Feelings, Facts, and Advice; Straight Talk About Having a C-Section
Many women who are having a baby have a birth plan that they hope will be carried out as closely as possible. At this important time in your life of being pregnant, you’re doing the research, and you’re probably feeling all the feels about things that could go wrong or could go right. This is good! Being informed will help you feel more in control when it comes time to deliver your baby.
At Wumblekin, our goal is to present evidence-based information and demystify pregnancy. This carries right into the birth process. Because having a baby by Cesarean section is quite common, we want to help discredit the idea that a Cesarean section is an “easy way” to have a baby, or that by having one, you are a failure in any way. Medical evidence and many happy mamas prove that neither of these is true!
The Mechanics of a C-SectionCesarean sections are the most common surgeries performed in the United States and make up about a third of all births. Mom will most often have regional anesthesia, which means that she’s awake but is given a spinal or epidural for pain. Occasionally general anesthesia (mom is asleep) is needed, but that is quite rare.
The C-section is performed in a surgical suite, and an incision is made in the lower abdomen through the skin and uterus, and the baby and the placenta are removed through the incision. Mom may have surgical glue, sutures or staples after the surgery is completed.
Why A C-Section?
If it is determined for any reason that your baby needs to be born by C-section, the most important thing to know is that your provider has determined that the outcome for mom and baby will be better than it would be for a vaginal delivery.
Common Reasons for C-Sections
Failure to Progress
This is one of those medical terms that can sound kind of scary, but “failure to progress” is the most common cause of C-sections; approximately 35% are categorized this way. What it simply means is that there is a problem that is preventing the baby from being born vaginally. It could be the baby’s size related to the pelvic opening, the position of the baby in the uterus, or if your cervix isn’t responding, even when given a labor-inducing medication like Pitocin.
It’s not you that is failing! The labor is “failing to progress", so medical intervention is needed to make sure mom and baby are safe during the birth process.
Non-Reassuring Fetal Status
Your practitioners and your nurses are the greatest allies for you during birth, and while you literally do the labor of becoming a mom, their job is to make sure that they are monitoring you and baby for any signs of distress.
In 24% of women who have C-sections, the provider has determined that the baby’s heart rate is not tolerating labor well.
The third most common reason for a cesarean section, making up 19% of all C-section, is positioning of baby. The most common reason is a baby that is breech but it can also mean that the baby is transverse, or sideways, or something else. Often this is discovered before the day even comes but occasionally it is discovered during labor.
Emergent C-SectionsOther less common reasons are more serious but are exactly what your provider is trained to do; this is why they are monitoring you and baby. Some of these emergent situations include maternal infection, a cord prolapse (the cord delivers before the baby and puts the baby’s life in danger), or a uterine rupture.
These situations are scary, but it is helpful to do everything you can to stay calm, trust in your provider’s skill, and practice the coping mechanisms you’ve learned during pregnancy and birthing classes.
Some of these medical indications can be determined ahead of time, and the surgery can be planned. Whenever possible, the cesarean section should be planned for the 39th or 40th week of pregnancy to give the baby the benefits of those last precious days of development.
Some common misconceptions are that C-sections are planned to make the baby’s birth more convenient for parents or providers, but this is not the case. Although we thankfully live in a time that modern medicine has minimized the risks that come along with c-sections, they are still major surgery, and that comes with risks.
If there are known risks related to your delivery and your provider has recommended a C-section, scheduling allows parents to plan work, childcare, and time to prepare and plan with the provider to offer a more controlled and relaxed delivery.
Complications can be minimized, and things like clear drapes, music, and skin-to-skin contact for mom and baby in the surgical suite can be discussed and planned just as is done with a vaginal birth. Talk to yourfacility about whether or not they offer a "family centered" or "gentle" cesearean section. This often involves dimming the lights, limiting background chatter, adding aromatherapy or music and passing baby skin to skin or as soon as possible. Asking about these options ahead of time can help in the moment!
Risks of a C-Section
Because a Cesarean section is major surgery, there is a risk of injury to nearby organs, infections, excessive bleeding (hemorrhage), and blood clots. There is a small risk of injury to the baby during the Cesarean delivery, though these instances are very rare.
Some babies do have temporary respiratory issues because they miss the squeeze through the birth canal and need some time to reabsorb the fluid in their lungs. They also miss exposure to the normal bacteria in mom’s vagina, which may help build their immune systems.
