Cesarean

What is a Cesarean?

A cesarean is major abdominal surgery allowing a baby to be born when there is an indication of medical necessity or need. Cesareans are one of the most common surgeries done in the United States today.  While they are often portrayed as easier, there are more factors and risks at play than is often given during doctor’s appointments or on an informed consent sheet in the hospital.  They should not be taken lightly and they are not an equal alternative to normal vaginal birth.

In most cases, the incision in a cesarean surgery is called a “transverse” or bikini cut.  This is a horizontal cut made with a scalpel along the bikini line.  In some situations, another incision type is used to get the baby out.  These can be referred to as vertical, classical, inverted-T, or J incisions.  There are also circumstances that may refer to extensions of the incision area.  There is more information about these type of incisions on the Special Scars page.

When the surgical incision is made in a cesarean, the surgeon must cut through each layer individually, going down through the skin, fat, muscle and tissues.  The uterine incision can be different from the external skin incision so careful attention should be paid to any medical reports.  The uterine incision is often made by first nicking the uterus with the scalpel, then pulling apart the actual muscle.  This is actually healthier than slicing because the muscle will tear along natural lines, allowing for easier repair and more complete healing.  The baby is born via the surgeon reaching in through the incision and pulling out.  Often, there is twisting and pulling on the presenting part of the baby and there can even be vacuum use or extension of the actual incision if there is a problem getting the baby out.  The surgeon then removes the placenta, cleans out the uterus and does the surgical repair, sewing together each individual layer in reverse of the original incisions and closing with sutures or staples on the external scar line.

The following links show actual cesarean surgeries.

*Warning* These videos are intense and can cause strong emotional reactions.

Shawnee Mission Medical Center

MemorialCare Health Center

The why of a Cesarean

Cesareans come in a wide variety of need.  The ultimate decision of whether or not a cesarean is needed should be based on a mother’s understanding of her pregnancy and the situation that has arisen, not provider preference, malpractice worries or insurance carrier.  The most common reasons for cesarean are being brought into question because they simply do not line up with evidence-based research.  For that reason, many people use different terms to refer to cesareans such as elective, preventable, emergent, and emergency, qualifying the spectrum from a planned, non-medically indicated cesarean to ones that present with an immediate need for birth due to obvious medical cause.

  • Elective cesarean is an actual term used on forms to denote that the care provider is doing the cesarean without a presenting emergency medical indication.  They are scheduled or are chosen in early labor.
  • Preventable cesareans are ones that could have been avoided.
  • Emergent cesareans are when something begins to occur which necessitates a cesarean once labor is in progress.
  • Emergency cesareans are done when it is obvious the mother and/or baby are in immediate danger.

Some common reasons given for cesarean:

  • Breech position of baby.  Three percent of babies are breech (head up!) at 40 weeks of pregnancy and many continue to turn, even up into and during labor, past forty weeks gestation.  Most of these cesareans are done in response to the flawed Hannah Breech Trials put out almost thirty years ago.  Newer research has led to a recent return to weighing the options of vaginal breech birth.
  • Placental abruption or placenta previa.  A true indication for cesarean surgery, complete or partial placental previa means that as the cervix dilates and the placenta lets go of the wall of the uterus/cervical os, there is a lack of oxygen that will be reaching the baby.  There is also typically a significant loss of blood to the mother, endangering both their lives.  Placental abruption is when the placenta lets go of the uterus before the baby is born, resulting in the same lack of oxygen and blood loss.  Both are highly dangerous conditions that usually result in an early cesarean (before 40 weeks) to prevent labor in the case of the placenta previa.
  • Failure to progress/failure for induction to work.  A catch-all term that is too loosely defined to be a reliable indication for cesarean.  Often used when Friedman’s Curve does not apply to a particular labor, meaning that the woman did not dilate and give birth in under twelve-twenty four hours of being induced or her water breaking/being broken.
  • Cephalo-pelvic disproportion.  Another catch-all term that is too loosely defined to be a good indication for cesarean.  Often used when a provider no longer wants to wait for a mother to give birth or the baby’s head is in a slightly askew position.

What are the risks?

The risks of a cesarean start with the obvious: on top of your normal risks with childbirth, you add surgical complications and other long-term risks.  Also, each cesarean adds more risk to both mother and baby, even during pregnancy, so it’s important to consider vbac when looking at future births to help decrease the overall risks if you desire more children.

Some common risks and side effects of cesarean are: reaction to anesthesia, infection at the surgical site, scalpel cuts to the infant, bladder damage, and adhesions.

While maternal and fetal death are not common, they are on the rise in part due to the rise in cesarean for everyday use.

Uterine rupture is a complication of cesarean that can arise in future pregnancies.  The reasons for uterine rupture are poorly understood but less than 1% of women will ever experience one and less than 6% of women who actually do have a rupture will have a catastrophic outcome such as loss of the mother or baby.  Often, this is the reason given for repeat cesareans but as one OB pointed out, you only create more problems when you do 100 more cesareans to prevent 0.03% of a problem.

Long-term risks to cesareans are rarely studied and since the rise of cesarean began in the 1980’s, many of those women are now just beginning to see the impact through early hysterectomy, adhesions, bowel obstructions and other damage from their cesareans.

Another little discussed risk to cesareans is the long-term impact emotionally and mentally on mothers.  If you are in recovery from a c-section and feeling like you are experiencing a vast range of emotions, this is normal.  Continue checking out the website for more healing resources and check out the book list including Cesarean Voices, a compilation of stories by mothers responding to their own surgeries when asked the question, “What’s so bad about a cesarean?” or Lynn Madsen’s book, Rebounding from Childbirth: Toward Emotional Recovery.

See our Cesarean FAQ.

Having a baby after Cesarean?

Here’s some support groups online that might be able to help you:

Birth After Cesarean – Online support group for mommas who’ve had a cesarean.

CBAC – Support for mommas who’ve had a c-section after planning a VBAC.

HBAC – Support for mommas who’ve had or are planning a home birth after a c-section

Special Scars ~ Special Women – Support for mommas who’ve had a special incision (anything other than a low transverse) and are considering their options for future births.

UBAC – Unassisted Childbirth. This list is for mothers who are planning an unattended birth or who have had one.

Cesarean Statistics:

The CDC releases the preliminary statistics in any time between September and December of the following year,finalizing in late spring, two years later.

2008 Statistics:

CDC Births Final Data for 2008

US National Average: 32.3%

2009 Statistics:

CDC Births Preliminary Data for 2009

US National Average: 32.9 %

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