Childbirth: Caesarean section

In Canada and in Quebec, a little over 1 in 4 women give birth by caesarean section. During this procedure, the baby is born through an incision made in the mother’s womb and uterus.

In some cases, caesarean delivery can be beneficial to both mother and baby, potentially even saving their lives. In other cases, the benefits to mother and baby are few or even doubtful. Furthermore, just like any surgical procedure, a C-section carries risks. When deciding whether to undergo this procedure, all associated benefits and risks must be taken into account. Should the possibility of a C-section arise, don’t hesitate to ask questions in order to fully understand the reasons behind it.

Why is a C-section performed?

The decision to perform a C-section is usually made based on the condition of the baby and the mother. In some cases, the doctor may even decide to schedule a caesarean section before labour begins to protect the health of the baby or the mother. In other cases, the decision to perform a C-section is made during labour. This is called an emergency or unplanned caesarean section, depending on the situation.

Planned C-sections

A C-section may be planned for reasons related to the baby.

• The baby’s position
  A baby’s position isn’t always favourable to a vaginal delivery. In 3–5 percent of pregnancies, the baby has an abnormal presentation, leading by the brow, face, buttocks, feet, or even shoulder rather than the head. When this occurs, at week 36 or 37 of the pregnancy, the doctor can attempt an ECV, or version, a procedure used to turn the baby into a head-down position if they are breech. This manoeuvre doesn’t always work, however, and it isn’t always possible due to medical reasons. In such cases, a caesarean section may be scheduled.
• The baby’s size
  A C-section is necessary if the health care professional feels that the baby is too large for the diameter of the mother’s pelvis.
• The baby’s growth
  If the baby’s growth is severely delayed, a C-section may be required to deliver the baby early.

A C-section can also be planned for reasons related to the mother.

• A previous C-section
  The old adage “Once a C-section, always a C-section” is no longer necessarily a given. The decision to perform a second C-section depends on the reason for the first surgery and the type of incision that was made. Today, 60–80 percent of mothers who’ve had a caesarean delivery in the past will be able to give birth vaginally in the future. For more information, read our fact sheet on vaginal birth after caesarean section (VBAC) (text in French).
• Problems related to the placenta
  At the time of your first ultrasound, the placenta may be covering your cervix. If it doesn’t move back up during the pregnancy and is still partially or fully blocking the cervix (placenta previa), a caesarean section will need to be scheduled. Similarly, a C-section is necessary if the placenta remains firmly attached to the uterine muscle (placenta accreta, increta, or percreta), or when the blood vessels connecting the fetus to the placenta lie across or too close to the cervical opening (vasa previa).

Download your C-section birth plan to map out your preferences for labour.
 

• The mother’s health
  A caesarean section may be necessary if the mother has a hypertensive disorder (e.g., preeclampsia) or diabetes and that has resulted in a high birth weight that would make it difficult for the baby to pass through the mother’s pelvis.
• Various infections
  A caesarean section may be required if the mother has an infection. For example, if the mother has active herpes lesions on her vulva or vagina, a C-section should be planned to prevent the baby from becoming infected during delivery.
  
  On the other hand, it’s possible for a woman living with HIV to have a vaginal delivery, as long as appropriate treatment is started early. She would need to discuss this with her treating physician.

Emergency or unplanned C-sections

In some cases, the decision to perform a caesarean section is made during labour. This is called an emergency or unplanned C-section, depending on the situation.

• Labour is not progressing
  This is the most common reason for having a C-section. In some cases, the mother’s cervix stops dilating for several hours despite strong and regular contractions. In other cases, the cervix may be fully dilated to 10 cm, but the baby isn’t descending into the pelvis or birth canal for delivery. If other methods used to advance labour are unsuccessful, an unplanned C-section will be required.
• Concerns about the baby’s well-being
  This is the second-most-common reason for having a C-section. Typically, the main concern is unusual changes in the baby’s heart rate during labour. If the baby’s health appears to be at risk and delivery is not imminent, an emergency caesarean section may be recommended.
• The placenta detaches from the uterus (placental abruption)
  The placenta needs to remain attached to the uterus until the baby is born. Premature placental abruption can cause severe bleeding and deprive the baby of the oxygen they need. In these cases, it’s necessary to do an emergency caesarean section.

How is a C-section performed?

In the case of a scheduled C-section, a nurse will help you prepare for the surgery. Certain aspects may vary from one hospital to another.

Here are some guidelines you may need to follow.

• Fast from midnight the night before your C-section, and no water for a few hours before the procedure.
• Change out of your clothes and into the ones provided by the hospital (gown and cap for the operating room).
• Remove all jewelry to reduce the risk of burns from the electrocautery instrument, which conducts heat. This instrument may be used to reduce bleeding from small blood vessels during the surgery.
• Do not wear makeup before coming to the hospital and remove any nail polish if possible.
• Do not wear contact lenses.
• Shave the area above your pubic bone before the operation to reduce the risk of surgical wound infection.

To ensure your safety, the following steps may be taken.

