C-section

• A cesarean section is the birth of a baby by surgery.
• You may need a c-section if there are problems with your pregnancy.
• Recovery from a c-section is longer than from a vaginal birth.

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Cesarean birth is the birth of a baby by surgery. The doctor makes an incision (cut) in the belly and uterus (womb) and then removes the baby. The surgery is called a cesarean section or c-section. The natural way for a baby to be born is through the mother's vagina (birth canal). But sometimes vaginal birth isn't possible. If you or your baby have certain problems before or during labor, c-section may be safer than vaginal birth.

You and your health care provider may plan your cesarean in advance. Or you may need an emergency (unplanned) c-section because of a complication that arises for you or your baby during pregnancy or labor.

Why might I have a c-section?
Your health care provider may suggest that you have a c-section for one or more of these reasons:

• You've already had a c-section in another pregnancy or other surgeries on your uterus.
• Your baby is too big to pass safely through the vagina.
• The baby's buttocks or feet enter the birth canal first, instead of the head. This is called a breech position.
• The baby's shoulder enters the birth canal first, instead of the head. This is called a transverse position.
• There are problems with the placenta. This is the organ that nourishes your baby in the womb. Placental problems can cause dangerous bleeding during vaginal birth.
• Labor is too slow or stops.
• The baby's umbilical cord slips into the vagina, where it could be squeezed or flattened during vaginal delivery. This is called umbilical cord prolapse.
• You have an infection like HIV or genital herpes.
• You're having twins, triplets or more.
• The baby has problems during labor that show it is under stress, such as a slow heart rate. This is sometimes called "fetal distress."
• You have a serious medical condition that requires intensive or emergency treatment (such as diabetes or high blood pressure).
• The baby has a certain type of birth defect.

A woman who has a c-section usually takes longer to recover than a woman who has had a vaginal birth. Women can expect to stay 3 to 4 days in the hospital after a c-section. Full recovery usually takes 4 to 6 weeks. Usually, the hospital stay for vaginal birth is 2 days, with full recovery taking less time than a cesarean. C-section may be more expensive than a vaginal birth.

What about the risks?
When c-sections are done, most women and babies do well. But c-section is a major operation with risks from the surgery itself and from anesthesia.

The National Center for Health Statistics estimates that 1 in 3 babies in the United States are delivered by c-section. Over the past few years, the rate of cesarean birth has increased rapidly. Some health care providers believe that many c-sections are medically unnecessary. When a woman has a cesarean, the benefits of the procedure should outweigh the risks.

The risk of late preterm birth
C-sections may contribute to the growing number of babies who are born "late preterm," between 34 and 36 weeks gestation. While babies born at this time are usually considered healthy, they are more likely to have medical problems than babies born a few weeks later at full term.

A baby's lungs and brain mature late in pregnancy. Compared to a full-term baby, an infant born between 34 and 36 weeks gestation is more likely to have problems with:

• Breathing
• Feeding
• Maintaining his or her temperature
• Jaundice 

It can be hard to pinpoint the date your baby was conceived. Being off by just a week or two can result in a premature birth. This may make a difference in your baby's health. Keep this in mind when scheduling a c-section.

Other risks for the baby

• Anesthesia: Some babies are affected by the drugs given to the mother for anesthesia during surgery. These medications make the woman numb so she can't feel pain. But they may cause the baby to be inactive or sluggish.
• Breathing problems: Even if they are full-term, babies born by c-section are more likely to have breathing problems than are babies who are delivered vaginally.

Breastfeeding
Women who have c-sections are less likely to breastfeed than women who have vaginal deliveries. This may be because they are uncomfortable from the surgery or have less time with the baby in the hospital. If you are planning to have a cesarean section and want to breastfeed, talk to your provider about what can be done to help you and your baby start breastfeeding as soon as you can.

Risks for the mother
A few women have one or more of these complications after a c-section:

• Increased bleeding, which may require a blood transfusion
• Infection in the incision, in the uterus, or in other nearby organs
• Reactions to medications, including the drugs used for anesthesia
• Injuries to the bladder or bowel
• Blood clots in the legs, pelvic organs or lungs

A very small number of women who have c-sections die. Death is rare, but it is more likely with cesarean than with vaginal delivery.

If a woman who has had a cesarean section becomes pregnant again, she is at increased risk of:

• Placenta previa: The placenta implants very low in the uterus. It covers all or part of the internal opening of the cervix (the birth canal).
• Placenta accreta: The placenta implants too deeply and too firmly into the uterine wall.

Both of these conditions can lead to severe bleeding during labor and delivery, endangering mother and baby. The risk increases with the number of pregnancies.

Making decisions
Every pregnancy is different. If you are considering a planned c-section for medical reasons or are interested in asking that your baby be delivered by c-section, talk with the health care provider who will deliver your baby. Carefully consider the risks and benefits for your baby and yourself. These questions may be useful when you speak to your provider.

If your provider recommends delivery before 39 weeks:

• Is there a problem with my health or the health of my baby that may make me need to have my baby early?
• Can I wait to have my baby closer to 40 weeks?

About c-section:

• Why do I need to have a c-section?
• What problems can a c-section cause for me and my baby?
• Will I need to have a c-section in future pregnancies?

July 2008