C-Sections: Truths, Myths, Facts, and Fiction

The Cesarean section (C-section) originally started around the 1600s as an alternative delivery method to vaginal delivery during childbirth emergencies. Over the centuries, there have been many advances to the point that delivery via C-section is a safe, effective, and sometimes the only way for a baby to be delivered. 

The providers at MacArthur Medical Center  are committed to our patients’ safety, and this sometimes means that performing a C-section is the best option. I want to take some time to discuss C-sections and dispel some myths and answer some FAQs about C-sections.    

Roughly 25% of patients will undergo a C-section. C-sections happen for various reasons, which almost always include one of the following.

  • Fetal distress (concern for the baby’s well being based on the monitoring)
  • Failure to dilate or progress in labor
  • Malpresentation (baby sideways – transverse or oblique lie, baby breech – “feet first”)
  • Placenta previa (placenta implants over cervix)
  • Mother’s history (prior myomectomy, prior uterine rupture, history of multiple C-sections in the past)
  • Baby’s size (too large)
  • Cord prolapse (umbilical cord protrudes out of cervix during labor). 
  • Prior C-section

 I always counsel patients that even though the expectation is for most patients to deliver naturally via vaginal delivery, a C-section might be needed at any point during pregnancy or labor. Labor is very unpredictable, and patients must know that C-sections might turn out to be the best or safest way to deliver the baby depending on how your pregnancy or labor is going. 

As always, I recommend that any questions regarding potential C-section be directed to your specific doctor. Your medical condition or situation will dictate whether a C-section is the best option for you. Here are the most frequent questions I get asked and some myths that I hear from my patients.

How big will the incision/scar be?

C-section skin incision is usually less than 10 cm. It is located just above your pubic bone. The vast majority of women will get a horizontal “bikini cut,” although a small minority will need to have a vertical incision if they have a previous vertical incision.

 Will I be put to sleep for my C- section? 

Typically no.  In general, we use regional anesthesia or anesthesia that numbs a “region” of your body, which for C-sections would be the entire belly and downward. The main reason for this is so that you can be awake to see your baby when he or she is born and to start the bonding process (breastfeeding, skin-to-skin, etc). Regional anesthesia is done either with an epidural (a catheter placed in your back that gives you a constant amount of numbing medication) that is often in place during labor or a spinal which is when numbing medication is given via a single injection and lasts for 2-4 hours just for the C-section. General anesthesia (“putting patients to sleep”) is only reserved for rare scenarios when platelets (clotting factors in your blood) are too low or when a C-section needs to be done STAT for an emergency, and the patient cannot wait the extra 5-10 minutes to get regional anesthesia.

Can my husband cut the cord?

Unfortunately no. Due to the sterile environment (drapes, gowns, gloves) during a C-section, the surgeon needs to cut the cord to avoid the risk of contamination and infection for the mother. If requested, we can leave the cord long, and the partner can trim the cord once the baby is stabilized. 

Will I be able to see my baby being born during a C-section?

Yes! Many times we do allow patients to view the baby coming out of the belly during C-section either by using a clear drape or by dropping the drape a bit. This is considered a family centered” or “gentle” C-section.  It is important to us that although we need to maintain a sterile and clean operating room environment, we want you to see your baby as much as possible, and this includes the moment when he or she is born. 

Can I still do skin-to-skin with a C-section?

Yes. We still encourage skin-to-skin bonding even during a C section. Typically, we doctors will hand your baby to a pediatric nurse who will clean, stimulate, and suction any secretions from your baby’s mouth. After that, they will wrap your baby to keep the baby warm and bring your baby over to you within 2 minutes after birth. Skin-to-skin promotes bonding, helps regulate your baby’s temperature, and helps facilitate breastfeeding. Many times babies are already breastfeeding even before we complete the C section. 

Can I breastfeed after a C-section?

Absolutely.  Breastfeeding is part of the skin-to-skin bonding process that happens just after delivery via C-section. Even in the recovery room, you will be encouraged to breastfeed if the baby is showing signs of feeding, which most do. Breastfeeding is an integral part of the immediate postpartum period, regardless of how your baby is delivered.

Will I have more pain from a C-section?

Generally speaking, a C-section will cause more pain than a vaginal delivery; however, this also depends on the clinical situation. For example, a woman who has a long labor, does not have any epidural, pushes for 2-3 hours, and has a significant vaginal laceration may have more postpartum pain than a woman who has an uncomplicated C-section. But remember, a C-section is a major surgery with an incision. There will be some pain afterward mainly from inflammation, as well as from the incision itself. On the flip side, you will not have any vaginal pain or tearing after a C-section.

How long will my recovery be afterward?

Recovery after a C-section is around 4-6 weeks total.  With that said, you will be able to move around and are encouraged to walk starting on day 1.  You will be able to urinate, eat, and hold and care for your baby right after delivery as well. Pain will often improve significantly after the first 3-5 days and you will be able to resume normal non-strenuous activities after that as well. Typically, you will need to see your doctor at 1-2 weeks after and 6 weeks after your C-section to make sure your incision is healing well. 

If I have a C-section, can I still have a vaginal delivery?

Possibly. The main concern is for uterine rupture, which is when the uterus spontaneously ruptures or breaks open during labor. This is a medical emergency that has a very high mortality rate for baby and mom. When this happens, the uterus opens up (usually under stress from contractions), the baby is expelled out of the uterus and into mom’s belly, the baby loses its blood and oxygen supply, and internal bleeding occurs. This always results in an unexpected emergency C-section to save the baby’s and mother’s life. Uterine rupture is more likely when a woman who has had a previous C-section is having contractions since the previous incision on the uterus is inherently weaker. In general, if you have had two or more C-sections, the standard of care is to perform another C-section to avoid uterine rupture. With only one C-section, there is a possibility for a vaginal delivery however it depends on your prior C-section incision type, the circumstances surrounding your previous need for a C-section, and if you are a good vaginal delivery candidate. You will need to make sure that your hospital has an Anesthesia provider and an OBGYN at the hospital at all times in case of the dreaded uterine rupture.  Unfortunately, most hospitals including ours, do not have this. The safer option is typically a repeat C-section since it avoids this risk. 

Is there a maximum number of C-sections that I can have?

There is no maximum number of C-sections that a woman can have. With that said, the more C-sections (or any surgery for that matter), the more adhesions (scar tissue) develop which make subsequent C-sections more difficult.  Adhesions cause distortion of the anatomy and make it difficult to distinguish the pelvic organs. This makes accidental injury to your bladder or bowels more likely. Adhesions also cause new scar tissue to form and sometimes cause your uterus to get “stuck” in the pelvis and makes it harder to get the baby out. Therefore, in general, the more C-sections a woman undergoes, the more surgical risk there is.  

 

By: Dr. Brian Enggano

Dr. Brian Enggano - OB/GYN

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