Cesarean Delivery (C-section): How to Prepare and What to Expect

• What is a C-section?
• What are the reasons that you may need a primary cesarean delivery?
• When should my planned c-section be scheduled?
• How should I prepare for a c-section?
• What should I expect on the day of my cesarean section?
• What Should I Expect During Surgery?
• What is a stat C-section?
• What happens after the c-section is over?
• One Day After Your C/Section
• I’m Home, Now What?

What is a C-section?

Babies are born through either the vagina or via a C-section. A C-section describes when a baby is born through an incision in your abdomen and uterus. Cesarean deliveries are major surgery.

According to the Centers for Disease Control and Prevention, cesarean sections (c-sections) account for 32% of births in the US. Your doctor may recommend a C-section before you go into labor or after your labor has started (8).

Your first C-section is called a primary C-section. C/sections occurring for the second time or greater are called secondary C-sections.

What are the reasons that you may need a cesarean delivery?

• Failure to make progress during labor – your labor may not be progressing as it should. The slow progress may indicate that your baby may not fit through your pelvis.
• Concern for fetal well-being. If the monitoring shows the baby may be struggling in utero, this is called a non-reassuring status of the baby.
• Breech Positioning. When your baby is not coming out head first, this is called fetal malpresentation or breech.
• Multiple Pregnancies. Pregnancies with twins or more are called multi-fetal pregnancies.
• Fibroids obstructing the birth canal.
• Maternal Infection. Some infections in the mom can travel to the baby through the birth canal, such as herpes or HIV, which can preclude an attempt at vaginal birth.
• Placental Problems
• Very Large Baby. If your doctor suspects that your baby is too large, this is called macrosomia. Macrosomic babies can get stuck in the birth canal.
• Maternal Medical Conditions. Concern that continuing your pregnancy places your health at significant risk. In addition, pushing can aggravate some heart conditions.
• Elective Repeat C/sections- you and your doctor decide to deliver your baby by C-section because you have had a previous C-section or other uterine surgery.
• Maternal Request- while rare, some women may request a C-section, choosing to avoid labor. C/sections performed without a medical reason are not recommended. Vaginal deliveries are a much safer way to have a baby. Cesarean deliveries based on maternal requests are discouraged (7).

When should my planned c-section be scheduled?

The timing of your scheduled repeat C-section will vary according to each medical situation. Your doctor will try to deliver your baby as close to 39 weeks gestation as possible. Thirty-nine weeks gestation is one week before your due date. However, it may not be safe to wait until 39 weeks. In some cases, your doctor may recommend delivery earlier. For instance, if you have severe preeclampsia, your doctor will deliver no later than 34 weeks. If you have chronic hypertension, your baby will likely be born at 38 weeks or sooner. Patients who would like a trial of labor after C-section may be allowed to go past 39 weeks in the hopes that spontaneous labor may occur. Your surgeon will schedule your C-section according to you and your baby’s personalized needs.

 Your doctor will try to deliver your baby as close to 39 weeks gestation as possible. On your due date you are 40 weeks pregnant. Thirty-nine weeks gestation is one week before your due date.

How should I prepare for a c-section?

Treat Your Anemia

One of the most important ways to prepare for your surgery well in advance is to correct your anemia. Take your prenatal vitamins along with any iron supplements your doctor may have prescribed. Avoid taking iron pills within two hours of taking any dairy or antacids. Calcium and antacids will not allow your body to absorb the iron. You will not see results. Taking your iron supplement with citric acid or vitamin c will help your body absorb the iron and boost your response.

One of the most important ways to prepare for your surgery is to treat your anemia.

Sign Informed Consent

Before your C-section, you will have an office visit with your doctor to discuss the surgery and sign the surgical consent forms.  Write down your questions in advance of your visit. Bring your birth partner or a close friend with you to take notes and ask questions.

Do Not Eat or Drink Eight Hours Before Surgery

Do not eat or drink anything after midnight, the night before your surgery. You may take your medicines with small sips of water. If you have diabetes, your doctor may advise you NOT to take your diabetic medicines since you will not eat.

Rest Up!

Get a good night’s rest before surgery. Having to care for a baby immediately after having a C-section will be exhausting. Rest up to avoid a sleep deficit right before your surgery.

Do Not Shave for One Week

Do not attempt to shave your pubic area. Home shaving can cause tiny nicks in the skin and increase your risk of infection. You will be shaved in the hospital using surgical clippers.

Surgical Prep

Your hospital may have your shower with surgical soap before you arrive.

Relax!

In the days leading up to your surgery, be sure to ramp up your self-care routine. Read, take hot baths, relax, surround yourself with positivity. Having surgery is one of life’s great stressors. Be sure to do all you can to keep your mind at ease. You will meet your baby in the best state of mind possible.

