYN will test to make sure the anesthesia is working well before making the incision. Sometimes women start to feel nauseated because of the anesthesia or because they’re lying flat; this can be remedied with medication.
In most cases, you can hold your baby right after birth while your OB-GYN closes the surgical incision.
Recovery from a C-section is typically a little more difficult than from a vaginal birth. Expect significant soreness for a few weeks; arrange for help for you and your new baby in advance. Your OB-GYN will ask you to avoid strenuous exercise and lifting anything heavier than 15 pounds for six weeks. However, your doctor will want you up and walking around as soon as is feasible after surgery (usually the same day), because this reduces your risk of postoperative complications such as blood clots and helps get your intestines working faster.
“You’re going to be pretty sore the first day, and then likely more sore on the second day, which is usually the worst,” Dr. Brimmage says. “After that, it tends to get a little better every day.”
OB-GYNs are committed to minimizing a mom’s pain and also decreasing the amount of narcotic medications that she needs. One approach is to schedule ibuprofen and Tylenol for the first few days after surgery to keep the pain at bay.
“Talk to your doctor about the plan for pain control ahead of time,” Dr. Brimmage says.
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