• An IV will be inserted to administer medication before, during, and after the operation. In most hospitals, you may also be given an antibiotic before surgery to prevent infection.
• C-sections are usually performed under epidural anesthesia or a spinal block. The anesthesiologist will explain each step, and a nurse will be nearby to provide guidance and support. When an emergency caesarean section is required, the health care team may choose to put you under general anesthesia.
• A urinary catheter will be placed in your bladder to keep it empty during the operation. This reduces the risk of bladder injury and helps the baby come out. The anesthesia used during surgery also reduces the feeling of a full bladder in the hours following your operation. The catheter will ensure that your bladder is emptied until the anesthesia completely wears off.
• An antiseptic solution will be applied to your abdomen once it’s confirmed that the anesthesia is effective. Your abdomen and legs will be covered with a sterile sheet. Once these steps are complete, your labour partner may be able to join you if the situation allows.

In general, the same steps are followed whether a caesarean section is planned or unplanned. However, since the goal is to deliver the baby quickly and to stabilize the mother, the order may differ.

After the surgery

Once you are transferred from the recovery room to your hospital room, you should be alert enough to hold your baby. You will be able to get up for the first time within 6–7 hours post-surgery, depending on the type of anesthesia, the medication used, the dosage, how quickly your body eliminates the effects of the anesthesia, and your pain management.

For your safety, you must have someone with you in your hospital room to help with your care for the first 24 hours after the C-section. They can help lift your baby out of the crib, or change the baby’s diaper for you if you’re still in bed.

Possible consequences of a caesarean section for the mother

Caesarean sections generally go smoothly. However, as with any surgery, a C-section can impact the mother’s recovery from childbirth.

• More and more birthing centres are promoting skin-to-skin contact immediately following a caesarean delivery (see box below). However, if the mother’s health does not allow it, there may be a delay before she can have skin-to-skin contact with her baby, particularly in emergency situations.
• There is a greater risk of pain following the operation and once the mother is back at home.
• The risk of infection at the wound site, in the uterus, or in the urinary tract (if a urinary catheter has been used) is also greater. Antibiotics can be prescribed to prevent or eliminate the infection.
• The risk of bleeding and clotting issues is increased.
• There is usually more blood loss after a C-section than after a vaginal delivery, which can lead to iron deficiency. Your doctor may prescribe iron tablets. A nutritious diet during and after pregnancy will ensure you have good iron reserves in anticipation of the birth and help replenish your reserves afterwards.
• As with any other surgical procedure, anesthesia and pain medication may cause constipation. Drinking regularly to satisfy your thirst and eating foods rich in fibre will help eliminate this discomfort. Moving as soon as possible after surgery will also help stimulate your bowels. If necessary, your doctor may prescribe medication to relieve constipation. The medication must be taken regularly, especially in the first 24 hours.
• The mother may have an emotional reaction to the disappointment of giving birth by caesarean section (e.g., anxiety and depression). These feelings may arise shortly after delivery or later in the recovery period. Regardless of when they come up, it’s important for the mother to share them with her doctor or midwife so that she can receive professional support before she leaves her birth location or once she gets home. This is especially important because depression can interfere with the parent-child bond.
• The likelihood of having to return to the hospital due to complications (e.g., bleeding) is greater.

Risks specific to women who’ve had a previous caesarean delivery

A mother who has already given birth by caesarean section is at greater risk of the following during a future pregnancy or delivery:

• The likelihood (20–40 percent) of a repeat caesarean delivery if conditions don’t favour a vaginal delivery.
• A small risk (approximately 1 percent) of having a placenta-related problem, such as the placenta covering the cervix (placenta previa) or detaching from the uterus before the baby is born (placental abruption). This risk increases with the total number of caesarean sections.
• A small risk (1 percent) of uterine rupture in future pregnancies. The level of risk may vary depending certain factors, such as the type of incision made during the previous caesarean section.

Possible consequences of a caesarean section for the baby

There are few significant consequences associated with caesarean birth for the baby. However, it can sometimes lead to the following:

• Mild and usually transient respiratory distress. The baby’s lungs may also contain slightly more secretions than if they had been born vaginally, since they weren’t able to expel them during passage through the vaginal canal.
• Lower body temperature, as operating rooms are cooler than normal room temperature. Skin-to-skin contact with one of the parents soon after birth helps to remedy this situation.
• Transfer to the neonatal care unit for closer observation and additional care if the caesarean section was performed after a long and difficult labour. However, if the baby’s condition is good at birth, they will go directly to the hospital room with the parents.

Recovering from a C-section

Postpartum recovery can be longer after a C-section. The mother may stay at the hospital 1–2 days longer than if she’d had a vaginal delivery. Increasingly, however, doctors are offering women who have had a planned C-section the option of being discharged 48 hours after giving birth, as long as both mother and baby are recovering nicely.

For more information, read our fact sheet on C-section recovery (text in French).

Things to keep in mind

• A caesarean delivery is sometimes needed to ensure the safety of the mother or baby.
• As with any surgical procedure, a C-section can affect the mother’s recovery.
• Caesarean delivery has few major consequences for the baby.

Scientific review: Roxanne Piché, nursing adviser, Maternal Fetal Medicine Clinic, CHU Sainte-Justine Research and copywriting:The Naître et grandir team Updated: April 2021

Photo: iStock/RapidEye