Cesarean Birth

A cesarean section (or C-section) is a surgical operation where the baby or babies are born through an incision in the uterus. Today one out of every four or five women in Canada gives birth by C-section. Canada’s C-section rate has increased dramatically over the past four decades. If you are planning to have a doctor deliver your baby, ask your doctor about the cesarean rate at the hospital where you will give birth. C-section rates vary from hospital to hospital, and from region to region.

The most common reasons for a cesarean are:

• dystocia (a slow or difficult labour)

• breech birth (when the baby has not turned into a head-down position but is in a position to be born bottom first or feet first)

• multiple pregnancy (particularly if there are more than twins, although many women do deliver multiples vaginally)

• placenta previa – a pregnancy complication that can cause bleeding before or during delivery

The Society of Obstetricians and Gynaecologists of Canada now recommends a cesarean delivery if the fetus is in a breech position at the time of the woman’s due date.

While cesarean sections can save lives and are usually safe procedures, they do involve major surgery and risks to both the mother and baby. There is an increased risk of infection and needing to be rehospitalized, blood clots, and infertility down the road. Although it is extremely rare for a woman to die during childbirth, there is a greater risk of death to the mother as a result of cesarean compared to vaginal birth. And babies born by C-section are more likely to have respiratory distress and to develop asthma later on.

Many feel that C-sections are performed too frequently, often unnecessarily. For example, the World Health Organization states that no area in the world should have a C-section rate higher than 10 to 15 percent (the rates in both Canada and the US are significantly higher). When it comes to the issue of elective cesareans, the Society of Obstetricians and Gynaecologists of Canada promotes natural childbirth and states that the decision to perform a C-section during labour and delivery should be based on medical indications, as opposed to being available on demand. Similarly, the International Federation of Gynecology and Obstetrics issued a statement, which says that “because hard evidence of net benefit does not exist, performing Caesarean section for non-medical reasons is ethically not justified.”

However, there is no consensus on this issue. The rate of elective cesareans is on the rise and some doctors and healthcare professionals advocate offering all women the choice between a vaginal birth and a cesarean birth, even when a C-section is not medically indicated.

With many cesarean births, there is plenty of time to ask questions before the surgery. Talk to your doctor about why a cesarean is being recommended, the risks and benefits of having a C-section in your particular situation, and what to expect when you have one. Continue to ask questions until you have enough information to help make an informed decision.

A cesarean section is surgery but it is also a birth. There are choices that can be made to make the birth more woman-centred, like having the mother remain awake or having her partner present. Talk to your care provider about the policies at your hospital.

What Happens During a Cesarean Birth?

An anesthesiologist will come to discuss your options for anesthetic. Most cesareans are done with an epidural or spinal anesthesia. A general anesthetic is used in an emergency, when there is little time, or when you cannot have an epidural or spinal anesthesia for some reason.

An IV will be inserted in your arm. The hair on your abdomen and pubic area may be shaved or clipped. You will be given an oxygen mask, which is commonly used until your baby is born. Several people will be present during the surgery. After the anesthesia has been given, your abdomen will be cleaned with antiseptic and a bladder catheter will be inserted to drain urine. If your partner is present, the area from your abdomen up to your shoulders will be draped, and your partner will be asked to sit near your head.

A cut is made in your abdomen, either horizontally above the pubic bone or vertically (necessary in emergencies or some special situations). The uterus is then opened and the baby is born, usually within the first five to 10 minutes of surgery. A pediatrician will be present, as a precaution, in case there is a concern about your baby’s health. If you are awake, you may experience sensations of pressure, tugging or pulling and hear suction sounds during the birth. You may also experience shakiness, and lightheadedness, breathlessness or nausea. The anesthesiologist is there to take care of you and to make sure you are safe throughout the surgery. It will take approximately 35 to 45 minutes to complete the surgery after the baby is born.

Afterwards

After your cesarean, you will be in the recovery room for approximately two hours. In many hospitals, both your partner and the baby can accompany you, if there have been no complications. Women are usually encouraged to get up and move around after the first 12 hours to help speed their recovery.

You will be able to eat solid food in a day or two and can start breastfeeding as soon as you are ready. Your incision may hurt, so put a pillow over it during breastfeeding. The nurse can show you how to hold a pillow against the incision so that coughing, sneezing or laughing is not so painful. Many women experience gas pains for one to four days after the birth and you will usually receive pain medication for the first few days. You will likely be ready to go home after about three days.

Your Next Baby

If you have had a cesarean birth, there is a good chance that you will be able to deliver subsequent children vaginally. Studies suggest this is possible in about 70 percent of cases. If possible, a vaginal birth is preferable, because you can recover more quickly and there are fewer possible complications. However, there is an increased risk of some complications in women who have previously had a cesarean, so you should discuss these issues with your care provider. If a woman has already had more than one cesarean, a cesarean is usually recommended for subsequent births.

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