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C-Sections Cubby

Cesarean FAQ
by Linda Walrod

What are the chances that'll I'll have to have a c-section?
Few people would choose to go through major surgery to give birth to their baby, but it does happen to many. Statistically speaking, the national average for a c-section is about 25%. But within each hospital, there will be strong derivations on this average. Depending on the doctors and policies in the hospital, your chances of having a c-section could be much higher or, hopefully, much lower. The best way of finding out is by talking to your doctor or a hospital administrator and asking what the c-section rates are for your particular hospital. This information should be readily available and help you understand your odds.
What situations usually warrant a c-section?
  • Cord prolapse (when the umbilical cord falls into the vagina)

  • Bleeding from the placenta

  • Abnormal pelvic structure, for example as a result of a serious injury.

  • Shoulder presentation of the baby.

  • Serious maternal health problems (e.g., infection, diabetes, heart disease, high blood pressure, etc.) when labor would not be safe for either mother or baby.

  • Dystocia (difficult childbirth), which includes labor that fails to progress, prolonged labor, and CPD (cephalopelvic disproportion) when the baby is too large to pass safely through the mother's pelvis.

  • Breech presentation (buttocks or feet first).

  • Fetal distress. The baby may show signs of distress such as slowing of heart rate or acid in the blood before vaginal delivery can be completed quickly.
What type of pain relief is offered before and after a cesarean?

Because a cesarean is major surgery, you will have to have some type of anesthesia during the delivery and then some pain relief afterwards. There are usually three types of anesthesia that are used in the c-section. General anesthesia or gas causes the mother to be completely asleep during the surgery. This is most common in emergency or life-threatening cesarean. The other two types of regional anesthesia, epidural and spinal, allow for the mother to be awake during the c-section. These will numb the mother from her breasts to her toes. To read more about the differences in epidurals and spinals, read Spinal, Epidural, and Combined Spinal Epidural Techniques: A Comparison in our Childbirth Cubby.

After a c-section, pain relief may come in a variety of forms. Most common are: morphine drip in your IV, Demerol, Percocet, Motrin 600 or 800, Tylenol 3 (with codeine), and Darvocet. Most women only need these prescription medications for a week or two, and then are able to use Advil or Tylenol after that.

How long will it be until my baby is born?

Once the c-section has started, it only takes about 5-10 minutes for the baby to be born. Then about 30-45 minutes for the doctor to check everything out and close up.

What is the procedure for a cesarean?

  • A catheter is placed into the bladder to drain urine during surgery.
  • An intravenous line inserted
  • An antacid for your stomach acids
  • Monitoring leads (heart monitor, blood pressure)
  • Anesthesia
  • Anti-bacterial wash of the abdomen, and partial shaving of the pubic hair
  • Skin Incision (vertical or horizontal (most common))
  • Uterine Incision
  • The doctor can then open the amniotic sac and deliver the baby. You may feel some tugging, pulling and some pressure.
  • BIRTH!!!! (Accomplished by hand, forceps, or vacuum extractor)
  • Cord Clamping and cutting
  • Newborn Evaluation
  • Placenta removed and the uterus repaired
  • Skin Sutured (usually the top layers will be stapled and removed within two weeks)
  • You will be moved to the Recovery Room (If the baby is able s/he can go with you.)

For more detailed information on the surgery, read Cesarean Section - What Happens During Surgery.

Can I still breastfeed if I had a cesarean?

YES!!!! Although you may encounter a few more difficulties in starting out, breastfeeding your child after a c-section is absolutely an option! The two most common difficulties are incision pain and getting started soon after surgery. The best ways to tackle these difficulties is by educating yourself in advance. Let the hospital staff know WAY in advance that you want to breastfeed your child. When you find out you are having a c-section, remind them that you still are planning on breastfeeding and you want to have the baby put to the breast as soon as possible. It is not uncommon for babies to be brought to the mother in recovery to breastfeed. If the hospital staff insists you must be out of recovery before seeing the baby, let them know that you want no bottles or artificial nipples used in the meantime. Most women are in recovery for about an hour, so unless there is a medical need for it, most babies can wait that long before their first introduction to the breast.

When you are first ready to breastfeed your new baby, ask for a lactation consultant to help. You will probably need someone to help position the baby at first since you will probably still be numb from surgery and unable to move easily. Learn in advance, alternate positions for nursing your baby after a c-section. This will help in the second difficulty, incision pain. If you are fortunate enough to nurse your baby in the recovery room or shortly after, you will probably still be numb around the incision and may be able to hold and feed the baby in the typical cradle hold. But once the anesthesia wears off, incision pain will make nursing more difficult. The football hold and side-lying positions are excellent positions for a c-section mother to successfully breastfeed her baby.

