Cesarean Section Q & A

Having a cesarean section was the last thing I wanted. But I had no choice. When my baby’s heart rate slowed and I had failed to progress after 17 hours of labor, I was whisked into the operating room.

My experience isn’t unusual. Nearly one-third (32.8%) of all U.S. babies are now delivered by C-section, according to the National Center for Health Statistics. What’s propelling the trend?

For one, fewer women who’ve already had a C-section are having vaginal births, known as VBAC (vaginal birth after cesarean delivery).

Technology is also a factor. With the advent of fetal heart rate monitoring during labor, obstetricians can see whether a baby is in distress, says maternal-fetal health expert Yoram Sorokin, MD. Doctors can also use ultrasound in the last weeks of pregnancy to predict whether a baby is too big to fit through the pelvis.

And while vaginal births were once the norm for breech babies, most doctors now think they’re too risky. Whether you have a scheduled C-section or an emergency one, educating yourself will make the experience

Q: What are the most common reasons that I’d need a C-section?

A: Your doctor may schedule you for the surgery if you’re carrying multiples, or if your baby is breech, very large or has been diagnosed in utero with a birth defect or a placental abnormality. Many ob-gyns recommend C-sections if you’ve had pregnancy complications such as severe preeclampsia or if you’ve had a previous C-section.

You might need to undergo an emergency C-section if, during labor, your baby shows signs of distress (such as elevated heart rate), your labor fails to progress or if you are running a fever.

Q:Does a C-section pose any major risks to my health?

A:Doctors say it carries the same risks that are associated with any significant surgery: internal bleeding that may require a blood transfusion; surgical injuries to the bowel, bladder and other internal organs; blood clots; or uterine damage or infection.

C-Sections carry the same risks that are associated with any significant surgery.

Q:Is a C-section safer for my baby than a vaginal birth?

A:“If there is real failure to progress with labor, or if the baby’s heart rate is a cause for concern, then it’s safer to have a C-section,” says ob-gyn Elena M. Kamel, MD. Still, there are risks.

“Babies who are born by C-section have a higher incidence of respiratory problems, possibly because they don’t pass through the birth canal and so they miss out on the squeezing action that helps clear their lungs of amniotic fluid,” she says.

Q:Does the surgery or the recovery hurt?

C-Section Surgery Specifics

After your lower abdominal area is cleaned and shaved, you're given IV fluids and spinal anesthesia to numb you from the chest down. A drape is set up in front of your chest so that you can't see anything.

The doctor makes a four-inch horizontal incision just above your pubic bone, and then another incision into the uterine muscle itself. “Then we extend that opening either with scissors or our fingers and put the baby out,” says Michele R. Lauria, MD, a maternal-fetal medicine specialist at Dartmouth-Hitchcock Medical Center in New Hampshire.

The placenta is removed then too. To close the incision, some doctors sew up the uterus while it’s in the abdomen; others pull the uterus out. Moms usually get to hold the baby within an hour of delivery.

A: Although you’re usually awake during a C-section, spinal anesthesia will ensure you’ll be completely numb and pain-free from the chest down. Expect to be sore after surgery. You may be given an intravenous narcotic pain reliever for 24 hours. You’ll likely be in the hospital for three days, and you’ll have to take it easy for several weeks while your incision heals. After six to eight weeks, you can probably go back to work. After three months, you can play tennis.

Q:Can I choose a C-section if I’m scared of labor?

A: Though more women are scheduling elective C-sections,  experts advise against it if it’s just to avoid labor pain. “A vaginal birth is safer for the mom and baby when possible, because there is a much faster recovery time and it’s best to avoid major surgery,” says Dr. Kamel.

Q:Is a C-section automatic if you’re having multiples?

A:It depends on how the babies are positioned in your uterus. “If the first baby’s head is positioned down toward the vagina, you could try a vaginal delivery with twins or triplets,” says ob-gyn John Larsen, MD.

The need for C-sections for multiples depends on the first baby's head position.

Q:Is vaginal birth after C-section (VBAC) safe?

A: A 2001 study found the risk of uterine rupture — a potentially life-threatening tear in the uterus — during VBAC to be higher than previously thought, so fewer doctors are now performing VBACs.
If your doctor offers them, evaluate your risk factors before making a decision, Dr. Larsen urges. Women who aren’t induced, have had only one C-section and are at least 18 months past their previous delivery have the lowest risk of rupture. With a VBAC, there’s also a small chance (five to ten babies per 10,000 each year) of brain damage or death to the baby.

“Besides a faster recovery time, VBAC is something to consider if you’re having your second child and want to have more,” Dr. Larsen says. With multiple C-sections, surgery gets more difficult, and there’s an increased risk of chronic pelvic abdominal pain and numbness developing at the incision site.

Sandra Gordon is a freelance writer specializing in women’s and family health issues.

Categories: Health & Nutrition, Maternity