Ask an OB/GYN – Your top C-section questions answered

Many moms who are expecting or considering starting a family wonder about what it might be like to have a C-section. This method of delivering a baby through a surgical incision of the mom’s abdomen has long been a topic of curiosity. To help us understand this procedure, we spoke with Adrianne M. Colton, MD, Fellow of the American College of Obstetricians and Gynecologists (FACOG) and obstetrician-gynecologist (OB/GYN) at Johnston-Willis Hospital. Dr. Colton graciously helped us compile answers to some of the top questions about C-sections.

What are some reasons a C-section may be recommended over a vaginal delivery?

“As OB/GYNs,” says Dr. Colton, “our goal is to have a safe, vaginal delivery when appropriate.” The decision to have a C-section over a vaginal delivery usually depends on the patient’s situation, but physicians will most often recommend C-sections because “there are some situations that arise where a C-section is the safer route of delivery for either mom, baby, or both.”

Such examples include:

• Baby is in a breech or feet-first position.
• Placenta is blocking the cervix.
• Mom has had previous C-sections or uterine surgery.
• Twins, triplets or more are expected.
• Labor is not progressing normally despite interventions.
• Baby’s heart rate is low.
• Mother has medical conditions that could increase the risk for the baby, such as:
  • Diabetes
  • Pre-eclampsia
  • Human Immunodeficiency Virus (HIV)
  • Active case of genital herpes

Aside from these recommended circumstances for a C-section, complications like excessive bleeding or umbilical cord entanglement/prolapse arising during an attempted vaginal delivery may result in an emergency C-section being medically necessary.

What are some of the risks associated with C-section delivery?

C-sections are considered routine procedures; they are very common. Dr. Colton does remind us that, as with any major surgery, there are risks “during and after surgery” that moms and their families should be aware of, including:

• Blood loss
• Infection
• Injury to surrounding abdominal organs
• Blood clots

Although it is unlikely that the baby will be harmed during a C-section, Dr. Colton does acknowledge that sometimes, “small cuts and some breathing issues are possible” for a newborn delivered via C-section. Families should also keep in mind that a C-section is usually a low-risk procedure for mother and baby, and the decision to perform one is usually in the context of other medical concerns and risks.

What kind of anesthesia will I get during a C-section?

The type of anesthesia the mom receives depends on the type of C-section she needs. Moms who have a C-section will typically receive regional anesthesia, which means that the medication will only affect a particular part or region of the body. Epidurals and spinal blocks are often used to numb the body from the waist down.

“Most patients are awake and alert during a C-section,” says Dr. Colton. But in general, moms will usually only feel “the sensation of pushing and pressure” on their abdomen once they receive the anesthesia treatment. They should not experience pain. 

In the event of an emergency C-section, a doctor may need to administer general anesthesia, which affects the whole body; in other words, mom will be asleep. Emergency C-sections require a breathing tube and allow for the rapid delivery of the baby. 

Once regional or general anesthesia is administered, the surgeon will make an incision on the lower part of the abdomen, through which the baby will be delivered.

How long does a C-section take?

According to Dr. Colton, the procedure's length, “is dependent on many factors, including the reason for needing a C-section, the urgency of the C and the patient’s prior surgeries. Typically, an uncomplicated C-section from start to finish will be done within 45 minutes to an hour, but your baby is usually delivered within the first five to 10 minutes.”

What kind of scar can I expect from a C-section delivery?

The most common type of incision used in C-sections is a low transverse incision, sometimes called a "bikini incision," that is done horizontally, just along the pubic hairline, in an area often covered by a swimsuit or underwear. If a larger incision is needed or if the baby must be delivered quickly, the surgeon may make a vertical incision just below the belly button to the pubic bone.

“After the first horizontal or vertical skin incision is made, a second incision is made in the uterine wall in either a horizontal or vertical fashion, and the baby is delivered through these two openings,” explains Dr. Colton. “This incision on the uterus is not visible, but the type and location of that incision is what will help dictate if you can have a trial of labor after c-section for future deliveries.”

