cesarean section

C-Section (Cesarean Section) Procedure, Risks & Recovery

What is a Cesarean delivery?

cesarean section cesarean delivery
A Cesarean section, commonly known as a C-Section or LSCS (lower segment cesarean section), is a surgical procedure designed to deliver a baby through the abdominal wall when delivering through the vagina is either not possible or not recommended. C-sections can be either planned in advance (elective) or may become necessary in emergency situations. According to National Center for Health Statistics, about 1 in 3 babies in the United States is delivered by a C-section, whereas the desired benchmark by The World Health Organization is 10 to 15 %.

Is it possible to know in advance if a C-Section will be required?

Yes if your doctor advises the prearranged scheduling of a cesarean delivery. The most common reasons for a cesarean delivery before onset of labor are:

  • The mother delivered a baby by cesarean in the past.
  • The baby is not coming out head first.
  • The baby is very large.
  • The mother has an infection, such as herpes or HIV. Which can infect the baby during a vaginal birth.
  • The mother has a condition called “placenta previa.” The placenta is the organ that brings the baby nutrients and oxygen and carries away waste. If placenta blocks the way to the vagina, the baby can’t get out on its own, its called a placenta previa.
  • The baby or mother has a problem, and the doctor believes labor and vaginal delivery might not be safe.

Some women choose to have cesareans even if there is no medical indication. You should talk to your doctor if you think you want to have your baby delivered by C-Section.

Elective Cesarean Section: Factors and Risks

In recent times, there has been a rising trend of mothers opting for elective cesarean sections to bypass the labor experience. This choice is often driven by the fear of a vaginal delivery or a desire to avoid perineal or vaginal trauma. In addition to the potential complications mentioned earlier, several other factors merit consideration:

  • Higher Incidence of Complications: Chronic pelvic pain, infertility, and dyspareunia (pain during intercourse) may be more prevalent post-operation.
  • Antenatal Complications in Subsequent Pregnancies: Increased risks of abnormal placenta implantation and scar rupture during subsequent pregnancies.
  • Baby-related Issues: Elevated risks of lacerations and respiratory problems for the baby.

Comprehensive research indicates that opting for elective primary cesarean sections entails significantly greater risks for both mother and child. These risks extend across the short term, long term, and future pregnancies when compared to a normal vaginal birth.

When should planned C-Sections happen?

In most cases, you should wait till the 39th week of pregnancy or later. (A normal pregnancy lasts about 40 weeks.)

Why do some women end up having C-Sections after labor begins?

A common reason is that labor doesn’t move along like it should. This can happen if:

  • Contractions (the tightening of the uterus that happens during labor) are not strong enough to get the baby out.
  • The baby is too big.
  • The mother’s pelvis size is too small (the pelvis is the set of bones around your hips and vagina).
  • The baby is in an unusual position, such as chin-first or sideways.

Other reasons that C-sections are done are:

  • The baby’s life is in danger; for example, because its heart rate is too slow.
  • The mother’s life is in danger; for example, because she is bleeding too much.

If my labor is moving slowly, will I need to have a C-Section?

Not necessarily. Your doctor or nurse can expedite your labor by artificially rupturing your bag of membranes, if the desired dilatation of cervix is achieved or start oxytocin  infusion to increase the contraction strength. If that doesn’t help within a few hours, your doctor might suggest a C-section.

How is a C-Section done?

cesarean sectionHere are the main steps:

  • First, you will get anesthesia to keep you from feeling what happens during the surgery. There are two kinds of anesthesia. With regional anesthesia (epidural or spinal) , you stay awake. Under general anesthesia, you are asleep. According to ASA practice guidelines, a spinal block or epidural is the preferred choice for most cesarean deliveries. These options expose the baby to the lowest amount of medication, allowing the mother to actively participate in the birthing process. However, in certain cases, general anesthesia may be deemed necessary.
  • Next, the doctor will make an incision on your lower belly. There are two ways of making the incision:
    • Most of the time, the incision goes across your belly, from one side to the other, an inch or 2 above your pubic hair.
    • In cases of excessive bleeding or imminent danger to the baby, the incision may be made vertically, going up and down. This type of incision is occasionally chosen as the quickest method to safely deliver the baby.
  • After opening your belly, the doctor will make an opening in your uterus and remove the baby. Then the doctor will cut the baby’s umbilical cord and take out the placenta.
  • Finally, the doctor will close your uterus and belly with stitches and possibly staples.

How long does it take to get better after the surgery?

Within a few hours, you will be able to move around, and eat and drink. The majority of women are discharged after two to three days, though they may experience some discomfort. Complete healing may require up to six weeks. Women who have a job can usually go back to work after this time.

Are there risks of having a C-Section?

Certainly. Despite the fact that the majority of mothers and babies do well following a C-Section, there are some complications, as it is a surgical procedure. Compared with a vaginal delivery, C-sections are more likely to cause following:-

  • Harm to the bladder, blood vessels, intestines, and other nearby organs.
  • Formation of blood clots that may obstruct blood vessels, leading to respiratory issues.
  • Lost bonding time between the mother and baby.
  • A longer time for the mother to heal after the birth.
  • Problems with the placenta and uterus in later pregnancies.
  • Trouble breathing for the newborn. This usually lasts for just a brief time.

Your doctor can assist you decide if the risks of surgery are worth taking for you or not.

What can be expected during the recovery process?

For the first few weeks, it is common to experience:

  • Mild cramps in your belly.
  • Light bleeding and yellowish fluids coming out of your vagina.
  • Pain where the incision was made.

See your doctor if:

  • You have a fever higher than 100.4°F (38°C).
  • Your pain gets worse.
  • Your vaginal bleeding gets heavier.
  • The incision in your belly gets more sore or red, or is bleeding or leaking fluid.

Does the C-Section leave a scar?

Yes, but over time, the scar may become less visible, especially in areas like a bikini line. The visibility of the scar varies among individuals. Sometimes, a vertical incision may be necessary during surgery, resulting in a more noticeable scar.

If I had a cesarean section before, will I need another one in the next pregnancy?

Not necessarily. Having a baby by caesarean does not dictate the delivery method for subsequent pregnancies. Vaginal birth after caesarean (VBAC) is a viable option for most women who have undergone a caesarean section. However, additional monitoring during labor may be recommended to ensure a smooth progression.
Some women might receive advice for another caesarean based on safety considerations for both them and their baby. The decision depends on various factors, and healthcare professionals will guide individuals on the safest delivery option for future pregnancies.

Will I be able to breastfeed after a cesarean section?

After a cesarean section, women are less likely to start breastfeeding in the first hour after the birth, but if they do start, they are just as likely to continue breastfeeding as those who have a vaginal delivery.

When is it safe for me to conceive after a cesarean section?

The cut in the womb will heal after six weeks, and the womb returns to its pre-pregnancy state. Theoretically, it will be safe to conceive after six months to a year after the cesarean section. However, do consider the physical and emotional stress of coping with a newborn. Conceive again only when you are ready for the next child.


Dr Sobia Mohyuddin

MCPS, FCPS, MRCOG, Consultant Obstetrics & Gynaecology

Doctor Sobia Mohyuddin is a highly skilled and experienced Obstetrician and Gynecologist, with 25 years of training and experience in renowned, large institutions. She holds the position of Associate Professor and Fellow at the College of Physicians and Surgeons Pakistan. She is also a member of the Royal College of Obstetricians and Gynecologists (UK).