How will I know if I need a Cesarean Section?

A Cesarean Section (C-section) is the surgical procedure that is performed to deliver a baby from the mother’s uterus. It is the most common major surgical procedure performed in the US and in the world, accounting for approximately 1/3 of all births. While C-sections are commonly performed and are generally safe, they do have the potential for more risks than a vaginal delivery, and that is why a vaginal birth is preferred. However, C-sections are necessary and indicative for a variety of reasons, especially when a vaginal delivery may pose a risk to the mother and/or baby. Sometimes a woman knows ahead of time that she will be delivered via C-section (scheduled) and other times it is decided during labor (unscheduled). 

 Here are more than V. (five) reasons why you may need a C-section.

i.  Abnormal fetal position

Typically, if the baby is not head down (vertex) but rather feet or buttocks first (breech) at term, then a scheduled C-section is indicated. Sometimes, the doctor may offer an attempt to turn the baby by applying pressure to the abdomen (this is called a version) in order to re-position the baby head down for a vaginal delivery.

ii.  Repeat C-section

In a woman who has had a prior C-section(s), she may elect, or her physician may recommend a repeat C-section. In certain circumstances, she may be offered a trial of labor or a VBAC (vaginal birth after C-section).

iii.  Placenta Previa or Low-Lying Placenta

When the placenta presents lower than the fetus or very close to the cervix, then a C-section is the safer approach to deliver the baby. This is usually schedule week(s) before the due date.

iv. Maternal Health Conditions

If the mother has underlying health issues where labor may pose a danger to her, then a scheduled C-section is the best approach for delivery.

v.  Multiple Gestation (twins, triplets, etc.)

In certain instances of twins, in particular if the lower baby is not in the head down or vertex presentation, or there are more than 2 babies in the uterus, then a C-section is often necessary.

vi.  Birth Defects

Certain fetal conditions may warrant a C-section to maximize the health and safety of the newborn.

vii. Previous Uterine Surgery

If a woman has had prior uterine surgery, for example a fibroid removed, then it may be safer for her not to labor and therefore undergo a scheduled C-section.

viii.  Maternal Viral Infections

In women who are HIV+ then a scheduled C-section is the preferred mode of delivery in order to decrease the likelihood of neonatal transmission. In women who have genital herpes simplex virus (HSV) and have an outbreak at the time of labor, then a C-section (unscheduled) is warranted.

ix.  Prolonged or Stalled Labor

When a woman has either failed to dilate or the fetus has not descended after many hours of labor then a C-section may be necessary for the diagnosis of CPD (cephalopelvic disproportion) due to either a big baby, small pelvis or both.

x.  Fetal Distress

During labor the fetal heart pattern is always monitored. If the heart pattern is not reassuring or even worrisome, and timing seems remote from delivery, then a C-section may be necessary (unscheduled) due to fetal intolerance to labor.

xi.     Cord Prolapse or Placental Abruption

If the umbilical cord drops down below the baby in labor, cord prolapse, or if there is significant bleeding suggestive of the placenta pulling away from the uterine wall --abruption, a C-section is performed.

 Now that I know the reasons why I might need to have a C-section, what should I expect?

Whether the C-section is planned or not, the surgical procedures are quite similar. Here are V. (five) things to expect when having a C-section.

i.     Anesthesia is administered for pain control.

There are several types of or places within the body that anesthesia may be administered during delivery. SPINAL anesthesia is an injection in the back that temporarily numbs the lower body. An EPIDURAL, the most common pain method used in both vaginal and C-sections, is an injection with a slow infusion of medication that temporarily numbs the lower body. And, GENERAL anesthesia is a painless sleep that is used most often for emergency C-sections and in cases where a spinal or epidural cannot be administered.

ii.    A catheter is inserted to drain the bladder.

Once the abdomen/surgical site is prepped and cleaned a catheter is placed to drain the bladder. The catheter remains for approximately 24 hours after the baby is born.

iii.   Incisions are made. Closure is performed.

The typical incision on the skin is transverse, just above the pubic hairline, and traverses through numerous layers until the uterus is reached. Once the baby is removed from the uterus, the wound is closed in multiple layers with the last layer being the skin, which is sewn with either a dissolvable thread or staples which will need to be removed.

iv. Cord + Placenta Removal

Once the baby is delivered, the umbilical cord (which supplies nutrients to the baby) is cut, and the placenta (an organ that provides oxygen and nutrients to the baby and removes waste) is expelled from the body.

v.   Postoperative Care

Most women stay in the hospital for 3-4 days after a C-section. On Day #1 the catheter is removed. While in the hospital the goals for mom are to receive pain management and wound care, dietary oversight, bladder and bowel regularity, stable emotional health and breast-feeding support.

Verbena does not provide medical advice, diagnosis, or treatment and is not a medical provider. Discuss elective or emergency C-sections reasons and options with your personal doctor.

If you think you may have a medical emergency, call your doctor or 911 immediately.