If a mom has had a C-section in the past, their surgeon will often make a new incision in the location of the prior scar. The incision is usually around 4 to 6 inches long, big enough for the baby’s head and body to squeeze through.

“After the delivery of both your baby and the placenta,” Dr. Colton tells us, “the uterus is closed with stitches that dissolve. The skin is usually closed with dissolvable sutures (stitches), staples, surgical glue or a combination of these techniques. Most often, these do not require removal as the body will dissolve and absorb them over time. On occasion, metal staples are used, and these will require removal after a few days.” Mom’s medical team will provide care instructions for the incision after surgery.

The amount of scarring may depend on certain factors, including genetics. Over time, the scar will fade for most people. Several treatment options are available to help minimize the appearance, including creams, injections and laser therapy. Finally, Dr. Colton assures us that, “It is also normal to experience numbness in the area of your incision for weeks or months after delivery. As the nerves heal, you may regain sensation in that area.”

Is it possible to deliver a baby vaginally after I have a C-section?

This will often depend on the circumstances of previous C-sections, and if there were any complications. However, even if a mom has had a C-section for one baby, it does not always necessitate another C-section for future deliveries.

Dr. Colton informs us that any moms who are interested in a trial of labor after C-section (TOLAC) to have a vaginal birth after cesarean delivery (VBAC) should discuss the risks with their doctor. It may also depend on the type of incision you had. For example, those with a prior vertical incision on the uterus are more likely to need a repeat C-section.

What is the C-section recovery process like?

A C-section is a major abdominal surgery, and it generally takes longer to recover from it than a vaginal delivery. Most patients who deliver their babies via C-section spend one or two days longer in the hospital than moms who deliver vaginally. “This often means going home on day two or three after your surgery,” says Dr. Colton.

Dr. Colton also tells us that recovery “is usually hardest in the first few days after delivery.” For days, and even weeks, after the procedure, you might feel tired, sore near the incision, experience constipation, and/or bloating. You may also have difficulty getting out of bed or lifting your baby. This recovery period typically lasts up to six to eight weeks before you can resume your routine activities.

To help with healing, here are some C-section recovery tips:

• Rest when possible.
• Drink plenty of fluids.
• Avoid sex until your doctor clears it (usually at the six-week checkup).
• Take any medication recommended by your doctors to manage pain.
• Walk as you can to help relieve discomfort and prevent blood clots.
• Use a pillow to support your abdomen when you sneeze, cough or laugh to relieve pressure.

In addition to the tips above, Dr. Colton offers this advice to new moms, “Please ask for help! Avoid lifting anything heavier than your baby in the first few weeks after delivery. Also, you may ask for an abdominal binder for additional support.”

“During the postoperative period,” Dr. Colton continues, “it is important to be aware of changes in your body and symptoms that may indicate an evolving problem. Symptoms that are concerning may include fevers, chills, worsening abdominal pain, leg pain (especially unilateral), significant shortness of breath, or redness or oozing from your incision.”

Does delivering via C-section affect breastfeeding?

There are no restrictions on breastfeeding for patients who deliver their babies via C-section. Moms can begin breastfeeding as soon as they feel up to it. Talk to a nurse, doula or lactation consultant if you have any of the following issues with breastfeeding:

• Feel uncomfortable breastfeeding because of your incision
• Feel pain while nursing
• Have issues with milk supply

These professionals should be able to help you find solutions. However, taking care of yourself is crucial at this time, and if you decide that breastfeeding isn’t right for you as you recover, supplementing or bottle-feeding are healthy options.

HCA Virginia Health System offers a wide range of women’s health services at our hospitals across the state, including gynecologic services, high-risk pregnancy care, prenatal care, midwifery and labor and delivery services. We also offer classes, events and maternity unit tours for new parents and expectant moms.