What should I expect on the day of my cesarean section?

• You will likely have an early morning start to your day. Be prepared to arrive at the hospital at least two hours before your scheduled C-section.
• The first member of the team you will meet is your nurse. She will take a detailed history and answer any last-minute questions you may have. Your nurse has several tasks at hand:
  • Start your IV.
  • Draw blood work.
  • Place the baby on the monitor.
  • Provide antacid to neutralize stomach acid just in case you throw up during surgery.
  • Shave the area around your pubic bone.

• You will sign consent forms for surgery if you haven’t done so already.
• The anesthesia team will assess you and take a history. Your anesthesiologist will discuss the type of anesthesia planned and the associated risks.
• If your baby is preterm, you will meet the neonatal intensive care unit (NICU) team. The NICU team is a diverse team of healthcare professionals who care for babies born early. They will inform you and your partner of what to expect.
• Once everything is ready, your nurse will walk you to the operating room.

In the C/Section Operating Room: 

• Your team performs a surgical pause. A surgical pause, or time out, is where your team will have you identify yourself and the intended procedure.
• Your anesthesiologist will perform regional anesthesia to numb you from the waist down.
• A nurse will place wraps on your legs that will blow up intermittently to prevent blood clots from developing.
• A catheter will be inserted into your bladder to drain urine. Keeping your bladder drained reduces the risk of injury during surgery.
• Antibiotics are given in your IV to help prevent infection.
• Your nurse will surgically cleanse your abdomen.
• Your surgeon will place sterile drapes. Sterile drapes help to prevent infection and shields you from seeing your surgery.
• Your arms will be outstretched to the sides and strapped to prevent injury.
• Your doctor will do a test to make sure that your anesthesia is working before beginning the c-section.
• Another timeout or surgical pause takes place before surgery starts. A surgical pause is when your team pauses to identify the patient, the planned procedure, and any concerns.

What Should I Expect During Surgery?

You may feel the pressure of your surgeon’s hands, but you will not feel the pain of an incision. You may also feel some pressure as the baby is being born. You may become nauseated. If so, let your anesthesia team know. They will give you medicine to relieve nausea.

At the time your baby is being born, your partner may stand up and take pictures. Most hospitals prohibit the use of video recordings of the surgery and only permit still photos. When the baby is at the warmer, your partner can record video.

Some hospitals have both a transparent and opaque drape between you and the surgeons. In that case, your surgeon may lower the opaque drape so you can see the birth of your baby. Not everyone will want to have this experience. You and your doctor will decide. Your doctor may also hold the baby up for you to glimpse your baby above the drape.

After stabilizing the baby, they will be swaddled and brought to you for you and your partner to enjoy. The baby nurse and your partner will escort your baby to the recovery room, where you will later join them.

Most C-sections last about an hour. Your first C-section will be the fastest. The time lengthens with each C-section as more scar tissue develops after each surgery.

What is an Emergency (Stat) C/Section?

If an emergency occurs with you or your baby, your doctor may recommend an emergency C-section. The medical term for an emergency C-section is a stat C-section. The most common fetal indication for stat C-sections is fetal distress. If the fetal monitoring suggests that your baby is not receiving enough oxygen, your doctor will recommend an emergency C-section.

Maternal indications for emergency C-section are more varied. Maternal hemorrhage or heavy vaginal bleeding is a common reason for requiring emergency delivery.

Indications for Emergency C/section

• Fetal Distress
• Umbilical Cord Prolapse
• Placental Abruption
• Maternal Hemorrhage
• Maternal Seizures

With a stat C-section, the staff moves very quickly. There is a race against the clock to prevent loss of oxygen that may lead to fetal brain damage. Prompt delivery is required. A key reason you sign a C-section consent when you first arrive at the hospital is to avoid the loss of valuable time in case an emergency C-section is required. While seeing all the staff move so speedily around you can be scary for you and your family, rest assured, this is best for you and your baby.

For a stat C-section, you may require general anesthesia if you do not have an epidural. There will not be enough time to administer regional anesthesia. With general anesthesia, you’re asleep. Your anesthesiologist places a tube in your throat, which is attached to a machine that helps you breathe. Unfortunately, this means you will not be awake for the actual birth of your baby. Your support person will not be allowed in the operating room if you receive general anesthesia. You and your partner will see your beautiful baby in the recovery room.

With a stat C-section, the staff moves very quickly. There is a race against the clock to prevent loss of oxygen that may lead to fetal brain damage. Prompt delivery is required.

What happens after the c-section is over?

