In the United States one third of women give birth by cesarean (aka C-section), a surgical procedure whereby your baby is delivered via an incision in your abdomen and uterus.
For being such a common (and medically necessary) procedure, people have a lot of feelings about it—you might have heard that it’s “worse,” a shameful alternative to delivering vaginally. There’s a lot of mommy shaming that occurs around C-sections, but the truth is C-sections can be a safer alternative for both mom and baby—it all depends on your pregnancy and your history.
Since knowledge is power, we asked doctors to help explain when C-sections are typically used, what happens during the procedure, what recovery after a C-section looks like, and how they compare to vaginal births.
Reasons for a C-section
It’s true that you can schedule a C-section to avoid having to worry about going into labor. “Sometimes the hardest part of labor and vaginal delivery is the uncertainty,” says Ashely Brant, D.O., an ob-gyn at the Cleveland Clinic. “It’s important for all parties to be flexible and open to changing the plan as labor unfolds.”
That’s not “lazy.” There are a lot of medically valid reasons that your doctor might recommend going this route, says Costa Sousou, M.D., chair of the department of obstetrics and gynecology at Mayo Clinic Health System. Some of the reasons your doctor might suggest planning a C-section:
You have a condition called placenta previa.
Placenta previa is a condition that occurs when the placenta, an organ that develops during pregnancy to provide your baby with nutrients, covers the cervix (the tissue that connects your vagina to your uterus and opens during labor). That can lead to severe bleeding during pregnancy and delivery, says Sousou, meaning a C-section can be the safer alternative.
You’re pregnant with twins or triplets.
Depending on the babies’ positioning, a C-section may be the safer option.
You’ve had a C-section before.
If you had a C-section with a previous delivery, there can be a small increased risk of uterine rupture (if you have prior uterine scars), explains Tajh R. Ferguson, M.D., an ob-gyn at Beth Israel Deaconess Medical Center in Boston.
Of course, just because you had a C-section once doesn’t mean it’s 100% certain you’ll need to have one again. “Deciding whether you want to schedule a repeat C-section or if you want to try vaginally calls for very individualized counseling with your physician—much of which is driven by patient preference if all else is healthy,” Ferguson says.
Your baby is breech.
If your baby is not head-down (maybe he’s butt-down, i.e., breech), vaginal delivery is dangerous if not impossible. Your doctor can try a procedure to turn the baby's head down, but if that doesn’t work, a C-section may be the only option.
You have a history of trauma.
“In rare cases, women may want to avoid vaginal delivery due to other circumstances, for example, a history of sexual assault that makes vaginal exams very difficult,” says Brant. “In cases like these, the patient should have a thorough discussion with her doctor about the risks and benefits of elective C-section."
Of course, there are plenty of scenarios for which your doc might order an unexpected C-section too. Some of those situations include:
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Baby’s heartbeat dropping (which may indicate fetal distress).
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You’re not progressing in labor (read: pushing for a long time without any progress).
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Your doctor is worried about your health or your baby’s health. “Oftentimes multiple factors contribute to the decision to have a C-section,” says Brant. “A doctor will recommend a C-section if the risks of vaginal delivery are thought to outweigh the risks of C-section.”
What to Expect During a C-Section Procedure
If you’re lined up for a C-section, first a nurse will prep you for the operation in an operating room, putting an IV in your arm or hand so that you can get fluids and medications such as antibiotics during the surgery.
If you already have an epidural (maybe you were pushing in labor and are now having a C-section), an anesthesiologist may give you more medication. If you haven’t had an epidural, which is an injection made into your lower back, you’ll be given general anesthesia, an epidural, or a spinal block to numb the lower half of your body.
After you’re numb, you’ll also have your abdomen cleaned and potentially shaved to lower risk of infection and a catheter will be placed into your urethra to drain your bladder. (This will stay in place well after the surgery is complete too.) Next you’ll be covered with sterile drapes, and the surgeons will wash their hands and dress in sterile gowns and gloves, explains Brant. While most drapes are opaque, some hospitals have started to use clear drapes for mothers who want to watch the procedure. If you’re watching, know that, in general, C-sections have a lot more bleeding than vaginal births—usually about double the amount of blood, says Torre Halscott, M.D., an assistant professor of maternal-fetal medicine and critical care medicine at The Johns Hopkins University School of Medicine. So be prepared.
