Brazilian women are having them in droves, some women report feeling pressured to have one, others are quick to tell you to never ever have one, and journalist Lisa Ling has gone public that she regrets having had one.
Based on the kind of press the very common medical procedure gets, you might think a C-section is akin to an enhanced tactic of interrogation. But not so, says Dr. Holly Puritz, an OBGYN with The Group for Women in Norfolk, Virginia, and a fellow (and past president) of the American Congress of Obstetricians and Gynecologists.
A C-section is an alternative to a vaginal delivery, which is most often the primary goal, Puritz says. “But the C-section is one of the tools in our toolbox if a safe vaginal delivery isn’t going to happen. There’s this misconception that it’s easier, that we prefer it, that it’s faster. No. I love doing a vaginal delivery, but I love even more delivering a health baby.”
So what actually happens during the procedure and why is it needed to deliver a baby in some cases? Let’s break it down.
Who gets a C-section and why?
When we’re talking about labor and delivery and any problems that might arise during that process, there are two elements to keep in mind: “the passage and the passenger,” as Puritz puts it.
The passenger is the baby, and if it’s in distress, then a doctor will turn to a C-section. Likewise, if there’s a problem with the baby’s passage through the vaginal canal, then a doctor would opt for C-section as well. “If something’s not going to fit, it’s not going to fit,” Purtiz says.
A patient’s prenatal and medical history are always taken into account when evaluating whether she might be a good candidate for a Cesarean delivery. A C-section might be planned in advance for women carrying mutiples, when a fetus’ head measures too large to pass through the vaginal canal on ultrasound, in cases of placenta previa (when the placenta is attached so low in the uterus that it blocks the cervix), or if toward the end of pregnancy the baby is positioned breech (with its feet positioned to deliver first) or transverse (with the baby positioned horizontally in the uterus as opposed to vertically, with its head facing down).
A mother could also deliver by C-section if the baby is in distress during labor, or if labor isn’t progressing adequately over time. Whether it’s an abnormal fetal heart rate or irregular contractions, a provider assesses the passenger versus passage dynamic to figure out the why—and plans appropriately to keep mom and baby both healthy and safe.
What really happens during a C-section?
When it’s time to actually operate, the mother’s heart rate is checked one last time. Since the bladder sits right under the uterus, it needs to be emptied before the surgeon can operate. A catheter goes in to drain the mom’s bladder. Local anesthesia is typically used in C-section deliveries, most commonly in the form of a spinal block. Monitors are then placed on the mom to check her breathing, oxygenation, and heart rate. An anaesthesiologist keeps an eye on airway breathing and cardiac issues.
Next, the woman’s stomach is sterilized and drapes are placed around her chest so that she doesn’t have to watch herself being operated on in real time. Oftentimes, this is when the husband or partner is invited in to watch, taking a seat behind the mom’s head (and behind the curtain).
Incisions are then made layer by layer, first through the skin, then the muscle, and then the abdominal cavity, where the doctor peels the bladder back from the uterus. “It’s an operation like any other,” Puritz says.
Just like a vaginal delivery, you want the baby’s head to come out first. After an incision into the uterus is made, the OBGYN reaches inside toward the cervix to deliver the baby’s head. The baby’s mouth and nose are then suctioned out and cleared of mucus and other fluids, and the physician checks to make sure that the umbilical cord isn’t wrapped around the baby’s neck. Then the baby’s shoulders are delivered and, finally, the rest of the body. The newborn is dried, the cord clamped, and he’s handed off to the pediatrician.
There’s one more delivery to be made though—that of the placenta, which gets pushed out through the uterus’ contractions. Once it’s delivered, through the same incision in the uterus, the OBGYN will stitch back up all the layers in reverse order.
From skin incision to delivery, a C-section goes pretty fast. Barring complications, it can be completed in under 15 minutes. And the rest of the process, including the delivery of the placenta and suturing of incisions, is also a very efficient one. From beginning to end, the entire procedure is usually done in about 45 minutes, on average.
At this point, just as in a vaginal delivery, hormonal levels start to drop.
How are C-sections and vaginal deliveries different?
While an upside of the C-section is that the woman doesn’t have to deal with a likely vaginal tear, the procedure does mean that the body has to recover from a major surgery. Among the symptoms your body might experience are low temperature and fatigue. C-section patients get special compression stockings for their legs while recovering in the hospital bed to prevent blood clots, for which they’re also at higher risk of developing. The catheter is also kept in overnight since the patient can’t get up on her own to use the bathroom. And more pain medication is administered than might be the case after a vaginal delivery. While mobility is more limited for the first 24 hours, physiologically, there’s not much difference compared to vaginal delivery, according to Puritz
C-section patients are recommended to take eight weeks off post-delivery, compared to the standard six weeks for vaginal deliveries. And they go for a check-up sooner than vaginal delivery patients, too. At two weeks, the provider will check to make sure the incision is healing correctly, looking for redness, swelling, or drainage that might indicate otherwise. Most doctors suggest not driving for four to six weeks to allow incisions to heal, and C-section patients might be on pain medications longer, too.
A C-section delivery for a first birth doesn’t mean that you’ll necessarily have one again. It goes back to whether the issue was with the passenger or the passage. If someone had a C-section during her first delivery because the baby was breech or in distress, there’s a good chance her next delivery could be vaginal. But if a woman ends up needing a C-section because the baby couldn’t fit through the vaginal canal, that’s a “passage” issue that’s likely to come up again because, as Puritz explains, “Your body didn’t change.”
“C-section or a vaginal delivery is a medical decision. It’s not a lifestyle decision,” Puritz says. All of which goes to prove that if you have a baby via C-section, you certainly don’t have anything to be embarrassed about or ashamed of—and they’re certainly not “unnatural”— since it’s just another way babies work their way into the world. “The key words, always, are the safety and health of the baby.”
Correction: Dr. Holly Puritz was a past Chair for American Congress of Obstetricians and Gynecologists' Virginia section, not a past president for the national organization. This post has been updated to reflect that.
Jen Gerson Uffalussy is a regular contributor to Fusion. She also writes about reproductive and sexual health/policy for Glamour, and television for The Guardian. She lives in Atlanta.