There is often worry that a C-section can interfere with the special time between the baby and the mother immediately after birth. Ask your provider and facility what they do to promote mother-infant bonding in the surgical suite and following delivery (discussed above); most places do a great job making sure the bonding is facilitated as much as possible.
What To Expect When You Have a C-Section
Before the scheduled C-section time, you will receive instructions regarding when and where to arrive, along with a time to stop eating and drinking. Some providers may have you drink a clear carbohydrate drink or take Tylenol at home.
When you arrive, you will answer lots of questions during the admission process, and then you may be given an oral medication that tastes a bit like a salty sweet-tart and/or an IV medication. The purpose of these is to reduce your stomach contents’ acidity and reduce the secretions in your mouth and nose. The IV will also keep you hydrated and can administer antibiotics.
If your Cesarean delivery is planned, you will most likely walk to the surgical suite to receive regional anesthesia. An injection delivers the anesthesia near your spine that numbs your abdomen and legs but allows you to be awake.
If you were laboring and had an epidural, they may give you an additional dose through your epidural, and that will serve the same purpose. Rarely, general anesthesia needs to be used, and then mom is asleep for the procedure.
The surgical suite may be full of bright lights, unfamiliar sounds and smells, and can be cold. If you have music that you would like to listen to, ask your provider or the facility if that is something that you can do. Your nurse will stay with you, and when everyone is in place, your support person will be able to join you and most likely can bring a phone or camera.
There are still lots of opportunities to personalize this delivery! Ask about a clear drape so that you can see the baby right away and cutting the cord. Request delayed cord clamping and skin-to-skin contact be allowed as soon as possible in the surgical suite.
Many women experience anxiety during this time, and it’s a great time to use those breathing techniques you learned in childbirth class, or use the grounding technique.
Grounding TechniqueTake a deep breath and look around:
- Name five things you can see
- Four things you can feel
- Three things you can hear
- Two things you can smell
One thing you can taste
You may also notice that your nurse or others in the room will engage you in conversation. Distraction can be a powerful calming technique, so try your best to let them help soothe you.
An anesthesia provider will monitor you throughout the surgery. A catheter will be placed in your bladder, and you may be wearing compression stockings or sleeves to help prevent blood clots. The room will fill up with your surgeon, your nurse and baby’s nurse, techs, and your support person.
It may feel like a lot of commotion but focus on your support person. After the incision, you will probably feel lots of pressure as the surgical team pushes on your abdomen during the delivery. Later, you may feel deep bruising or soreness from this part, which is normal.
The cord is clamped and cut before the placenta is delivered, and the uterus and abdomen are closed. Often, your support person can trim the cord immediately after, and you can meet your baby and enjoy some sweet skin-to-skin time if you’re both feeling up to it.
Recovery After a C-Section
You’ll be monitored closely for the first few hours. Chewing gum during this period can actually help speed your recovery! You’ll still have to wait a bit to eat food, and it’s recommended to start slowly with something light and sips of liquid as you ease your gut back into food.
You can breastfeed during this time, but it may be a bit awkward and require some assistance until you’re able to move more. Ask your provider if there is a lactation consultant available and let your nurse, doula or support people help you.
Your nurse will help you start with (slowly) sitting and then standing and walking. You can generally shower the following day, but some warm washcloths go a long way in the meantime!
As your anesthesia wears off, your nurse and provider will help you find a balance with activity, rest, and pain medication. Shoulder pain is often caused by the gas pain, and a little nurse trick is ½ ginger ale and ½ hot tea (ginger or peppermint work great) but moving is the best treatment!
During the next six weeks, you will have some restrictions as your incision heals. You may experience cramping, some vaginal bleeding or discharge, incisional pain, and numbness around your incision. It’s important to keep your incision clean and dry and contact your provider if you have a fever, flu-like symptoms, or drainage from your incision.
We cannot stress this enough: a Cesarean section is NOT the easy way or a failure in any way!! There have been many moms who have been through both a vaginal and a C-section birth, and they can tell you that neither one was a walk in the park!
If you have any questions about how your provider feels about C-sections, have a discussion with them during your pregnancy. Some women have two birth plans, a vaginal and a C-section plan, because that helps them feel more in control before they give birth.
The important thing is that you understand what may be ahead of you so you can welcome your sweet baby into the world; whichever way they choose to make their way into it.