Over 30 percent of babies born in the US are delivered by Cesarean section. Many C-sections are planned based on pregnancy complications, like high blood pressure, an obstruction, a prolapsed umbilical cord, the position of the baby, or multiple babies. If a vaginal labor isn’t progressing smoothly, a doctor might choose to perform an emergency C-section. In any case, a Cesarean section is a major surgery and one that is good to be familiar with even if it isn’t part of your birth plan.
How to Prepare
With your practitioner
If you plan to have a C-section, you will go over your medical history in detail with your practitioner. (You might also want to talk to the anesthesiologist who will likely be administering your epidural during the procedure.) Discuss how much—or how little—you’d like to see the day of surgery. During surgery, a curtain will separate you and your partner from the operating team, so you won’t see the operation, but you will be awake. If you want to watch the baby being removed, a drape can be pulled back during this part of surgery. “Some people really want to do that. Some people really don’t,” says OB-GYN Kelsey Kossl. “If your C-section is planned, discuss with your provider about what your goals are.”
The Day Before
Shower but don’t shave: Your doctor will give you an antiseptic soak for bathing the night before and morning of surgery to make sure the abdomen and body are free of bacteria. Don’t shave your pubic hair—tiny nicks or irritation can increase the risk of infection. Any hair that needs to be trimmed or removed will be taken care of in the operating room.
Food and drink: “The general rule of thumb is that you can’t have any solid food eight hours before a scheduled C-section,” says Kossl. “Ask your provider. Some institutions allow patients to have clear liquids up until two hours before their scheduled C-section.”
At the Hospital
If your C-section is planned, you’ll be asked to arrive two hours before surgery. “That time is important because you need to meet with your team: your provider, your nursing staff, and your anesthesia staff. You'll be getting an IV placed; you’ll be going over consent forms,” Kossl explains.
Once you’re prepped and in the operating room, the next step is anesthesia. This injection can be a spinal injection, an epidural injection, or a spinal epidural injection—all regional anesthesia. “These are different techniques based on different patient factors, but they share the same outcome, which is to provide numbness for the surgery,” says Kossl. Your body will be numb from just below your breasts to your toes.
It’s completely normal to get the chills as a side effect of anesthesia. “A lot of women might find themselves shaking intensely, like they’re shivering, even if they don’t feel very cold,” Kossl says. That sensation is common, and warm blankets can help. Some women experience nausea from the anesthesia and may need to throw up. “Share with your anesthesiologist that you’re starting to feel nauseous, and they can help put your head in a good position,” Kossl says. “If you do need to throw up, it’s completely OK. You’re not the first and you won’t be the last person to throw up during a C-section.”
A C-section takes about 45 minutes, with a total of 60 to 90 minutes spent in the operating room.
A catheter will be placed in your bladder. Any pubic hair that needs to be removed before surgery will be trimmed, and your abdomen will be cleaned and shaved at the incision site. A curtain will be set up separating the operating team from you and your partner or birthing coach. “A lot of patients are concerned or scared that they are going to feel something [during surgery], but there are tests that the anesthesia and the surgical team undertake to make sure that you are numb,” Kossl says. “You will be able to feel pressure, or a sensation of being touched, during surgery and at the time of delivery, but you will [be numb to any sharp sensations].”
There are two incisions needed during a C-section. The first is in the lower abdomen and is either a horizontal (which is more common) or vertical incision. The second is internal—in the lower part of the uterus. There are two different uterine incisions your practitioner may use:
Low transverse incision: This is the most common incision type, made across the lower, thinner part of the uterus.
Vertical incision: Made across the top of your uterus, this incision gives easier access to the baby and is used if the baby is sitting in a certain position. A vertical incision causes less bleeding but usually means you won’t be able to have a vaginal birth in the future due to a greater risk of uterine rupture.
Once the incision is made, the doctor will reach into the uterus and lift the baby’s head, while an assistant helps ease the baby out of the uterus. “You will probably feel an enormous pressure at the time of delivery of the baby. It might feel like an elephant is sitting on your chest,” Kossl says. “The anesthesiologist will be at the head of the bed with you and your support person, so share how you’re feeling and squeeze someone’s hands, but it will pass. Usually the surgeon will alert you when that time is coming so it doesn’t take you by surprise.”
You won’t see what is happening during surgery, but if you’d like to watch your baby being delivered, the curtain will be pulled back when the doctor removes the baby from the uterus.
After the baby has been delivered comes the fun part: After a nurse or pediatrics team assesses the baby, you can hold your baby for the first time—but with help. “Your arm motions might be a little bit limited, but if skin-to-skin contact is important to you and you’ve shared that with your support person and the people in the room, then someone can help you make that happen.” If your C-section is planned, discuss this with your doctor. In some operating rooms, it’s standard procedure to take the baby straight to the hospital nursery, so let your team know if you’d like to hold your baby first. Some hospitals practice “gentle C-section” surgery. This can include things like having one arm free of an IV and EKG monitors placed on your side instead of your chest so you can hold your baby (and even breastfeed) easily. Drapes can be set up in advance, and the team will operate as quietly as possible.
