Cesarean Birth: What to Expect

Learning about cesarean birth, even if you are hoping to avoid it, is always a good idea. When I was taken for an emergency c-section, there was little time for anybody to explain things to me. I was grateful I had gained knowledge about cesarean birth in the birth classes I attended. As a first time mom, this helped me understand what was about to happen. For example, I was not surprised or confused when my arms were strapped down on the operating table.

Cesarean birth can be an overwhelming experience for some, especially when it is unplanned. The more preparation and understanding you have, the better your experience will be if you need a cesarean.

What is a cesarean birth? 

It is a surgical procedure where a baby is delivered through an incision in the mother’s abdomen and uterus. This is typically done when vaginal birth is not an option or poses a risk to the mother or baby’s health. A cesarean can be a life saving event when complications are threatening. 

However, a c-section is major abdominal surgery, and carries risks to the mother and baby. It is best used for only those situations where there is a true medical need. Cesareans can be planned in advance. They sometimes occur during labor with time to discuss your situation and ask questions or, they may be performed quickly in an emergency. There are a variety of reasons why your care provider may recommend one.  

Some of the most common reasons for a cesarean include:

• Malpresentation: your baby is breech, transverse or other 
• Multiples: twins, triplets or more 
• Mother’s health: high blood pressure, heart disease or pregnancy diabetes
• Placenta previa: when the placenta lies low in the uterus and partially or completely covers the cervix
• Placental abruption: separation of the placenta from the uterine lining prematurely 
• Cord prolapse: A rare emergency, when the umbilical cord slips through the cervix and protrudes from the vagina
• CPD: (cephalopelvic disproportion): baby’s head won’t fit through mother’s pelvis
• Sexually transmitted disease, such as HIV or an active herpes outbreak
• Fetal distress during labor
• Labor is not progressing or has stalled  

If you and your care provider have determined a planned cesarean birth is the best option for you, take some time to prepare yourself mentally and emotionally. 

Here is what to expect with a cesarean birth:

Before the procedure:

You will be asked to change into a hospital gown and be given a surgical cap to wear. Usually one person may stay with you and rarely two (your partner and your doula.) Bringing your partner and your doula into the operating room with you does require strongly advocating for yourself. The anesthesiologist is the best person to speak to, as they have the final say on who can be present.

Your partner (and/or doula) will also be asked to wear a hospital gown over their clothing, a surgical cap and a mask. In the operating room you will meet with the medical team, including an anesthesiologist who will administer the anesthesia so you do not feel pain. 

Regional (spinal or epidural) anesthesia is used most often. However, sometimes general anesthesia is needed. It is used for emergencies when there is little time to place an epidural, or if there is a medical condition that does not allow for an epidural. With general anesthesia you will not be conscious during the procedure. The medicine is usually inhaled through a breathing mask which slowly puts you under.

Sometimes your arms will be strapped down, in a T position away from your sides. This is done to prevent you from reaching down and touching near the surgical site. You can also request to have your hands left free during the surgery. An IV and bladder catheter will be placed. The IV fluids will keep you hydrated, and the bladder catheter will collect urine throughout the process. 

During the surgery:

Once the anesthesia has taken effect, the medical team will begin the procedure. A curtain will be placed above your chest to keep the surgical field sterile. Some hospitals offer a clear drape to allow parents to see the birth. 

Your care provider will make an incision in your abdomen and uterus to deliver your baby. The safest and most commonly used incision is a horizontal cut along the bikini line. Other incisions used more rarely include classical (a vertical cut) or an upside down T- shaped incision. With these variations, usually the scar on the outside is still a bikini line cut, and the classical or T-shaped incision is only used on the uterus. (For example I have a bikini cut incision on my abdomen, and an upside down T-shaped incision on my uterus.)

You may feel pressure, tugging, or pulling during the procedure, but you should not feel pain. If you do feel pain, make sure to let the surgical team know right away. 

To learn more about the step by step cesarean process and see photos of the procedure, check out this article. 

After your baby is born, she may be placed on your chest for skin-to-skin contact, if possible. Once the placenta is delivered, the surgical team will close the incision in your uterus using sutures, then your abdominal skin will be sutured or stapled. You will be taken to a recovery room to be monitored as you come out of anesthesia.

You do have some choices and options regarding procedures that take place during a c-section. Learn more about those options in this article: What is a Gentle Cesarean? 

After the procedure:

After the cesarean birth, you will spend some time in the recovery room before being moved to a hospital room. If you were put under general anesthesia, it will take some time for you to slowly wake up and adjust to your new environment. (Personally I felt like I had been hit by a truck after general anesthesia.) 

You will likely feel groggy and may experience some discomfort, but your care provider will prescribe medication to help manage your pain. 

Usually within 6 – 8 hours after birth, you will be encouraged to get up and walk around to help prevent blood clots and aid in your recovery. Your care provider will continue to monitor you and your incision. Notify your provider right away if you experience any signs of infection, sharp or sudden pain at your incision, or tenderness, pain, redness or swelling in your legs. 

Recovery from a cesarean birth can take longer than recovery from a vaginal birth, but with some preparation and support, you can ensure a smooth recovery.

Here are some tips for a successful recovery:

• Rest: Rest is crucial after a cesarean birth, so take it easy and avoid strenuous activities for at least 6 weeks.
• Eat and Hydrate: You need nourishment and hydration to heal your body. Eat nutritious meals and drink plenty of water. 
• Pain Management: Your care provider will prescribe pain medication to manage your pain after the surgery. Make sure to take it as directed and communicate with your provider if you experience any side effects or if the medication is not managing your pain effectively.
• Support: Having a support system during your recovery can make a huge difference. Reach out to family, friends, or a postpartum doula to help you with emotional support, household tasks, etc. 
• Incision care: Follow your care provider’s instructions for caring for your incision. This may include keeping the incision dry, changing dressings regularly, and avoiding tight clothing.
• Breastfeeding: Breastfeeding releases oxytocin, which can help return the uterus to its pre-pregnancy size, reduce postpartum bleeding, and the risk of hemorrhage. This hormone has a pain-relieving effect and promotes relaxation. Talk to a lactation consultant if you have any concerns about breastfeeding after a cesarean birth.

For more tips on recovery, check out this article: Recovering After a Cesarean. 

Emotional recovery:

If you were hoping for a vaginal birth and your labor resulted in a cesarean birth, it is totally normal and okay to grieve the loss of the birth experience that you wanted. Talk to a trusted friend, family member, doula, counselor, or seek help from a support group. It is healthy to take the time and space you need to process the mental and emotional pain you are going through. 

Every cesarean birth is unique, and your experience may differ depending on your individual circumstances. If you have any concerns or questions about cesarean birth or your birth plan, make sure to talk to your care provider and your labor doula. We are here to support you every step of the way to make the most of your birth experience. 

Want more on this topic? Read: Yes, Doulas are for Cesareans, Too and Helpful Recovery Steps For C-Section Healing Week by Week.