C-Section Delivery
Childbirth and Labor: Cesarean Section

Giving birth by cesarean section


C-Section Delivery


What Is A Cesarean Section?
Why The Increase In C-Section Deliveries?
When Are They Performed?
How Long Does It Take?
How Much Does It Cost?

Having a Baby
For a delivery overview, see:
Guide to Childbirth

What Is A Cesarean Section?

A Cesarean section (image) is also called a C-Section. It is a surgical procedure where the baby is delivered through an incision of the abdomen and uterus. C-Sections have been performed for thousands of years to save the lives of children but invariably it always caused the death of the mother. Fortunately with medical advancements maternal deaths from hemorrhage and infection are very rare. Cesareans are in fact the most common operation performed on women in the United States today. According to the American Academy of Family Physicians (AAFP), Cesarean delivery rates are at an all time high of more than 31 percent of all deliveries. This figure has risen 50 percent over the past decade. Sometimes caesarean's are planned, in particular where known pregnancy complications have been diagnosed or where a previous C-Section has ruled out a normal vaginal birth. In other cases, complications which arise during delivery and childbirth may prompt the necessity for a C-Section.

Why The Increase In C-Section Deliveries?

1. The increasing widespread use of fetal monitoring, which picks up signs of fetal distress, promotes the use of C-Sections rather than continuing with a vaginal birth.
2. The AAFP’s ruling which insists that any previous surgical delivery must now rule out a normal vaginal birth for subsequent children.
3. The AAFP also called for all breech births to be delivered with a C-Section.
4. More insurance policies are now covering the costs of C-Sections.
5. Increasing trend in births to mothers undergoing pregnancy after 35.
6. Increase in IVF (In Vitro Fertilization) and other infertility therapies, resulting in multiple births.
7. Is there a limit? How many cesareans can you have?

When Are They Performed?

Repeat Cesarean’s account for 35 percent of all C-Sections performed. This is where a C-Section is performed to avoid rupturing the scar of a previous Cesarean. The AAFP’s advice is against a vaginal birth after Cesarean (VBAC).

Another common cause is dystocia, which is an abnormal or too slow (stalled) progression of labor. This accounts for about 30 percent of all Cesarean’s. Failure to progress through the stages of labor, either because the cervix is not dilating or the head of the baby will not or cannot descend through the mother's pelvis. See also labor induction techniques.

Breech Baby: Abnormal presentation of the baby accounts for just over 12 percent of all Cesarean’s.

Fetal Monitoring: If your baby's heart beat is too weak, or indicates fetal distress or asphyxia your midwife may recommend a C-Section. This accounts for about 10 percent of all Cesarean’s.

Slightly less common causes are hemorrhaging due to placenta previa, preeclampsia, eclampsia or serious infection. Also in the case of RH factor incompatibility, HIV virus and hepatitis B or C.

Why Do Some Women Choose A C-Section?

More women are choosing to have C-Sections performed without any medical necessity to do so. The term 'too posh to push' became a popular catch phrase in the noughties when film stars elected to have C-Sections to prevent too much stretching of the stomach by waiting for a later natural delivery (avoiding stretch marks in the process). This is substantiated by statistics which show that 23 percent of women from a higher socioeconomic group are likely to have a C-Section, compared with just 13 percent of those from low income groups.

What Is the Procedure?

There are two main types of Cesarean procedures: (1) Cervical Incision, also known as the Kerr Incision which leaves a scar just top of the bikini line. (2) The Classic C-section, which leaves a vertical scar across the belly.

Cervical Incision/Kerr Incision

In recent years, doctors increasingly prefer to use this method because of its lower risk of complications, blood loss and post-operative infections. An incision is made by the surgeon, through the belly tissue, just above the bikini line. The doctor will then cut through the tissues which lie above the uterus and then make a horizontal incision of the uterus itself. Amniotic fluid is suctioned out. The doctor can usually then lift the baby out without complications. He may use an instrument, such as a forceps or vacuum extractor to help him. Sometimes, because of space issues (where the baby is too small or too big), a vertical incision (Kronig-Selheim) is performed instead.

Classical C-Section

This technique may be more familiar to an older generation of women. Nowadays this procedure is usually only performed in emergency Cesarean’s, where speed is of the essence (such as a very premature baby). Usually a vertical abdominal (tummy) incision is used which can leave a larger scar than with a cervical incision. Then a vertical incision is made into the body of the uterus (rather than just the lower portion). This allows for a larger surgical opening to remove the baby, important in an emergency. This particular type of incision however is associated with more bleeding and intra-abdominal infection post-operatively. Doctors have since realized that fewer complications are associated with smaller openings. Women who have gone through a classical C-Section are less likely to deliver further children through a vaginal birth as a result of a high risk of uterine rupture.

Read about how to prepare your body for pregnancy. Also see our Prenatal Care Guide.

What Preparation Is Involved?

1. The first step is to thoroughly wash the lower abdomen area, possibly including shaving the pubic hair.
. An IV is inserted to a vein so that drugs can be administered later.
. Then the expectant mom is moved to the operating room and an anesthesia is administered. This usually comes in the form of an epidural (in a non-emergency C-Section), which numbs the regional area but allows the woman to stay fully conscious. In an emergency section, the woman receives a general anesthetic which means she is not conscious for the procedure. General anesthetic is not usually applied where a woman has already received an epidural and then has to have an emergency section. Usually the birthing partner or coach is allowed to accompany the mother in the operation room, but only after she has received the anesthetic.
. A catheter is inserted into the bladder after the anesthesia has taken effect to ensure that the bladder remains drained of urine.
. If the woman is awake, a screen is placed between her lower and upper body so that she does not have to view her internal organs as the baby is lifted out. Alert your partner beforehand if they are particularly squeamish!
. The area of incision is wiped with an antiseptic and a sterile drape is placed around it. One the woman feels totally numb, the incisions can take place.
. Once the baby and placenta have been removed, first the uterus, then the abdominal tissue is clipped or sutured back together with dissolving stitches. Recently some surgeons are closing the top layer of skin with (Dermabond) Glue. It should be pointed out that a C-section delivery is not a possibility at birthing centers or during a home birth.

How Long Does It Take?

The complete procedure timeline usually takes about 45 minutes (or an hour in the case of a classical C-Section).

How Much Does It Cost?

According to the AAFP the average costs of a C-Section birth without Complications is $11,500 and with complications is $15,500. See also prenatal care costs.

These are hospital fees only. Doctor’s fees are usually charged on top of this and average $1,500. Do ask your hospital in advance for details of any payment plans they may have and check your medical insurance for coverage.

See Next: C-Section Recovery - Guidelines for recovery at home.


For more options for labor and caring for your unborn, see the following:

Natural Labor Induction Methods
Early Signs of Labor
Is An Epidural Safe?

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