While very few women head into labor hoping for a cesarean birth, cesareans do account for one fifth of American deliveries. Many women feel that their birth experience is compromised if they don’t have a vaginal delivery, and never prepare for the possibility of a cesarean birth. Truly the success of the birth is not measured by the route of delivery, but by the health and experience of the mother and baby. In my practice, although I prefer to do vaginal deliveries whenever possible, I have seen many joyful births with cesareans. Preparing for the possibility of a cesarean birth can allow you to enhance your experience if an operative delivery becomes necessary.

Why are cesarean sections necessary?
Most cesarean sections in this country are done because the baby just won’t fit through the birth canal. This could be because the birth canal cannot accommodate the size of the baby’s head, or because the baby’s head enters the birth canal at an angle that makes navigating the birth canal more difficult. The decision to proceed to cesarean section may not occur until late in the labor; sometimes it is impossible to know if a surgery is needed until the second stage of labor (the pushing stage). Some cesarean sections are necessary because the baby is in a breech (buttocks first) or sideways position.

When a fetal heart rate pattern suggests the baby is not tolerating labor well, a cesarean section may be the quickest and safest route of delivery. Some causes of fetal stress are compression of the umbilical cord or a problem with the placenta.

If heavy vaginal bleeding occurs during labor, this could indicate that the placenta is separating from the uterus (placental abruption) or that the placenta is located too close to the cervix (marginal placenta previa).

Planned cesarean sections
A cesarean section may be recommended when a mother has had a previous cesarean delivery or uterine surgery, if the placenta is covering the cervix (placenta previa), if the fetus is unusually large, or if the mother has an active infection (such as herpes) that could be transmitted to the baby during delivery.

Other cesarean sections may be done because of fetal anomalies that make an operative delivery safer for the baby, or because the mother has severe pelvic narrowing. And some women have medical conditions that necessitate surgical deliveries for the safety of the mother.

What to expect if you need a cesarean section
Cesarean sections must be done in an operating room, and require anesthesia. Most cesarean sections can be done with “regional anesthesia.” This means that your body will be made numb from the waist down, using either a spinal anesthetic or an epidural, and you will be awake. In some cases, a general anesthetic is preferred. In this case, you will be asleep during the operation. It is safer to have an empty stomach during surgery, so you will be asked not to eat or drink and an oral antacid is often given to reduce stomach acidity. An intravenous line is used to provide fluids before and after surgery, and a catheter (small tube) is used to drain your bladder for a day. The operating room has monitors to check your blood pressure, heart rate, and blood oxygenation – these monitors will be in use throughout the procedure. Before the surgery begins, your belly will be thoroughly cleaned, shaved, and covered with a sterile drape that prevents you from seeing the surgery itself. Your surgeon will check to ensure that the anesthesia is working well before beginning to operate. It is possible that you will feel a sense of pushing and tugging during the operation, but you shouldn’t experience any sharp pain. Many hospitals allow one family member in the room to join you during the surgery. Often you can bring music into the room, and you may be allowed to take pictures of the birth and your baby immediately after delivery.

Once you have been fully prepped for the surgery, your doctor will make an incision in the lower abdomen. Usually this is a bikini cut but sometimes a vertical incision is safer. A tough white sheath below the skin and fat called the fascia is opened, revealing your abdominal muscles. These muscles are separated, allowing the surgeon to enter the thin translucent layer called the peritoneum that lines the abdominal cavity. The lower portion of the uterus is opened with a transverse cut in most cases, allowing the baby to be delivered. The baby has its nose and mouth suctioned at the time of delivery, and is then brought to an area where pediatric staff will ensure that the baby is breathing well. As the surgery continues, your doctor removes the amniotic fluid and placenta from the uterus, and closes each layer that was opened. During this time, you may be able to see and touch your baby.

Risks and disadvantages of having a cesarean section
Like all other surgeries, cesarean sections have risks including blood loss causing anemia, infection, injury to the bowel or bladder and post-operative blood clotting. Antibiotics are often given at the time of surgery to prevent infections. As you heal from surgery, your abdomen will be sore for a few weeks, and you will be given pain medications that are safe to use while breast-feeding. Once you have had a cesarean section, there is a slightly higher risk for uterine rupture in a subsequent pregnancy. This is particularly true if a vertical incision on the uterus was used.

How you can make a cesarean section a better experience
First of all, having good communication with your doctor is essential. It is much easier to accept the recommendation to have a cesarean section if you trust your physician and have understood concerns that may have developed during labor. Find out if your labor is proceeding in a typical fashion, or whether your progress is slower than usual. Learn whether your baby is entering the birth canal in a position that makes vaginal delivery easy or difficult. If your baby’s heart rate pattern is concerning your health care providers, ask whether a cesarean section could become necessary.

If you are advised to have a cesarean section, think about ways to make your birth special. Did you wish to have your favorite music played during the delivery? Have you thought about who you wish to be present with you during the operation? Would you like pictures taken of the birth itself? Would you like your doctor to talk to you as the surgery is being performed? Once your baby is born, do you want your partner to remain by your side or to be with the baby? Who would you like to give the baby its first bath?

I think it helps when a couple makes a Cesarean Section Birth Plan as part of their birth preparation. Find out ahead of time whether your hospital is flexible about the things that you would prefer to happen if a cesarean section is necessary. Show your birth plan to your doctor during your prenatal visits, when there is time to discuss your preferences. While having a cesarean section may be disappointing for some women, there are most certainly ways to create a positive experience.