Medically reviewed by Mark Zakowski, MD, June 12, 2024.
C-Section
“C-section” (short for “cesarean section”) is the commonly used term for a procedure clinically known as a cesarean delivery. This is a type of surgery in which a baby is delivered through incisions in the mother’s abdomen and uterus. In 2022, about 32% of all births in the United States were cesarean deliveries, according to the National Center for Health Statistics.
When is a C-section needed?
A cesarean delivery is needed if a baby can’t be born vagin*lly for reasons such as the positioning of the baby or placenta, or because of other health risks to the mother or baby. Some C-sections are planned, but many are done when unexpected problems occur during labor for a planned vagin*l delivery.
What is the procedure and how long does it take?
In most cases, the physician makes a horizontal incision of about 4 to 6 inches in the abdomen, at or near the pubic hairline, then makes an incision in the uterine wall and delivers the baby through that opening. If everything goes smoothly, the procedure often takes about an hour. The baby can usually be taken out in 10 to 15 minutes, or even faster in an emergency. After the baby is delivered, the womb and the various layers of the abdomen are carefully stitched up. This stitching takes longer than the delivery and accounts for the majority of the procedure time.
What type of anesthetic will I receive so I don’t feel pain?
According to American Society of Anesthesiologists® practice guidelines, a spinal block or epidural is preferred for most cesarean deliveries because the baby is exposed to the lowest amount of medication, the mother can still actively participate in the baby’s birth, and it is generally considered safer for the mother. However, general anesthesia may be necessary in some cases.
- For an epidural, a small area on the back is numbed with the injection of a local anesthetic. Then an anesthesiologist inserts a tiny tube called a catheter through a needle inserted in the lower back. The needle is removed and the catheter is left in place so anesthesia medication can be delivered through this tube as needed, to numb the entire abdomen for surgery. Although there is no pain, there may be a feeling of pressure as the needle is being inserted.
- For a spinal block, an anesthesiologist injects medication into the spinal fluid through a needle inserted in the lower back. After the medication is administered, the needle is removed. The relief from pain is immediate and lasts from an hour and a half to three hours. The mother is numb from the abdomen to the legs and feels no pain.
- General anesthesia is the only pain relief method used during labor that causes a loss of consciousness. The mother is not awake for the birth of the baby. With general anesthesia, the baby may be exposed to some of the medications before delivery.
Whether you have general, spinal, or epidural anesthesia for a cesarean birth will depend on your health and that of your baby. It also depends on why the C-section is being performed.
- For a planned C-section, you may have a choice of anesthetic, although you should be aware that spinal blocks and epidurals are generally considered the safest options for both you and your baby.
- In an emergency or when bleeding occurs, general anesthesia may be necessary.
- If you already have an epidural catheter in place during labor and then require a C-section, your anesthesiologist can usually inject a higher concentration of a local anesthetic or a combination of stronger drugs through the same catheter to increase your pain relief.
Research has found disparities in the type of anesthesia used for cesarean deliveries, with Black and Hispanic women receiving general anesthesia at higher rates.
The ASA® Committee on Obstetric Anesthesia, noting this disparity, advised anesthesiologists in October 2023 on best practices for pain management during delivery. Those practices include shared decision-making, in which the anesthesiologist meets with the patient before surgery to explore “the risks, benefits, and alternatives to treatment options in a collaborative fashion.” Consult with your anesthesiologist about the best option for you. And if you feel discomfort or pain during a C-section, let your anesthesiologist know—they can treat it.
What are the risks of the surgery?
Like any surgery, a C-section carries some risk. As explained by the American College of Obstetricians and Gynecologists, complications occur in a small number of patients and usually are easily treated.
These potential complications include:
- Infection
- Blood loss
- Blood clots in the legs, pelvic organs, or lungs
- Injury to surrounding organs, such as the bowel or bladder
- Adverse reaction to medication or anesthesia
How do I manage my recovery?
Your recovery time will be longer than for a routine vagin*l delivery, and you will have to follow some physical restrictions during the weekslong healing process (e.g., not lifting anything heavier than your baby). Your medical team will talk to you about signs of infection and how to prevent it, as well as other postoperative care.
For as-needed pain relief in the days and weeks following the operation, consult with an anesthesiologist, who is specially trained in pain management. Many hospitals and anesthesiologists use a protocol called “enhanced recovery after cesarean” to give the mother high-quality pain relief and minimize the need for opioids (narcotics). This protocol involves various steps taken before, during, and after surgery related to eating and drinking, walking and moving around, the types and timing of medicines used, and more. Non-opioid forms of pain relief—such as acetaminophen, anti-inflammatories, and local anesthetic medications—are prioritized.
Will the surgery leave a scar?
Yes, although in the long term it may not be very visible, even in a bikini, because of where the incision is made and because the scar fades somewhat over time. However, this varies from individual to individual. Sometimes during the surgery, a vertical incision is required instead of a horizontal one, leaving a more visible scar.
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