What Really Happens During a C-Section

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From the first incision to the final staple, getting a newborn out via a cesarean section takes less than an hour. (Photo: iStock)

Whether it’s a scheduled procedure or a last-minute switch in plans because labor isn’t progressing, a cesarean section is major surgery. And since approximately 30 percent of all U.S. births are C-sections, an expectant mom has a one in three chance of giving birth via a surgeon’s scalpel.

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True, having a baby in an operating room in front of a dozen surgical team members isn’t very intimate, and the recovery time is longer than with a vaginal delivery. But the good news is, a C-section is relatively safe and low-risk for mom and baby. Here’s a step-by-step look at what goes on from the moment you sign the consent form until you’re wheeled into the recovery room.

Surgeons prep you for the procedure. In the operating room, members of the surgical team wipe your belly with an antiseptic solution. “A catheter is also put inside your bladder to keep it empty, since you can’t exactly get up to go to the bathroom anytime soon,” Dr. Gil Weiss, assistant professor of clinical medicine at Northwestern University and an ob-gyn in Chicago, tells Yahoo Parenting. Your partner can be there with you, of course, usually after putting on scrubs to protect you from germs. But it’s not like a birthing room, where multiple family members are usually allowed to crowd around.

You’re given anesthesia. “You generally have a choice of an epidural or spinal block, both of which will numb your entire lower body, so you’re awake and alert during the operation,” Dr. Alyssa Dweck, ob-gyn in Westchester, New York, and coauthor of V Is for Vagina, tells Yahoo Parenting. “Though you won’t feel any pain during the procedure, some women do feel some pushing or pressure,” says Dweck.

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Drapes are placed around your belly. Sterile drapes will cover all but your bump, and a screen or drape will also block the surgery from your view, so you don’t have to watch if you’re squeamish. “But some women and their partners want to see, so in that case, we’ll use a transparent drape that keeps germs out but allows you to watch,” says Weiss.

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The first incisions are made. Using a surgical scalpel, your ob-gyn will typically make a six-inch horizontal cut at your bikini line, just above your pubic bone. After cutting through the outer layer of skin, she’ll slice into subcutaneous fat, then muscle, then connective tissue, says Weiss. After each cut, tools called retractors are placed to hold open tissue. “It’s kind of like drawing curtains back from a window to see better,” says Weiss. Also, a wandlike suction device is used to vacuum blood and other fluids so the doctor can see.

The uterus is cut open. Once the doctor passes the abdominal wall, all of the internal organs are visible — including the uterus. “It has a reddish color, kind of a rosé,” says Weiss. “We’ll cut into the uterine wall at the lower end, where the baby’s head is.” Now the amniotic sac is exposed; when that is cut, fluid spills out. “At this point, the doctor puts her hand gently under the baby’s head and presses softly against the uterus where the baby’s bottom is, to ease the baby out rather than pull him out,” says Dweck.

The baby, and then the placenta, emerge. Once the baby slides out and the umbilical cord has been clamped and cut, he’s cleaned off just as he would be during a vaginal delivery, given a once-over by a pediatrician in the room, then handed to you (unless you’re too exhausted), says Dweck. Meanwhile, the doctor is paying attention to the placenta now. “I’ll massage the mom’s uterus a bit, which prompts the placenta to come out soon after,” says Weiss.

Your belly is stitched back up. After suctioning out excess blood and fluids and making sure the area is clean, your ob-gyn will use dissolvable stitches to sew up each layer of tissue, with staples closing the outermost layer of skin. Through your IV, you might also be given Pitocin, a drug usually used to speed up labor. “Pitocin cuts down on bleeding,” says Weiss. You and your bambino are then brought to a recovery room, where your vitals are checked and you can feed your baby. “It’s different for each woman, but milk can come in almost immediately after the surgery,” says Weiss.

After 2-4 days, you can go home. Complications sometimes occur — postsurgery infection or bleeding is the most common. But for the most part, a C-section should heal slowly and smoothly. The incision site will be sore for a few weeks, and once that eases up, scarring will be minimal.

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