If you have had a C-section and would like information about how a cesarean affects future deliveries, see the topic Vaginal Birth After Cesarean (VBAC).
A cesarean section is the delivery of a baby through a cut (incision) in the mother's belly and uterus. It is often called a C-section. In most cases, a woman can be awake during the birth and be with her newborn soon afterward. See a picture of a delivery by C-section.
If you are pregnant, chances are good that you will be able to deliver your baby through the birth canal (vaginal birth). But there are cases when a C-section is needed for the safety of the mother or baby. So even if you plan on a vaginal birth, it's a good idea to learn about C-section, in case the unexpected happens.
A C-section may be planned or unplanned. In most cases, doctors do cesarean sections because of problems that arise during labor. Reasons you might need an unplanned C-section include:
When doctors know about a problem ahead of time, they may schedule a C-section. Reasons you might have a planned C-section include:
In some cases, a woman who had a C-section in the past may be able to deliver her next baby through the birth canal. This is called vaginal birth after cesarean (VBAC). If you have had a previous C-section, ask your doctor if VBAC might be an option this time.
In the past 40 years, the rate of cesarean deliveries has jumped from about 1 out of 20 births to about 1 out of 3 births.footnote 1 This trend has caused experts to worry that C-section is being done more often than it is needed. Because of the risks, experts feel that C-section should only be done for medical reasons.
Most mothers and babies do well after C-section. But it is major surgery, so it carries more risk than a normal vaginal delivery. Some possible risks of C-section include:
If she gets pregnant again, a woman with a C-section scar has a small risk of the scar tearing open during labor (uterine rupture). She also has a slightly higher risk of a problem with the placenta, such as placenta previa.
Before a C-section, a needle called an IV is put in one of the mother's veins to give fluids and medicine (if needed) during the surgery. She will then get medicine (either epidural or spinal anesthesia) to numb her belly and legs. Fast-acting general anesthesia, which makes the mother sleep during the surgery, is only used in an emergency.
After the anesthesia is working, the doctor makes the incision. Usually it is made low across the belly, just above the pubic hair line. This may be called a "bikini cut." Sometimes the incision is made from the navel down to the pubic area. See a picture of C-section incisions. After lifting the baby out, the doctor removes the placenta and closes the incision with stitches.
Most women go home 3 to 5 days after a C-section, but it may take 4 weeks or longer to fully recover. By contrast, women who deliver vaginally usually go home in a day or two and are back to their normal activities in 1 to 2 weeks.
Before you go home, a nurse will tell you how to care for the incision, what to expect during recovery, and when to call the doctor. In general, if you have a C-section:
Call your doctor if you have any problems or signs of infection, such as a fever or red streaks or pus from your incision.
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Most cesarean sections are done with epidural or spinal anesthesia, used to numb sensation in the abdominal area. Only in an emergency situation or when an epidural or spinal anesthesia cannot be used or is a problem would fast-acting general anesthesia be used to make you unconscious for a cesarean birth.
The hospital may send you instructions on how to get ready for your surgery, or a nurse may call you with instructions before your surgery.
In preparation for a cesarean section, your arms are secured to the table for your safety, and a curtain is hung across your chest. A tiny intravenous (IV) tube is placed in your arm or hand; you may be given a sedative through the IV to help you relax. A catheter is inserted into your bladder to allow you to pass urine during and after the surgery. Your upper pubic area may be shaved, and the abdomen and pubic area are washed with an antibacterial solution. The incision site may be covered with an adhesive plastic sheet, or drape, to protect the surgical area.
Before, during, and after a cesarean section, your blood pressure, heart rate, heart rhythm, and blood oxygen level are closely monitored. You will also be given a dose of antibiotics to prevent infection after delivery.
After the anesthesia is working, a doctor makes the cesarean incision through your lower abdomen and uterus. See a picture of cesarean section incisions. You may notice an intense feeling of pressure or pulling as the baby is delivered. After delivering your newborn through the incision, the doctor then removes the placenta and then closes the uterus and the incision with layers of stitches.
Right after surgery, you will be taken to a recovery area where nurses will care for and observe you. You will stay in the recovery area for 1 to 4 hours, and then you will be moved to a hospital room. In addition to any special instructions from your doctor, your nurse will explain information to help you in your recovery.
A cesarean section can be done by a doctor who has specialized training, such as:
If your pregnancy care provider doesn't perform cesareans and foresees a possible need for a cesarean, you will be referred to a cesarean-trained doctor ahead of time. Your family medicine doctor, certified nurse-midwife, or certified professional midwife can assist with the surgery and provide your follow-up care.
