Cesarean section (c-section) is the surgical delivery of a baby through an incision (a cut) in the abdomen and the uterus. It can be a lifesaving operation when either you or your baby experience certain problems before or during labor and delivery. There is a chance you might deliver your baby surgically, but you probably won't know for sure until the last minute.

If you're like most women, you probably won't give cesarean section much thought unless your pregnancy is high risk. But did you know that one in five babies in the United States is delivered by c-section? Also, most women who have c-sections do not know they'll deliver this way ahead of time.

Taking the time now to learn what c-sections are, why they are performed and what recovery involves can make the whole process easier to cope with if you are one of the 20 percent of mothers who deliver by c-section.

Why Do Some Women Need C-Sections?
C-sections are performed when the health of the baby or mother is at risk. Some of the situations that could put you or your baby at risk include:

• Problems with the umbilical cord. Sometimes the umbilical cord falls into the vagina or is pinched or compressed.
• Bleeding from the placenta.
• Abnormal pelvic structure in the mother. For instance, some women have had a serious injury to the pelvis, or they were born with a pelvic defect.
• Serious maternal health problems (such as heart disease or an active herpes infection) when labor would not be safe for either mother or baby.
• Delivery is advised but the mother is not in labor. Reasons include infection or severe preeclampsia.
• Failure of labor to progress. About one-third of c-sections are done because labor progresses too slowly or stops. 
• Shoulder or breech presentation. The baby's buttocks or feet enter the birth canal first, instead of the head.
• More than one baby. Many women having twins are able to deliver vaginally, but the risk increases with the number of babies.
• Fetal distress. The baby may show signs of distress such as slowing of heart rate or acid in the blood before vaginal delivery can be completed quickly.
• Fetal illness. Babies diagnosed prenatally with certain medical conditions, such as spina bifida (a birth defect that affects the backbone and sometimes the spinal cord), may need to be delivered by c-section.

But keep in mind that having any of these conditions does not necessarily mean you will have to have a c-section—it just increases the chance that you will have one.

What Will Happen if I Need a C-Section?
C-sections usually are performed in an operating room set aside for these special surgeries. Either general or regional anesthesia (epidural or spinal) is used. If your c-section is an emergency procedure, general anesthesia may be needed and you will be asleep during the delivery. If spinal or epidural anesthesia is used, you will be awake for the birth of your baby, but numb from pain from below your breasts to your toes.

A thin tube called a catheter is placed into your bladder to drain urine during surgery, and a needle is inserted in a vein in your hand or arm to give you fluids during the operation and medications if needed. After your abdomen is shaved and washed, and you are numb or asleep, the doctor makes the first incision. This is usually a horizontal or "bikini" cut just above your pubic bone, although sometimes a vertical incision is needed (depending upon the position of the baby or the placenta). The second incision is made in the wall of the uterus. The doctor can then open the amniotic sac and remove the baby. You may feel some tugging, pulling and some pressure. Next the doctor detaches and removes the placenta. Then the incisions in the uterus and abdomen are closed.

The procedure usually takes about 45 minutes to an hour. The baby is born in the first 5 to 10 minutes. Then the incision is repaired. If you're feeling up to it, you may be able to hold your baby in the delivery room, once the baby's nose and mouth have been suctioned and he or she has been checked.

Physical and emotional recovery from a cesarean delivery takes more time than recovery from a vaginal delivery. You can expect to spend two to four days in the hospital, and four to six weeks at home before feeling back to normal. You'll need to take things as slowly as you can and get as much help as possible until you are back on your feet again.

Are There Risks Associated With C-Sections?
Cesarean birth carries greater risk for both the mother and the baby than a vaginal delivery. Some of the increased risks for the mother include possible infection of the uterus and nearby pelvic organs; increased bleeding; blood clots in the legs, pelvic organs and sometimes the lungs; and, in very rare situations, death. For babies, there is the risk of being born prematurely if the due date is not accurately calculated. This can mean difficulty breathing (respiratory distress) and low birthweight. The baby also may be sluggish as a result of the anesthesia. A cesarean birth also is more painful, is more expensive, and takes longer to recover from than a vaginal birth.

Are All C-Sections Necessary?
Some health care experts believe that half of all c-sections performed in the U.S. are unnecessary, and you may have heard publicity about the high c-section rate in the U.S. So why are they so common? Many people suspect doctors' motives, including fear of malpractice suits and convenience. Others dispute these accusations, point to the lifesaving aspects of c-sections, and argue it is better to be safe than sorry.

Unless there are serious medical risks, fewer than half of women who have previously had c-sections need them again. If you've had a c-section before, and you want to try to deliver your next baby vaginally, be sure to discuss VBAC (vaginal birth after cesarean) with your health care provider.

It is important to keep in mind that a cesarean section delivery is major surgery and should be done only when the health of the mother or baby is at risk. It should not be considered an option for the convenience of the doctor or the parents, or for any other nonmedical reason.

Is There Anything I Can Do to Avoid Having a C-Section?
Since no one can plan for a "perfect" delivery, and most c-sections are unexpected, it is unlikely there is anything special you can do to avoid a c-section. You can, however, take good care of yourself during your pregnancy so that you have the best chance of delivering a healthy baby. Some of these things may help you avoid the need for a cesarean:

• Get early prenatal care. When you choose a hospital or health care provider, ask about their cesarean rate. Look for rates around 15 percent. If you've already had a c-section, ask how many of the provider's patients try to deliver vaginally with later babies.
• Stay fit and maintain a healthy lifestyle during your pregnancy. Watch your weight—too much weight gain can increase the baby's size, making vaginal delivery difficult.
• Watch for any signs of trouble during pregnancy and alert your provider immediately.
• During early labor, drink plenty of fluids, and suck on ice chips during active labor. Remember to urinate, too! Walk around as much as possible or change positions frequently during labor to see what is most comfortable for you.

Remember, by learning all you can about cesarean birth, you'll know when it is appropriate and what to expect. And if you do need one, try not to feel disappointed. While most mothers would prefer a vaginal birth, virtually all would agree that having a healthy baby and being a healthy mom are much more important than the method of delivery.