Childbirth is no walk in the park—no matter how your baby is delivered. There is a stigma around Cesarean deliveries, or c-sections, that incorrectly assumes they are “the easy way out,” but that is simply untrue. C-sections are major abdominal surgeries which require a longer recovery time than a vaginal birth, and reasons for having them vary from being medical emergencies to precautions that keep mom and baby safe.
In a Cesarean delivery, the baby is delivered surgically via incisions made in the mother’s abdomen and uterus. In the United States, around 31% of live births are via c-section.
When C-Sections Are Needed
“The most common reason we do a scheduled c-section is that a mom has had a previous c-section in one of her prior pregnancies,” says Susan Dalton, MD, an obstetrics and gynecology specialist at University of Utah Health. “But there are cases where we do non-emergency c-sections because we feel that a vaginal delivery would be less safe than a c-section for mom or baby.”
Emergencies
There are a few instances when your doctor may determine that immediate delivery via c-section is necessary for the safety of you or your baby, including:
- Fetal distress: If your baby has a low or unusual heart rate, it may mean they are in distress and need to be delivered immediately.
- Maternal hemorrhage: A significant amount of bleeding can cause a drop in maternal blood pressure and threaten the mother’s life.
- Placenta or umbilical cord issues: Placenta abruption, which occurs when the placenta detaches from the wall of your uterus, or a prolapsed umbilical cord, which occurs when the cord comes out of your cervix ahead of your baby, are serious complications that need immediate care.
- Uterine rupture: This occurs when the uterine wall tears open. It can be life-threatening for both you and the baby.
Unplanned Non-Emergencies
Sometimes, a pregnant patient may have an unplanned c-section that is still urgent but not a life-threatening emergency. These include:
- Prolonged labor: Being in labor for more than 24 to 48 hours with little to no progress can lead to both fetal and maternal distress. Nearly a third of c-sections are due to failure to progress.
- Weak contractions: If your contractions aren’t strong enough, you may be given a medication like Pitocin to strengthen them. If labor still isn’t progressing after several hours in active labor, a c-section will likely be presented as an option.
Planned C-Sections
There are reasons why a c-section may be medically necessary for some patients and can be planned in advance, including:
- Baby is in breech position: Babies usually move into a head-first position before 37 weeks’ gestation, but sometimes they are still in a breech position when labor starts. This means they’re positioned bottom- or feet-first. C-sections are the safest way to deliver breech babies to avoid complications with a vaginal delivery, such as the baby getting stuck in the birth canal.
- You are pregnant with multiples: If you are pregnant with twins, triplets, or more, a c-section is more likely. Two or more babies is always considered high-risk, and about 50% of twin pregnancies are delivered via c-section.
- Placenta previa: If your placenta is covering the opening of the cervix, a c-section is always recommended.
- Maternal medical issues: Active infections in the mother, such as herpes or HIV, could be transmitted to the baby during a vaginal birth.
- Previous c-sections: While a vaginal birth after a c-section (VBAC) is possible, sometimes it is not recommended. If the uterine incision in your previous c-section was vertical or T-shaped, attempting a VBAC puts you at risk for uterine rupture, which is an emergency.
“We will have a thorough discussion with the patient about trying for a successful VBAC,” Dalton says. “But it’s important to have realistic expectations going into labor and delivery, because having previous c-sections can make a vaginal delivery more high-risk.”
Recovery After Your C-Section
Remember, a c-section is a major abdominal surgery, and you can expect to need a longer time to recover, both physically and mentally.
“I’ll tell patients after a c-section to expect to feel almost back to normal around postpartum week four,” Dalton says. “That first week is usually the most uncomfortable with the incision, and patients may be nervous to move around a bit. But moving your body will actually promote more efficient healing and pain relief in the long run.”
Bringing a baby into the world is no small feat, no matter how it’s done. While you may feel like you need to focus all your attention on taking care of your newborn, it’s important to take care of yourself too after a c-section.
Do the following things to promote your healing and recovery:
- Rest: Resting with a newborn may seem like an impossible task, but it’s important for your body’s recovery to take any opportunity to rest that you can. For the first couple of weeks postpartum, avoid lifting anything heavier than your baby. If you have friends or family members that can help you with household tasks, or holding the baby while you nap, let them.
- Pain management: Pain at the incision site is common and can be managed with medications prescribed by your doctor or over-the-counter pain relievers like ibuprofen or acetaminophen.
- Incision care: You will likely get instructions from your health care team on how to care for your incision site before you leave the hospital. Be sure to look for signs of infection, such as leaking fluid, swelling, changes in color, or developing a fever.
- Emotional Support: Postpartum life and trying to recover from a c-section can be emotionally challenging. If you’re feeling overwhelmed or have symptoms of postpartum depression or anxiety, reach out for help from loved ones and health care professionals.
“If you’re having thoughts of hopelessness or depressive thoughts or are struggling with feelings of regret or disappointment from the delivery process, talking with a therapist early on is definitely better,” Dalton says. “You don’t have to wait any amount of time to ask for help.”