What is a c-section, and when might you need one?
A cesarean section (or c-section) is a very common, well-established operation that many women have. Reasons for a c-section may include prolonged labor, high risk pregnancy, large babies, multiples, fetal distress, breech presentation, a previous cesarean where vaginal birth after cesarean (VBAC) is not advised or desired, placenta previa, and cord prolapse. Some c-sections are scheduled (planned before labor), some are unplanned (a decision is made during labor) and some are a true emergency (in the case of placental abruption, severe bleeding, or fetal distress).
Part 1 of this series explored reasons for having a c-section, what to expect before and after the operation, and how best to prepare your body for the surgery and recovery. In this article, we’ll walk through what happens during the procedure itself. Having a c-section might not be the birth experience society has told you to have or what you had expected, but it was necessary to ensure the safety of the child and mother. It is important to remember that you are still giving birth to a human being, it is not a lesser form of delivery, and it can still be an amazing birth experience. Using the time during the actual procedure to establish a good connection and appreciation for your body and knowing what to expect can help eliminate fear or disconnection that can otherwise occur.
C-Section procedure, step by step
A typical c-section takes about 45 minutes. Here is a quick overview of the steps you can expect and what you can do during the procedure. Do not underestimate the power of your breathing and your thoughts while you are being prepared for the c-section as well as while you are giving birth.
Cesarean Section Preparation and Anesthesia
Prior to the surgery, you will receive your anesthesia. This is usually a regional pain block such as an epidural or spinal block. A regional anesthesia allows you to feel no pain during the surgery while also remaining awake to witness the birth of your child. A general anesthesia is used in some emergency cases, which means you will be asleep.
The room will be busy while your anesthesia is being administered, as the other nurses and doctors will be preparing the room with instruments and getting the warmer ready for the baby. Anesthesia can take about 20 to 30 minutes to administer. The powerful numbing will happen quickly and effectively. A drape will be placed on your abdomen to keep you from seeing directly into the incision, but you will be able to see the doctors and (most importantly!) the baby after delivery.
In most cases, your partner or support person will be able to stay in the operating room with you and will be positioned near your head to provide support and witness the birth.
During this time, it is very powerful to connect with your baby and let her/him know that it is time to be born. The birth will be through your belly, and it will be fast. There will be lights and faces expecting her/him before she/he will be placed in your arms. Breathe deeply and focus on getting great, 360 degree breaths all the way into your sides, back, and down into your pelvis.
In the vast majority of cases, the incision is horizontal (across the lower abdomen, below the belly button, and just above or below the start of pubic hair). Please note that there is no need to shave beforehand. Hospital staff will do this if it is necessary, and it might not be.
Continue to focus on your good breathing. You know that your healing already starts now by relaxing the tissues through breathing so that the incision happens without much tissue tension.
There are multiple layers that your surgeon must go through before reaching the baby. This includes cutting through skin, fat, into the abdomen, and then the uterus. The abdominal muscles won't be cut, but they will be separated in order to access the uterus. The bladder and intestines may need to be pushed aside.
Keep focusing on your relaxed breathing, abs, and pelvic floor, and remain connected with your baby.
Suctioning of Amniotic Fluids
When the doctor reaches the uterus, you may hear suctioning. After cutting through the uterus, the amniotic fluid will be suctioned away to make a bit more room in the uterus for the doctor's hands or instruments such as forceps or a vacuum extractor, which are sometimes used (forceps less often than vacuum extractor, but most often neither is needed) to facilitate the extraction of the baby.
The birth of your child is approaching. You remain relaxed and full of anticipation, breathing well and connecting with your child.
Delivery of Baby's Head
Your baby is often engaged in the pelvis, usually head down but perhaps rear first (called breech). The part that has entered the pelvis will be lifted out by the doctors. You may feel pressure at this point, and some women report feeling nauseated during this intense but brief moment. Although you may feel pressure, you should not feel pain.
Once the head is out, your doctor will suction the baby's nose and mouth for fluids. In a vaginal birth, these are squeezed out by the constriction of labor. In a cesarean birth, the baby needs some extra help getting rid of these fluids. If meconium (the baby's first bowel movement) is present, there may be extra suctioning required.
You still are as relaxed as possible, breathing your nice, 360 degree breaths and looking forward to finally meeting your child.
