A cesarean section or C-section birth, is a surgery to deliver the baby via the abdomen. Cesarean births are fairly common in the United States with one in three babies are delivered this way. Some cesareans are scheduled and planned for and others are done due to problem or concern in labor.  Your provider will work with you to have a safe and optimal experience based on your individual factors. Below is a step-by-step outline of what to expect in the OR (operating room).

You may be facing a cesarean for a variety of factors.

Planned cesareans are scheduled before labor begins. Reasons to schedule a cesarean:

  • Placenta previa (when the placenta blocks the cervix)
  • Multiples (twins can be born vaginally if in optimal positioning)
  • Transverse lie (when the baby’s head is sideways in the uterus)
  • Breech position (feet or buttocks first) *note some rare providers do offer breech vaginal births
  • Medical problems (primary herpes outbreak in labor, very large babies, unusually uterine formation, etc.)
  • Previous cesarean birth (however a VBAC is a safe option and would be considered)

 

Unexpected situation or concerns can present in labor that would require a cesarean in labor:

  • Abnormal fetal heart rate
  • Labor is not progressing despite augmentation efforts
  • Poor fetal position change in labor
  • CPD- cephalopelvic disproportion (when baby’s head does not fit through the pelvis)
  • Infection

 

True emergency or stat cesareans are rare happening in less than 1% of all births.

  • Placental abruption (the placenta separates from the uterus prematurely)
  • Cord prolapse (the umbilical cord is presenting in front of the baby)
  • Uterine rupture (a tear in the uterine wall)
  • Extreme changes in fetal heart rate

 

As you can see cesarean sections can save lives. They also can be scary and full of the unknown. I have interviewed Cynthia King, MD an OB/GYN in Rockville Maryland to help demystify the cesarean procedure step-by-step.  This step-by-step outline is based on a non-teaching hospital and a scheduled cesarean for a first-time parent. The time frame my vary in a teaching hospital or if there are other concerns about the baby or the parent. A typical cesarean takes less than an hour from start to finish of the surgery, but it can take over two hours if there is lots of scar tissue, so it is difficult to give times for each step.

Q: Dr King can you walk us through what happens upon admission for a scheduled cesarean?

A: “For a schedule cesarean, you will be in the pre-op area for more than an hour before surgery. During this time the nurses will ask you lots of questions that are already in your chart and input your answers into the computer. Some People report that this feels repetitive, but they need to hear the s answers directly from the birthing parent. They will hook you and your baby to monitors. An IV will be placed for fluids, antibiotics, and additional medication if needed. Soon afterwards the anesthesiologist and your Ob/Gyn will also come to see you to review the procedure and answer questions.”

 

Q: How is this different if you are laboring?

A; ” If you are laboring and need a cesarean, your Ob/Gyn will talk to you about their recommendations and the reasons why. They can tell you a timeline on when you should expect to go into the operating room. If they are concerned about the mother or baby’s wellbeing, it will be very soon. If it is due four any other reason it can take longer.”

 

Q: What happens once you are brought back to the OR?

A: “When you are on your way to the operating room you and the nurse will go in with you first. Your partner will join you once they are prepped and ready for them.  Traditionally the anesthesiologist will use spinal anesthesia if you do not already have an epidural placed (laboring clients). Spinal anesthesia involves a one-time dose of fast acting dense medicine to numb you form the bellybutton down. If you already have an epidural, they will add extra medicine.

Some patients experience nausea right after the medication is placed. This is most often due to a drop-in blood pressure that can happen with the spinal. After the spinal is placed you will lie down and the staff will place monitors, a bladder catheter, and prep your stomach for surgery. They will also listen to the baby’s heartbeat one more time. If the Ob/Gyn is not already in the room, they will come in now and so will an assistant.

Once these things have been done the drapes will be placed and the doctor will check to make sure you cannot feel more than you should and they will do a “time out” procedure required in every hospital before every surgery to make sure they are doing the right thing on the right patient.“

 

Q: Can you say are what happens step-by-step during the procedure?

A: “After the time out your support person will be brought to the room and sit next to you at the head of the bed near the anesthesiologist behind a sterile drape so that you cannot see the procedure.

You should not notice when surgery begins, but you can ask to be informed of each step if it helps you. Even with a repeat cesarean is often takes less than 5 minutes to reach the baby, but it can take much longer if there is a lot of scar tissue.

Most parents have limited sensations until it is time to deliver the baby. Just before the birth the surgical assistant has to put a lot of pressure on the top of the uterus to help deliver the baby and this can be uncomfortable.

After the baby is delivered, they will typically let you see the baby before he/she is passed to the pediatricians or pediatric nurse. If this is a scheduled cesarean you can request your support person to be given the option to cut the cord (Note: this should be discussed before going into the operating room).

A few minutes after baby is born the pediatric staff will usually call your support person over to see the baby/ take pictures of the baby being weighed etc. If the baby is doing well, your support person will then hold the baby next to you or on your chest (behind the drape) during the rest of the surgery.

Meanwhile, the OB will be delivering the placenta, making sure your ovaries look normal, clearing out blood from your abdomen and starting to put layers back together. The clearing out of blood from your abdomen and repair of the deeper layers (uterus and peritoneum) is another time people can experience nausea or discomfort. This usually only takes a few minutes, but you can be given extra medicine if things are too intense for you. Once the peritoneum is closed things get a lot better, if were feeling anything at that point.

There are still several superficial layers, and these can take some time to sew, but any nausea of discomfort should pass by then. At the end you will be moved to a recovery bed and your baby will come with you to the recovery unit for binding and feeding.”

 

Family centered cesareans

As Dr King, said you can make a few requests in a non-emergency situation. Here are some to consider. Remember to speak with your team about these options BEFORE being in the OR.

  • Have your provider explain what they are doing in the procedure
  • Wear ear buds or ask to have your music played in the OR
  • Have some essential oils on sterile gauze placed near your head to mask OR smells
  • Ask if your partner can cut the cord
  • Have photos or videos taken if possible
  • Have your provider lower the screen, use a clear drape, or a mirror so that you can see your baby emerge.
  • Ask for skin-to-skin in the OR to facilitate bonding if possible.
  • Breastfeed in recovery

 

Reducing the risk

You can reduce the risk of needing a cesarean by:

  • Avoid gaining more than the recommended weight gain
  • Exercise and work with a body worker for optimal maternal & fetal alignment
  • Have continuous hands-on support in labor. Consider hiring a doula (link) who can suggest position changes and comfort strategies to facilitate delivery.
  • Avoid induction unless medically necessary.
  • Labor at home as long as you and your provider feel it is safe.
  • Consider a VBAC or vaginal birth after cesarean. ACOG recommends that women who can to consider trying for a VBAC. Hyperlink https://www.acog.org/Patients/FAQs/Cesarean-Birth?IsMobileSet=false

 

Thank you Dr Cynthia King, MD for your assistance.

 

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