Some cesarean deliveries are planned ahead of time. Others are done when a quick delivery is needed to ensure the mother's and infant's well-being.
Some cesarean sections are planned when a known medical problem would make labor dangerous for the mother or baby. Medical reasons for a planned cesarean may include:
Many cesarean deliveries are planned ahead of time for women who have had a cesarean in the past. Reasons for a planned repeat cesarean may include:
Depending on the reason for a planned C-section and the risks to you or your baby, the C-section may be scheduled near your due date or weeks before. Talk to your doctor to learn about the timing that is best for your situation.
Some women request to have a C-section even though they have never had one before and there is no medical need for it. This is called an elective primary C-section. Because of the risks of C-section, experts recommend that C-sections generally be done only for medical reasons. If you're thinking of having a C-section for personal reasons, you may want to talk to your doctor about reasons for and against an elective primary C-section.
Some unplanned cesareans happen when there is a problem before or during labor. Sometimes this is an emergency. Medical reasons for an unplanned cesarean may include:
Cesarean section is considered relatively safe. But it does pose a higher risk of some complications than does a vaginal delivery. If you have a cesarean section, expect a longer recovery time than you would have after a vaginal delivery.
After cesarean section, the most common complications for the mother are:
Cesarean risks for the infant include:
While most women recover from both cesarean and vaginal births without complications, it takes more time and special care to heal from cesarean section, which is a major surgery. Women who have a cesarean section without complications spend about 3 days in the hospital, compared with about 2 days for women who deliver vaginally. Full recovery after a cesarean delivery takes 4 to 6 weeks. Full recovery after a vaginal delivery takes about 1 to 2 weeks.
Women who have a uterine cesarean scar have slightly higher long-term risks. These risks, which increase with each additional cesarean delivery, include:footnote 5
After a routine cesarean section, expect to be monitored closely for the next 24 hours to make sure that you don't develop any problems. You will receive pain medicine and will likely be encouraged to begin walking short distances within 24 hours of surgery. Walking can help relieve gas buildup in the abdomen. It is usually very uncomfortable to begin walking, but the pain will decrease in the days after the delivery.
The typical hospital stay after a cesarean delivery is about 3 days. You can feed and care for your newborn as you feel able. Before going home, you'll receive postsurgery instructions, including warning signs of complications. It can take 4 weeks or more for a cesarean incision to heal, and it isn't unusual to have occasional pains in the area during the first year after the surgery.
It is important to take care of yourself at home while you are healing.
For information about how a cesarean affects future deliveries, see the topic Vaginal Birth After Cesarean (VBAC).
Call 911 anytime you think you may need emergency care. For example, call if:
Call your doctor now or seek immediate medical care if:
Some women feel shoulder pain for days after a cesarean section. This is referred pain, caused by trauma to the abdominal muscles during the delivery. It goes away on its own during recovery.
If you plan to deliver vaginally and have concerns about having an unnecessary cesarean delivery, talk to your doctor or midwife ahead of time. Ask in what types of situations cesarean section is usually used and what steps he or she takes to promote a vaginal birth.
Public health experts have urged the North American obstetric community to reduce the percentage of deliveries done by cesarean, identifying birth scenarios that may not necessarily require surgical delivery. These include:
Some doctors are more likely to see a need for a cesarean than others. For example, what one doctor considers a slow labor may be a normal labor to another. But all doctors are guided by the common goal of a healthy labor and delivery for both the mother and her newborn.
- Cunningham FG, et al. (2010). Cesarean delivery and peripartum hysterectomy. In Williams Obstetrics, 23rd ed., pp. 544–564. New York: McGraw-Hill.
- American College of Obstetricians and Gynecologists (2000; reaffirmed 2010). Scheduled cesarean delivery and the prevention of vertical transmission of HIV infection. ACOG Committee Opinion No. 234. Washington, DC: American College of Obstetricians and Gynecologists.
- Kolås T, et al. (2006). Planned cesarean versus planned vaginal delivery at term: Comparison of newborn infant outcomes. American Journal of Obstetrics and Gynecology, 195(6): 1538–43.
- Tita ATN, et al. (2009). Timing of elective repeat cesarean delivery at term and neonatal outcomes. New England Journal of Medicine, 360(2): 111–120.
- Scott JR, Porter TF (2008). Cesarean delivery. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 491–503. Philadelphia: Lippincott Williams and Wilkins.
Other Works Consulted
- Thorp JM, et al. (2014). Clinical aspects of normal and abnormal labor. In RK Creasy et al., eds., Creasy and Resnik's Maternal-Fetal Medicine, 7th ed., pp. 673–706. Philadelphia: Saunders.
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