Delivery of Baby's Head and Shoulders
Once your baby has been well-suctioned, the doctor will start to help the rest of the body be born. The surgeon will need to maneuver the baby back and forth to help them emerge. This should not be painful, though you may experience sensations of tugging or pulling.
They will check for umbilical cord entanglement or other complications as the body is born. You may also have the assistant surgeon pressing on the upper part of your abdomen (stomach fundus) to assist in the birth.
Almost there! Keep on breathing, relaxing your pelvis and abs one more time very consciously.
Baby Is Born
The moment you've been waiting for — your baby's birth! It has been about 5 to 10 minutes since your surgery started. Your baby will typically be briefly held over the drape to show you the baby, the umbilical cord will be cut, and then the baby will be taken away by a nursery nurse or neonatologist to a nearby warmer, depending on the setup of the operating room.
If your baby goes to the warmer, it is usually in the same room as the surgery. Your baby will be suctioned again to ensure they have help clearing the amniotic fluid. Your baby may also have some basic care like weighing, measuring, cleaning, and vitamin K administration.
With participating practitioners and hospitals and prior planning, and assuming both you and the baby are doing well, you can request a "gentle" c-section which is also called a natural cesarean.
In a gentle c-section, the surgery remains the same. The difference is that efforts are made to personalize the experience and mimic a vaginal birth. Lights may be dimmed, music may be played, the drape that normally obscures the mom's view of the operation may be clear, and once the baby's head is out of the abdomen, the rest of the body is brought out more slowly (this can help to squeeze out fluid from the baby's lungs), and skin-to-skin contact with your baby is prioritized immediately after the birth.
You did it! Great job on breathing and relaxing throughout the whole time. Your baby is born. Time to relax even more, and let the joy and pride overwhelm you.
Delivery of the Placenta
The next steps are the delivery of the placenta, followed by the suturing of the uterus and the layers that were cut during the surgery. Once the placenta has been removed, it will be examined by your doctor. The closing up of everything that has been cut through to get to the baby is usually the longest part of the cesarean section, which in total takes about 30 to 60 minutes to complete.
During this time, you can usually have your baby with you to breastfeed or hold. However, don't feel pressure to begin breastfeeding immediately. You can start any time in the first hours after your baby is born, and a small delay won't cause any harm. Simply enjoying your baby in whichever way works best for you is fine. It may also be possible for your support person to hold the baby close to your face if you are unable to hold your baby yourself.
One more little effort, if you like. You may connect with your placenta, thank the placenta for all it has given the baby, and mentally detach it from the uterus. It must also be born. Then your body will belong to you all over again — or if you are breastfeeding, almost all over again.
Closing the Incision
After everything is finished surgically, your surgeon will stitch your incision shut. While the uterus is typically sutured (sewn) closed with dissolving stitches, the doctor can choose to close the abdominal incision with either staples or stitches.
There are advantages to both methods — staples are faster (saving around seven minutes), while stitches decrease rates of wound separation and infection and usually yield a finer scar. The type of wound closing that is used will depend on physician preference and the specifics of your particular surgery. In a planned procedure, you can discuss the options with your doctor. Once closed, the wound will be covered with a bandage.
You can also help here mentally if you have the opportunity. If you are holding your child in your arms, you will probably be overwhelmed with all the feelings, and this step of sewing together will pass without noticing it much. However, if you don't have your child with you yet, you can help to close the different layers — from the uterus to the skin — and imagine how everything heals wonderfully and without complications, and how all the layers glide together later. You are fully aware that your healing is about to happen, that your layers are healing properly, and you are doing everything in order to have a fantastic wound healing.
Congratulations! You have brought a child (one or more) into the world. Feel proud of what you have accomplished, and appreciate your body for all it has been through. Make sure to continue appreciating your body as you start your journey into c-section healing and recovery by reviewing “recovery from a c-section” in Part 1 of this series. It’s important to remember that you just had major abdominal surgery that needs time to heal, so ask for help as needed and minimize stress on your incision and abdomen. As you resume activities, make sure you proceed slowly and progressively to optimize your recovery. Then don’t forget to check out Part 3 for more specific tummy exercises for your c-section recovery, particularly to help with the lower belly pooch or low back pain that might occur and help you transition back into your workouts safely. If you need some inspiration for your c-section recovery, check out Laura’s journey through her diastasis recovery after 6 c-section surgeries.