What if I need a c-section?

What if I need a c-section?

While most women are able to delivery vaginally, there are several instances that require a c-section. Some of these conditions are known about before a woman begins to labor, and some occur once a woman starts laboring.

Scheduled c-section

There are several common reasons your doctor may discuss scheduling a c-section with you:

▪ Prior c-section

▪ A baby that is not oriented with the head down (breech or transverse lie)

▪ Multiple gestation (twins or triplets)

▪ Abnormal position of the placenta such as placenta previa

▪ A history of uterine surgery such as myomectomy for removal of uterine fibroids

▪ A prior history of shoulder dystocia (the baby “got stuck” at the time of delivery)

If you and your physician decide that you will be delivering by c-section, this is typically scheduled around your 24-week visit. Our nurse scheduler will contact you, typically within three days of this visit, and the two of you will determine a date. Repeat c-sections are usually scheduled around the 39th week of pregnancy. Our office will tell you when to arrive at the hospital on the day of your delivery.

Unscheduled c-section

Sometimes during labor things can happen that make a c-section a safer way of delivering. We always consider very carefully our recommendation of a c-section and always try to make recommendations that are in the best interest of you and your baby. A few of the more common reasons for unanticipated c-section include:

▪ Changes in the fetal heart rate concerning for fetal distress —during labor your contractions and the baby’s heart rate are monitored constantly. Sometimes we see patterns in the heart rate that are concerning. Sometimes the cause of this is easily treated—sometimes it is not. In situations where you are still a long time from delivering and the fetal heart rate is concerning, your physician may recommend c-section.

▪ Failure to progress—sometimes despite medications to cause contractions and despite an adequate contraction pattern, the cervix fails to dilate. Your doctor will check you regularly while in labor and discuss your progress with you.

▪ Changes in the medical status of the mother—unforeseen complications of pregnancy such as high blood pressure or pre-eclampsia can develop at any time in pregnancy. If your doctor feels the condition is serious enough to require delivery early, the cervix may not have started to dilate. If this is the case, your doctor may discuss a c-section with you.


You will receive anesthesia for the c-section. There are several different ways this can be given.

▪ Epidural—this is an injection given into a space in the back. Sometimes a small catheter is placed so that you can receive more of the numbing medications. This can sometimes be used for anesthesia for the c-section if you have been laboring and have an unscheduled c-section. You will be awake for the c-section if this is used.

▪ Spinal—if you have a scheduled c-section, this is the most common form of anesthesia. It numbs the lower half of the body and is placed in a way similar to the epidural. As with an epidural, you are awake for the c-section.

▪ General anesthesia—this is limited to use typically for very emergent deliveries or in cases where adequate pain control cannot be achieved with the epidural or spinal. If this is used, you will not be awake for the delivery.

What happens next?

If you have scheduled a c-section, you should have nothing to eat or drink after midnight. On the day of your c-section you will check in through Admissions at the Emergency Room at Flowers Hospital. You will then be directed to Labor & Delivery. The nurses on L&D will direct you to a room where you will change, an IV will be started, and labwork drawn.

Whether your c-section is scheduled or not, you will meet with the CRNA (nurse anesthetist) and sometimes the anesthesiologist before you go to the operating room. They will discuss pain management options with you. Prior to leaving the labor room, you will be given something to reduce the acid level in the stomach and then taken to the operating room. If you have an epidural in place, more medicine will be given through this prior to the c-section. If not, a spinal will be placed in the operating room. You will be awake for the surgery except in rare circumstances. You will not be able to move your legs, but will feel the sensation of touch and pull. You will not have pain during the c-section.

In the operating room one other person is allowed to be with the mother during the c-section. This person has to remain at the head of the bed until the baby is delivered. Pictures are allowed of the baby, but no pictures can be taken below the drapes. Once the baby has delivered and the nurses are finished taking measurements and assessing the baby, they will take the baby to the nursery. The family member typically leaves at this time with the baby.

Risks of c-section

First of all, understand that vaginal birth and c-sections both carry risks. Some of these risks are similar regardless of mode of delivery:

▪ Risk of infection in the uterus

▪ Risk of damage to major pelvic organs including the uterus, ovaries, bladder, bowel, ureters (the tubes that run from the kidney to the bladder), and major blood vessels or nerves

▪ Risk of bleeding, sometimes significant enough to require blood transfusion

Additional risks specific to c-section include:

▪ An increased risk of damage to major pelvic organs including the ovaries, bladder, bowel, and ureters

▪ Increased blood loss

▪ Risk of infection at the site of the skin incision

After Delivery

After you deliver, you will be taken back to your room on L&D to recover. Your blood pressure, heart rate, and oxygen measurements will be followed. If you and the baby are both stable, you will be able to hold the baby and breastfeed if you are planning to do so (a very common misconception about c-section is that it changes a mother’s ability to breast feed. This is not true). Once your recovery period is over and your vital signs are stable, you will be transferred to a room, typically on 2 South.

For the first 12 hours, you will have multiple things attached to you! A catheter will be in the bladder, and an IV with IV fluids will be running. 12-24 hours after delivery, these things will be stopped, the catheter taken out, and you will be able to move around a little more freely. Your diet will also be slowly advanced to regular food. Your nurse will help you the first few times you get out of bed—do not try to do this alone. She will give you instructions on taking a shower and walking around the hallways.

You can anticipate being in the hospital for 3-4 days. The sooner you are up and moving around, the better. One of the problems that most women are bothered by most is the pressure of gas and bloating. This will pass! You can help this happen sooner by walking in the hallways and being mobile.

When your doctor feels you are ready, you will be discharged home with a prescription for pain medications. You will also be given an appointment to follow-up in our office in four weeks. Please feel free to call the office once you get home with any problems or questions.