After you’re prepped for surgery, your partner or another support person can come into the operating room, and the surgery begins. Because space is limited—and it’s necessary to maintain a sterile environment—most hospitals allow you to have only one person in the room with you, explains Halscott. You’ll want to discuss ahead of time who that person is. It might feel like there are a lot of people in the room (C-section surgery itself always involves two people operating, says Brant), which can be stressful, but everyone in the room has a role, Brant says.
As for the procedure itself? “An incision is usually created just above the bikini line in a side-to-side manner, and we go deeper until we reach the uterus,” explains Sousou. The muscles in your abdomen are often separated and may not always need to be cut. “Once at the uterus, we create a side-to-side incision at the lower part of the uterus,” he says. You shouldn’t feel any pain, but when you’re ready to deliver, you might feel some pressure as your medical team applies pressure on your uterus and guides the baby out, he says.
Once out, the umbilical cord is cut, your baby’s handed to a pediatric nurse for evaluation, and you deliver your placenta. Your doctor might massage your uterus to allow the placenta to separate or an anesthesiologist might administer a synthetic version of the hormone oxytocin called Pitocin, to allow the uterus to contract and release the placenta, Sousou explains.
Lastly, the layers impacted by the incision (your uterus, connective tissue layers, and skin) are repaired and closed up. “Usually the incision is closed with absorbable sutures, but sometimes staples or non-absorbable sutures are used,” says Brandt. After surgery a bandage is placed over the incision.
FYI: Nausea and vomiting are normal reactions to the anesthesia and the manipulation of your abdomen, Brant says, so if you’re sick after surgery, know that that’s normal.
C-Section Recovery
In short, recovery from a C-section takes longer and is more painful (ugh) than a vaginal birth, says Brant, who notes that you should expect to stay in the hospital, on average, three to four nights. After surgery you’ll gradually progress through what is known as “post-op milestones”: walking, eating and drinking, peeing, and passing gas.
Recovering from major surgery also means dealing with some pain in your lower abdominal area—prescription pain meds are often necessary for the first few days—but symptoms should improve over time, says Sousou. During recovery you’ll need to take it easy: No heavy lifting (which puts added pressure on your incision) or strenuous physical activities. Things as simple as getting out of bed or walking around can be challenging, says Halscott.
Postpartum bleeding, a.k.a. lochia, is also a common side effect of childbirth (for both vaginal births and C-section deliveries)—a result of the placenta detaching from your uterus and other blood and mucus from the cervix exiting your body, explains Halscott. It’s normal and is worst in the first few days postpartum, but bleeding can last (ugh again) up to six weeks. You just want to keep an eye on how much your bleeding, docs say. If you’re soaking through more than a pad an hour, tell your doctor.
C-Section Risks
When medically necessary—when it’s a safer, more viable option than a vaginal delivery—a C-section is absolutely the preferred form of delivery. But, like any surgery (and like vaginal birth), it does have risks, according to the Mayo Clinic.
Infection
As with any incision, you are at higher risk for an infection after a C-section. There’s also a risk of infection in the lining of the uterus.
Bleeding
The risk of postpartum hemorrhage—i.e., heavy bleeding—goes up with a C-section.
Blood clots
A C-section can also increase your risk of developing blood clots, especially deep-vein blood clots (called deep-vein thrombosis). These can be particularly dangerous—if one of these clots travels to your lungs (called a pulmonary embolism), it can be deadly.
Risks during future pregnancies
After you have a C-section, it’s more likely that you’ll have complications like placenta previa in future pregnancies.
There are also benefits to having a C-section, like a reduced risk of injury to both your vagina and perineum (the skin between your anus and vagina) and lower rates of short-term urinary incontinence, Brant says.
How to Prepare for a C-Section
You can plan a C-section—a totally valid choice. But Brant notes that typically this isn’t something doctors do purely for convenience. “Most of the time, this convenience isn’t important enough to warrant taking on the risks of surgery and longer recovery,” Brant says. After all, “a C-section is major surgery and carries an increased risk of infection, blood, loss, pain, venous blood clots, injury to abdominal organs like the bladder and intestines, and anesthesia complications.”
If you do need to plan a C-section, you’ll want to avoid food for six to eight hours before your surgery, Brant says, since anesthesia can slow down your digestion and make you vomit. Often you’ll also be given an antimicrobial and antiseptic soap to wash your abdomen with before your surgery, says Sousou.
Ultimately, it’s up to you and your doctor—no one else—to determine the best form of delivery for you and your baby.
Cassie Shortsleeve is a writer in Boston covering health, lifestyle, travel, and parenting. Follow her @cshortsleeve.
Originally Appeared on Glamour