• If your baby does not need NICU care, you will be able to hold your newborn when you get to the recovery room.
• Your team will monitor your temperature, blood pressure, urine output, vaginal bleeding, and pain level.
• Your nurse will massage your uterus intermittently to ensure you are not bleeding excessively.
• As the anesthesia begins to wear off, you will be able to start wiggling your toes. Sensation will gradually return, starting in your feet and moving upward.
• As the feeling returns, you will begin to notice pain and numbness around your incision. Your team will make sure the pain medications keep you comfortable before taking you to the postpartum room.
• Don’t be surprised at the speed of your recovery. You will be allowed to start eating shortly after surgery.
• You are allowed to get out of bed with assistance either a few hours after surgery or the following morning.
• A nurse or tech will remove your bladder catheter and encourage you to urinate the morning after surgery.
• Studies show that walking within four hours after delivery and for at least ten minutes four times a day makes your body recover faster. Early walking causes your intestines to get back to normal faster and decrease the chance of developing a blood clot in your vein. Early ambulation also reduces your risk of respiratory infection. Gentle walking is an essential part of your recovery.
• Expect discomfort the first few times you get up. Some pain is normal, but it will continue to improve daily.

One Day After Your C/Section

If not already done, your nurse or tech will remove the bladder catheter. She will assist you out of bed to the bathroom to attempt urination. If you have an incisional dressing, you may remove it during your shower. Removal during the shower will reduce your discomfort from the tape pulling on your skin.

Your doctor will switch your pain medicines from IV to pills. Don’t forget that you may need to request pain pills. Your nurse will not give them automatically. Using a breathing tool called an incentive spirometer will encourage your body to take deep breaths, which helps prevent lung infection. You will be encouraged to walk. Walking goes a long way in preventing multiple complications and boost recovery.

Don’t forget that you may need to request pain pills. Your nurse may not give them automatically.

I’m Home, Now What?

• Barring any complications, you can anticipate a discharge from the hospital anywhere from two to four days after your C-section.
• If you can stay on top of the pain, it will be easier to get around, and you can care for yourself and your baby better. A good regimen is to alternate non-opioid pain medicine with opioids regularly. So, alternate your ibuprofen with percocet or lortab. After a few days, you will be able to limit your opioid use to nighttime only and eventually phase them out altogether. Discuss this with your physician.
• Deep breathing and coughing exercises are essential to prevent lung infections after surgery. Take a slow deep breath, trying to fill your lungs with air. Hold it for two seconds and then slowly release the air, forcing out every last bit at the end. Try to do a few of these every hour for the first four days you are home. Holding a pillow against your incision as you breathe or cough makes it more tolerable.
• You may notice that the swelling in your feet and hands worsens when you get home. You received a lot of IV fluids in the hospital, so be patient, drink a lot of water, elevate your feet as much as you can. The swelling will gradually improve. If you notice excessive facial swelling with headaches or visual changes, contact your doctor.
• Don’t forget that although common, a cesarean section is major surgery, and you have to take care of yourself, too. Accept help with cooking, cleaning, and child care. Don’t try to do it all yourself.

Persistent heavy lifting places stress on the wound and can lead to your incision opening up. You must avoid heavy lifting for four to six weeks after surgery to minimize stress on the healing wound.

• Use an abdominal binder to help you feel more stabilized as your incision and muscles heal. Don’t try to use your abs to transition from lying to sitting. Roll to your side and use your arms to push yourself up instead.
• Your incision might look a little pink and swollen when you get home. Call your doctor for signs of infection such as drainage, redness, fever, chills, or foul odor from the wound. Numbness and tingling around the incision are normal and will get better with time.
• Heavy lifting and lifting from a squatting position increase your intra-abdominal pressure, which then pushes against the wound. Increased pressure against your wound can cause it to open up. Ask your doctor what weight limit is appropriate for you. For some, it may be anywhere from 10-15 lbs. Some surgeons recommend avoiding lifting anything heavier than the baby. Persistent heavy lifting places stress on the wound and can lead to surgical complications. You must avoid heavy lifting for four to six weeks to minimize stress on the healing wound.
• Do not drive if you are taking narcotics. If you do, you will be driving under the influence. You should put off driving until you can turn your body quickly without hesitation. You will need to be able to turn your head and body and move your legs without pain. Give yourself a minimum of two weeks after surgery before attempting to drive. You may slowly increase aerobic activities, depending on your level of discomfort.
• Resume sexual intercourse when vaginal discharge stops, and you feel ready. Remember to use contraception because you can still ovulate unexpectedly and get pregnant in the postpartum period, although it is less likely.

Do not drive if you are taking narcotics. Give yourself a minimum of two weeks after surgery before attempting to drive.

Lastly, remember that recovery from surgery is a process, so be patient and enjoy your time with your new baby.

Written by: Lisa Ann Shephard, MD | Editor: Dayna Smith MD | Reviewed: July 30, 2021 | Copyright: myObMD Media, 2021