Cesarean section: what is it and how it is performed

Medically reviewed: 1, February 2024

What is a Cesarean Section?

Cesarean section is a procedure where a baby is delivered by cutting through the front wall of the abdomen to open the womb.

Approximately 20% of babies born in the United States are delivered by cesarean section because there may be an urgent or potential medical risk to mother or baby.

A cesarean section is indicated when there is a significant risk to the health of the mother or baby if the operation is not performed at a given time.

The principal clinical reasons for the medical decision to perform Cesarean section are situations involving danger to the unborn baby, failure to progress with the labor, breech (bottom-first) presentation, and cases where the mother has had a previous Cesarean section.

Why Cesarean Section can be necessary?

In an emergency situation there may not be time to fully discuss the options for Cesarean section, and it may be necessary as a lifesaving procedure.

When a vaginal (normal) delivery would pose significant risks to the mother or baby, the midwife or doctor will discuss the option of a Cesarean for delivery and the reasoning behind it.

Medical circumstances for a Cesarean include:

• Severe pre-eclampsia (pregnancy-related high blood pressure)
• The unborn baby is not receiving enough oxygen, but a quick vaginal delivery is not possible at that time
• Labor is not progressing. Sometimes, despite all efforts, labor fails to move the baby sufficiently quickly down the birth canal (the channel through the exit of the womb, through the pelvis and out through the vagina) and the mother or baby is in distress

Some other reasons for a C-section:

No contractions

Labor has been induced (brought on) for some medical reason but the methods used to induce labor are failing to produce contractions effective enough to lead to a vaginal delivery.

Too narrow pelvis

It has been found that it would be highly unlikely that the baby will fit through the normal birth canal. For instance, an x-ray or scan may have shown that the baby has a head larger than the space in the pelvis through which it needs to travel;

Baby is ‘sitting’ wrong

C-section can be performed, if the baby is in an abnormal position inside the womb such that it is unlikely to fit through the birth canal.

Placenta is placed on the wrong side

The placenta (afterbirth) is blocking the exit to the womb. This is called placenta praevia. It can cause a massive bleeding due to the labor, so doctors most likely will choose C-section.

If mother is infected

Some types of infection are an indication for a planned Cesarean section. These include active genital herpes, where a normal delivery would risk transferring the virus to the baby, and HIV infection in the mother, where a Caesarean section reduces the chances of the baby becoming infected with the condition.

Baby is born too early

Premature labor; sometimes an emergency Caesarean section will prevent possible trauma to the delicate head of the premature baby as it travels through the birth canal.

Very small babies are especially at risk of brain hemorrhage if they have a normal delivery.

Heart problems

A medical condition such as a heart problem that would put the mother at risk during the efforts of a normal delivery.

How Cesarean Section is performed?

It may be performed as:

• a planned procedure, where the medical need for the operation becomes apparent during pregnancy;
• an emergency procedure, where a situation arises during labor that calls for urgent delivery of the baby; or
• an elective procedure – this refers to a procedure that someone chooses to have done, not because of medical necessity, but because of their own personal preference.

Caesarean sections are usually done by making a horizontal incision (cut) in the lower abdomen along the ‘bikini line’ which allows another horizontal incision to be made in the wall of the womb to deliver the baby.

The low incision avoids weakening the womb muscles unnecessarily and allows the operation to be performed more than once on the same woman, if necessary.

The operation is performed under a general, spinal or epidural anesthetic; the last two of which involve the injection of local anesthetic into the fluid that surrounds the spine (dura mater). Local anesthetics numb the body from the waist down and allow the mother to stay awake, but free of pain, during the operation. In certain urgent situations, a surgical procedure involving a vertical incision on the abdomen and womb might be employed.

Once the baby has been delivered through the incision made into the womb, the placenta soon separates and is also removed. The wall of the womb is swabbed and closed with stitches that will later safely dissolve. The layers of the abdominal wound are then sutured together to close it.

Recovery after Cesarean Section

This is much the same as for any other abdominal operation except that the mother will usually be in a healthier state.

She should be able to get out of bed fairly soon after the operation, and the hospital will give instructions about how soon she can resume normal activities.

In general it will take about six weeks for all the tissues to heal completely. However, before this time the basic activities of life such as caring for the baby and for herself should be possible, but the mother should avoid heavy lifting and may need help especially in the days immediately after the birth.

If the operation was done for a reason that will not have changed for the next delivery (for instance, if the mother has a very narrow birth canal), a Cesarean section will be necessary for each childbirth.

Also, the scar left on the womb will mean that any future labors will not be allowed to go on for too long, since this may risk the scar opening up, which would be dangerous.

Women who have had a previous Cesarean section are usually offered what is called a ‘trial of scar’, where they are left to go into labor in the usual way but are closely monitored. Any sign of a hold-up in the progress of labor then leads to an emergency Cesarean section.

Risks of a Cesarean Section

There are health risks associated with caesarean section. Although a common procedure, it still represents major abdominal surgery, and any operation carries a certain amount of risk.

The main risks include:

• infection of the wound
• thrombosis, also known as clot formation, can occur in the legs, and it can pose a serious risk if a fragment of the clot detaches and becomes lodged in the lungs. This condition, known as pulmonary embolism, can have severe consequences and requires immediate medical attention.
  excess bleeding
• temporary problems with bladder control, and
• temporary breathing difficulties for the baby.

There is a very small risk of death during delivery for mother or baby. This risk is three times greater for caesarean section than for vaginal delivery, and the recovery period is generally longer.

It is crucial to bear in mind that this particular procedure has been instrumental in preserving the lives of numerous women and infants throughout the course of time.

Where a danger to health has been identified, the risks of the caesarean section are usually far outweighed by the risks of not doing it, particularly in an emergency situation.