If you are worried about how the pain medications will affect the baby, be sure to discuss it with your doctor. There are options that are okay for mother to take while nursing. The hospital's lactation consultant is always an excellent source of information and help. Be sure to enlist her help whenever you feel unsure.

How long do I have to stay in the hospital?

Most hospitals like to keep mom and baby for 3-4 days, although some moms have been released sooner than that. You will have to stay longer if complications arise.

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What will my recovery be like?

Recovery will vary based on age, body type, and general health. Most women will deal with gas pains (as your digestive functions resume), incision pain, uterine contractions, and exhaustion. Usually within a day or two, you will be encouraged to get out of bed and walk. As painful and uncomfortable as this might sound, it is EXTREMELY helpful in your recovery. Usually a nurse will stand with you. Take your time as you sit up and turn to dangle your feet off the edge of the bed. Once you feel okay, stand up. If you feel lightheaded, immediately sit down and wait. If you feel okay, take a few steps with the nurse. Do this as often as you can, and lengthen the distance until you are able to walk on your own. DO NOT ATTEMPT TO LIFT YOUR BABY OR CARRY YOUR BABY.

Most doctors want to know you are passing gas before you are discharged. Foods will probably be limited at first and gradually increased to normal. If you had staples to close your external incision, it will be checked daily for infection and will possibly be removed on the day of your discharge. This is not very uncomfortable.

One of the most common recovery comments I've heard is that most women feel really good the first day. This is usually because the anesthesia from the surgery is still lingering, and often moms are on a "high" from seeing and holding their new baby. They feel surprisingly good and painfree and feel like this was a "breeze." Then on the second day, reality sets in. The incision pain is sharper, you feel more tired, it's harder to get around. This is very common and doesn't mean something is wrong. Just take it easy and rest.

Other parts of recovery are similar to a vaginal birth. You will still have uterine contractions (to help the uterus contract back down to size), exhaustion, uterine massage (to also help the uterus return to normal), and postpartum bleeding. Often c-section moms are surprised that they have to experience lochia even though they did not have a vaginal birth. So, just like after a vaginal birth, your lochia flow will be checked and you will have to wear pads for a few weeks after birth.

How long until my incision stops hurting?

Recovery time varies for many women. Some women feel fine after just a few weeks, while others continue to feel uncomfortable for months. But, on average, most women will feel pretty well recovered within 6-8 weeks. Keep in mind that a sudden increase in pain or discharge from the incision area warrants a call to your doctor.

I've had one cesarean (or more!). Will I have to have another cesarean?

In the past, the saying used to be "once a c-section, always a c-section." This is simply no longer true. Depending on they type of incision and reason for your c-section(s), a VBAC is possible. VBAC stands for Vaginal Birth After Cesarean. If you had a horizontal incision (uterine) then the possibility exists for a VBAC. If you had a vertical incision (uterine) then chances are that you would have to have a repeat cesarean because of the risk involved. A horizontal incision is believed to be stronger and less stressed during pregnancy and delivery. But with a vertical incision, there is a greater chance of uterine rupture . . . a potentially life-threatening situation.

How can I prepare for a c-section?

  • Plan ahead. No one can predict whether or not you'll need an emergency c-section. So prepare yourself with information. If you know you'll be having a cesarean, take special c-section prenatal classes.

  • Discuss your pain relief options. If it means talking to the anesthesiologist about the difference between epidurals and spinals, then do it.

  • Ask about having someone with you and ask about photos. Support during the birth of your baby is important. Also ask about photo options. Some hospitals will let your partner take pictures of your baby's birth.

  • Ask to wait for labor to begin before having your planned c-section. Many experts believe that even a little bit of labor gives the baby some of the advantages of uterine contractions in stimulating breathing and ensuring maturity. If you have had a previous c-section with a vertical uterine incision or have a long way to travel to get to your hospital, this may not be advisable.

  • Request a running commentary on the delivery process and to watch the actual delivery if you would like.

  • Tell the staff that you and your partner want to hold the baby right after delivery. You and your partner should be allowed to hold your baby in the recovery room unless the baby needs medical attention. If you feel up to it, you can breastfeed immediately, too. Don't be afraid to ask questions throughout your labor and delivery so you are comfortable with every procedure.

  • Enlist help for when you go home. Chances are you'll need someone around to help you care for yourself and your baby for at least a week. Be sure to let them know that you need them for help with the house and caring for the baby, NOT just someone to hold the baby for you. Don't try and be supermom after a c-section. You risk your own health by doing this. Get LOTS of rest and remember . . . you had major surgery; you need time to heal.

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