C-Section: What It Is, How It's Done, Risks, and Benefits

A cesarean section, more commonly referred to as a C-section, is a term to describe a surgical childbirth method. There are many different reasons why a C-section may be necessary (or requested), but it is usually performed as a result of a safety concern for the parent, baby, or both. It is a common delivery method in the U.S., with one in three births resulting in a C-section. Here we explore in finer detail what a C-section is and why it might be performed, as well as what happens before, during, and after the procedure.

What Is a C-Section?

A C-section is a surgical childbirth procedure, during which an incision is made through layers of skin, the abdomen, and the uterus. The baby is then delivered through the incision, as opposed to a vaginal delivery, where the baby is born via the vaginal canal.  

Your C-section might be scheduled in advance, which is called an elective C-section. Or it may be unplanned, which is called an emergency C-section. This means that the baby needs to be born surgically and quickly due to a safety concern for the parent, baby, or both during labor. For those that require an emergency C-section, it can be a lifesaving procedure.

Why You Might Need a C-Section

There are many different reasons why you may need or want a C-section. According to the American College of Obstetricians and Gynecologists (ACOG), these can include:

• Labor failing to progress: A labor that takes too long can result in injury to both the birthing parent and baby
• Fetal distress: A medical issue related to the baby 
• Twins or multiple pregnancies: When carrying more than one baby, the risk of C-section increases
• Placenta previa: A low-lying placenta that covers the entrance to the uterus, essentially blocking the baby's way out
• Previous surgeries: A previous C-section or prior uterine surgery can increase your chances of having a C-section
• Position of baby: If your baby is breech, laying feet first, or measuring very large, your doctor may recommend a C-section.

Of course, C-sections are not always performed due to medical concerns. If a C-section is a birthing method that appeals to you, you can discuss having an elective C-section with your doctor.

Different Types of C-Sections

While every C-section involves the baby being born via a surgical incision, there are different types of cesareans. “The concept is the same but there are different types of incisions, such as the type of skin incision [and] type of uterine incision,” explains Sara Twogood, MD, a board-certified OB/GYN at Cedars Sinai in Los Angeles and co-founder of Female Health Education.

Most C-sections are done via a horizontal cut through the skin low down on the bikini line, says Monte Swarup, MD, FACOG, a board-certified OB/GYN in Chandler, Arizona, founder of HPD Rx. What might surprise you, though, is that the incision in the uterus can be either vertical or horizontal. The direction of the cut depends on the urgency of the procedure, the health history of the parent (including any prior scarring), as well as the health, position, and term of the baby.

How You Can Prepare For Your C-Section

If your C-section is planned, you can prepare practically and emotionally for the procedure. “Take a class specifically for scheduled C-sections and then ask questions [of your provider] in the office during your prenatal visit," recommends Dr. Twogood.

Talking to friends and family members who have previously had a C-section can also be informative. However, be clear that you are not looking for "birth horror stories" that will leave you anxious about your own upcoming experience, advises Dr. Twogood. Instead, ask for specific advice, like the best ways to get out of bed following the surgery or what others found helpful during the C-section procedure.

Refrain from eating, drinking, or smoking eight hours before the scheduled time of your procedure. "Make sure to share any medication you are taking with your doctor, and shower before coming to the hospital," says Dr. Swarup. Your provider might have other preparation instructions for you, too. Be sure to follow them closely, and ask if you have any questions.

Risks Associated With C-Sections

Generally, C-sections are safe and routine. However, as with all major surgery, there are some risks to consider. These can include:

• Infection 
• Loss of blood
• Blood clots
• Bowel or bladder injury, or injury to other organs
• Allergic reaction to the medication
• Potential complications with future pregnancies, including placenta previa and placenta accreta

What Happens During a C-Section

Although they can vary slightly, each C-section follows a particular sequence of events. You will be positioned on the operating table and have a urinary catheter inserted. This is a small flexible tube that will empty your bladder during the operation.

You will then receive an anesthetic, which is usually an epidural or spinal block. A sterile screen is placed between your chest and abdomen. This is to prevent the open wound from infection and to also to prevent you from seeing the operation. 

“An incision is [then] made in the tissue, layer by layer, to get to the uterus,” explains Dr. Twogood. Abdominal muscles are rarely cut as they can usually be separated instead. “Pressure is applied to the top of the uterus to help deliver the presenting part of the baby, such as the head or the feet,” continues Dr. Twogood.

Once the baby has been delivered and the umbilical cord cut, the operating surgeon will remove the placenta and then suture closed each incision. “The uterine stitches dissolve and your abdomen will be closed using a combination of stitches, surgical glue, and/or staples,” says Dr. Swarup.

What Happens After a C-Section

Provided that you are awake during surgery, you will be able to hold your baby immediately after your C-section. If you have chosen to, you will be able to breastfeed your baby soon after delivery.

“You will [then] be taken to a recovery room where your blood pressure, abdomen, amount of bleeding, and pulse will be monitored regularly,” says Dr. Swarup. You can usually expect to spend around two hours in the recovery room. 

Every person and every delivery is different, and you may need to receive IV fluids until you are able to eat and drink. "Typically within a few hours, it is encouraged to stand up slowly, walk around, and eat food," says Dr. Twogood. This is to promote healing.

Your bladder catheter will usually be removed between 12 and 24 hours after surgery and you can expect to spend two to four days at the hospital after delivery. "Your abdomen will be sore for a few days," says Dr. Swarup. However, your doctor will provide pain medication.

"Recovery is day by day," says Dr. Twogood. Gentle exercise, such as walking, is advised, but avoid heavy lifting, driving, and any sudden jerky movements.

A Word From Verywell

There are many different reasons why you may need or want a C-section. However, it is natural to feel a certain amount of apprehension surrounding it, even if it is the delivery method that you have requested. Every pregnancy and expectant parent is different, and your healthcare team will be on hand to alleviate any concerns and discuss your options along the way. Remember, the only "right" way for you to give birth is the way that is safest for you and your baby.