The final part of the procedure involves cleaning the areas around the uterus and stitching up the incision and usually takes between 20 and 40 minutes. “Cleaning the areas next to the uterus can actually be a little bit irritating to the lining of the abdomen and cause nausea,” Kossl says. Though it’s uncomfortable, this is normal.
If You Have an Emergency C-Section
If your C-section is unplanned, the whole thing may seem very fast—that’s a good thing and nothing to worry about. You will likely already have an epidural, which can also be used to administer a high enough dose of anesthesia to numb the area. “The nursing team, the surgical team, the anesthesia team—we have the capability of getting a C-section done in 45 seconds or less in a true emergency,” Kossl says.
“Know that the team has done this hundreds of times. While it might seem kind of chaotic or rushed, the team is more than capable of getting everything prepared and getting the baby delivered safely.”
Day of surgery
Most women stay in the hospital for two to four days following a C-section. “Everyone’s a little different as far as how long it takes for the numbness [from the anesthesia] to wear off, but women start regaining sensation within the first hour or two,” says Kossl. “A lot of times, the anesthesiologist might give you an injection for pain control that lasts for up to 12 to 18 hours.”
Women usually have a catheter in their bladder for the first 12 hours following surgery, and once it’s removed, it’s normal to feel a burning sensation when you urinate or as if your bladder isn’t emptying completely. It may also feel like emptying your bladder takes longer. “That’s normal,” Kossl says. “The bladder sits right on top of the uterus and there’s a lot of recovery going on in that area.” Women will experience cramping for a couple of days following delivery as the uterus sheds leftover blood and tissue.
Rest is incredibly important, but so is moving around. Expect nurses to encourage you to sit up in bed, walk around, and be lightly active.
“I've had some patients tell me, ‘I felt pretty good on day one, and day two really knocked me out,’” says Kossl. “It might be that [pain] injection wearing off, and I also find that patients are pretty comfortable on day one. They’re excited, they have visitors, and they have a new baby, and they’re up and active on day one because they’re comfortable doing so.” Expect soreness as the pain injection wears off, and transition to oral medication as recommended by your doctor.
Lochia, or postpartum bleeding, will be bright red for the first few days after delivery and will change in color and consistency over time. Women who deliver by C-section typically experience less bleeding after the first 24 hours. In all cases, if you are soaking a maxipad in less than an hour or passing clots larger than a plum, consult your doctor immediately.
Day Three to Four
Most women will be discharged from the hospital after about three days, but if you don’t feel comfortable, or still feel completely wiped out, speak with your doctor about the possibility of staying longer. Before leaving the hospital, make sure you have a plan for pain management. Talk to your doctor about a schedule for your medication, and ask for stool softener. Constipation is common after a C-section, and most hospitals will send you home with a prescription.
As you get acclimated to breastfeeding, avoid positions in which your baby is pressing up against your scar. One comfortable option is the clutch position. In this position, your baby’s head is supported with one of your hands while you cup your breast in the other, using your other arm and pillows to support and bring your baby to the correct height. Picking up and carrying your baby is safe, unless your provider tells you otherwise, but take care not to brush your scar.
You’ll visit your doctor to check your wound. “It’s normal to have a small amount of pinkish spotting or drainage,” says Kossl. “But if you have copious amounts of drainage, or it’s foul-smelling, or it looks like pus, those would be reasons to call [your practitioner].”
At home, keep in mind that as you recover from a major surgery, simple movements like getting up off the couch or out of bed may take more effort. Move slowly, and use pillows and chair or couch arms to help transition from one position to another.
The Next Six Months
The American College of Obstetricians and Gynecologists now recommends that postpartum care be an ongoing and tailored experience, rather than one six-week checkup. Work with your practitioner to schedule appointments on a time frame that feels right to both of you, and as always, never hesitate to call with questions.
“For six weeks [after a C-section,] we don’t want you lifting anything heavier than 10 pounds, so your incision can heal,” Kossl says. “A good guideline is to not lift anything heavier than your baby.” That means if you are holding your baby in one arm, you shouldn’t be picking up anything with your other.
Some women find that an abdominal binder—also called a belly band—provides comfort after a C-section and makes getting up and moving around easier. “We don’t have any evidence that an abdominal binder has medical benefits in terms of healing,” Kossl says, “but lots of women love them. If it makes you more comfortable and gives you the ability to be up and moving, that’s what we want.”
It typically takes six weeks for a C-section scar to heal, and during this time it’s important to support your body nutritionally, keep the incision site clean, and avoid strenuous activities. It’s common to feel numbness, itching, or sensitivity once the initial soreness wears off around the incision site. “For many women, this fades over the course of weeks to months, but I do have patients who still feel a difference in their skin sensitivity even a year or two out from their C-section,” Kossl says. If your postpartum journey involves a physical therapist for pelvic floor therapy, they may recommend scar massage. Always feel empowered to check in with your provider about the healing process.
Dr. Kelsey Kossl is an adviser to Anya.