Cesarean Section Procedure, Step by Step

A cesarean section (or c-section) is a very common, well-established operation that many women have when delivering a child. In fact, the cesarean section surgery rate is about a third of all births in the United States of America. This procedure is often used for many reasons, including 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.

When the decision to have a cesarean is made before labor, it is often called a planned or scheduled cesarean. The decision might also happen in labor. This might be because the labor is taking too long, the mother or baby is not tolerating labor well, or other issues (see above). This is typically called an unplanned cesarean. In a few cases, it will be a true emergency and the surgery may happen very quickly, as in the case of placental abruption, severe bleeding, or fetal distress.

Knowing what to expect may help you feel more comfortable with the procedure. Here is a picture essay, with a step-by-step explanation of a c-section birth.

1

Cesarean Section Preparation and Anesthesia

Pregnant couple talks to obstetrician
Photo © StockByte/Getty Images

Prior to the surgery, you will receive your anesthesia, which is usually a regional pain block such as an epidural or spinal block. Regional anesthesia allows you to feel no pain during the surgery while also remaining awake to witness the birth of your child. In some cases of emergency, general anesthesia is used, which means you will be asleep.

While your anesthesia is being administered, the room will be busy as the nurses and doctors prepare the room with instruments and the warmer for the baby. Anesthesia can take about 20 to 30 minutes to administer. The powerful numbing will happen quickly and effectively.

Sometimes, your arms will be strapped down in a T-position away from your sides. This is done to prevent you from accidentally interfering with the surgery. You may also have a catheter placed. There will be a drape placed at your abdomen to keep you from seeing directly into the incision. However, you will be able to see the doctors, and most importantly, the baby when they are delivered.

In most cases, the patient’s partner or support person will be able to be in the operating room and will be positioned near their head to provide support and witness the birth.

2

Initial Incision

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initial cesarean incision

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In this photo, you see that the mother has been draped with sterile drapes and is in the operating room as they make the initial incision into the abdomen. 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). 

A vertical incision is usually only used in emergencies or complicated cases where better access to the baby is needed quickly. The drawbacks of a vertical incision are that a VBAC is not possible in later pregnancies due to the risk of uterine rupture and the scar is more visible. On the plus side, this type of incision usually results in less bleeding for the mother.

Also, note that there is no need to shave beforehand. Hospital staff will do this if it is necessary, and it might not be.

3

Follow-Up Incisions

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Subcutaneous layers in cesarean section

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There are multiple layers that your surgeon must go through before reaching the baby. This includes cutting through the skin, fat, into the abdomen, and uterus. The abdominal muscles won't be cut but will be separated in order to access the uterus. The bladder and intestines may need to be pushed aside, as well.

The doctor will use a variety of instruments during the procedure as they go through each layer of the body. You may also hear whirring noises from a machine used to cauterize (burn) small blood vessels to prevent excess bleeding. Sometimes, there are strange smells, caused by disinfectants and cauterizing, which is a burning smell.

While the c-section is a major surgery (any invasive procedure that enters a body cavity, such as the abdomen), the procedure is very safe and effective. That said, it does carry risks, like any surgery, such as infection, blood clots, or hemorrhage. However, serious complications are rare.

4

Suctioning of Amniotic Fluids

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Suctioning Amniotic Fluid during a c-section

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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 more often neither) to facilitate the extraction of the baby.

5

Delivery of Baby's Head Is Born

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The baby's head is born during a cesarean birth.

 Universal Images Group/Getty Images

Your baby is often engaged in the pelvis, usually, head down, but perhaps rear first or breech. Whatever part has entered the pelvis will be lifted out by the doctors. You may feel pressure, tugging, or pulling 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. The anesthesiologist is usually positioned right by your head in order to monitor your pain and general well-being. Alert them if you feel any pain. They will also often keep you informed about everything that is happening during the procedure and can answer any of your questions.

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.

6

Delivery of Baby's Head and Shoulders

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Getting the shoulders out during a cesarean section

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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. You may feel this wiggling, but again, while you may experience sensations of tugging or pulling, this should not be painful

The doctor 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 to assist in the birth.

7

Baby Is Born

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A baby is born via cesarean section

Universal Images Group/Getty Images 

The moment you've been waiting for—your baby's birth! It's 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 is 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. Here, your baby will be suctioned again to ensure that they have help clearing the amniotic fluid. Your baby may also have some basic care like weighing, measuring, cleaning, and vitamin K.

With some prior planning with participating practitioners and hospitals, 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.

For example, 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 slower (this can help to squeeze out fluid from the baby's lungs), and skin-to-skin contact with your baby immediately after the birth is prioritized.

8

Delivery of the Placenta

The next steps are the delivery of the placenta, followed by the suturing of the uterus and all the layers that were cut during the surgery. Once the placenta has been removed, it will be examined by your doctor. Closing up everything that's been cut through to get to the baby is usually the longest part of the cesarean section, which in total typically 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—a small delay won't cause any harm. Simply enjoying your baby however 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.

9

Closing the Incision

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Staples and wound care after a cesarean

 Universal Images Group/Getty Images

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 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.

10

Recovery

Woman holding newborn baby in hospital bed soon after birth

Ariel Skelley / Getty Images

You will be watched in the post-op area for at least an hour to ensure that your vital signs are stable and that you aren't bleeding too heavily, though everyone will bleed vaginally for a few weeks from the healing uterus. You will then be taken to your postpartum room. Usually, your baby and support person can be with you.

There you will spend the remainder of your hospital stay, which is usually two to four days. Stitches or staples come out in around 5 days to a week after surgery. Your doctor will let you know once it's safe for you to bathe. During the first few weeks of recovery, aim not to pick up anything heavier than your baby to avoid strain on your wound. However, walking and getting up out of bed is encouraged to promote healing.

A Word From Verywell

Many people are nervous, and some are disappointed, about having a c-section, but what matters most is the safe delivery of your baby. Once your bundle of joy is in your arms, that's all you'll be thinking about.

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