Cesarean Or C Section Delivery.

My doctor just told me I may need to have a Cesarean delivery or C Section, and I'm scared. What is it exactly?
When a woman has a Cesarean delivery (also called a C section), her baby is delivered through an incision made in her abdominal wall and uterus.

I've read that more Cesareans are being done today. Is this true?
There has been a change in the rate of C-sections. In 1965, 4% of all deliveries were by Cesarean. In the 1980s and 1990s, the C-section rate rose to 20 to 25%. Today in the U.S., the rate has dropped, and only 15 to 20% of all deliveries are Cesarean deliveries.

Why are there more Cesarean deliveries today than when my mom had me?
We believe the increase is related to better monitoring during labor and safer procedures for Csections. Women are also having bigger babies. Another factor in this increase may be rising malpractice rates and the fear of litigation. However, the goal is the same a safe delivery of the baby and the safety and health of the mother.

How is a C section done?
The doctor makes an incision through the skin of the abdominal wall down to the uterus, then cuts the wall of the uterus. He or she cuts the amniotic sac containing the baby and placenta, and removes the baby through the incisions. After delivering the baby, your doctor removes the placenta and closes the uterus in layers with sutures that are absorbed (they don't have to be removed), then the abdomen is sewn together.

If I have to have a Cesarean, can I be awake?
With most C-sections, the anesthesiologist will give you an epidural or a spinal anesthetic. You are awake with these.

Can't my doctor tell if I'll need a C section before I go into labor?
It would be nice to know this so you wouldn't have to go through labor, but it isn't that easy. We often have to wait for labor to see how your baby handles it and to see if the baby fits through the birth canal.
Research has indicated that a woman's weight may be an indicator of whether she will have a Cesarean delivery. A woman's body mass index (BMI) a ratio of her height to her weight may be used to predict whether a C-section may be necessary. A survey of over 2,500 women found that mothers with a higher BMI had more Cesarean deliveries. The reason it is important to determine whether risk of a Cesarean delivery is higher is to help medical personnel prepare for an emergency C-section. This can be done by inserting an epidural catheter for regional anesthesia, which is considered safer than general anesthesia for obese women.

Are there any advantages to having a Cesarean delivery?
The most important advantage is delivery of a healthy baby. Babies usually do well after a C-section. Studies show babies who are delivered by Cesarean section do as well on the Apgar tests as babies that are born vaginally.

I'm sure there are disadvantages to having a C-section. What are they?
This is major surgery and carries with it the risks of major surgery. You will probably have to stay in the hospital 2 or 3 days.

Does walking during labor make labor easier and reduce the chance of a Csection?
A recent study found that walking did not provide any harm or benefit over resting in bed. Their conclusion was that a woman should be allowed to choose whichever option works best for her.

How long does it take to recover from a Cesarean?
Recovery at home takes longer with a Cesarean than it does with a vaginal delivery. The normal time for full recovery is 4 to 6 weeks.

How many Cesarean deliveries can a woman have?
There is no exact number. Many doctors recommend no more than two or three, but this is evaluated at the time of each delivery. We know of one woman who had eight C-sections! But this is unusual.

Some women at my childbirth-education class said if you have a Cesarean, you've failed as a woman. Is this true?
No! If you have a Cesarean, you have not failed in any way! The goal in pregnancy, labor and delivery is a healthy baby and a healthy mother. In many situations, the only way to achieve that is with a Cesarean delivery.

If a woman has repeat Cesarean sections, how does the doctor perform the surgery? Is a new, different incision made for every birth?
Usually your doctor will use the same incision site for each delivery. If you have a large scar, your doctor may cut out the old scar.

Vaginal Birth after Cesarean (VBAC)
I've heard that once you have a Cesarean, you must always have one. But don't some women deliver vaginally after having a Cesarean?
In the past it was believed that once a woman had a C-section, all later deliveries would have to be Cesarean also. Today it is becoming more common for women who have had a C-section to deliver vaginally with later pregnancies. This is called vaginal birth after Cesarean (VBAC).

How does a woman know whether she can have a VBAC?
Your doctor must consider various factors in making this decision. The type of incision done with the Cesarean delivery is important. If the incision on the uterus (not the woman's abdomen) is high, labor is not permitted in subsequent pregnancies. If the woman is small and the baby is large, it may cause problems. Multiple fetuses and medical complications, such as diabetes or high blood pressure, may require a repeat C-section.

How many Csections can I have and still be a candidate for VBAC?
The American College of Obstetricians and Gynecologists states two Cesarean deliveries are all right, other factors permitting. This is a very individual decision. Discuss it with your doctor.

What factors determine whether I can have a vaginal birth after having had a C-section?
The following situations give a woman the best chance of having a successful vaginal delivery after a C-section:
•   The original cause for a Cesarean delivery is not repeated with this pregnancy.
•   The woman has no major medical problems.
•   The incision on the uterus from the previous C-section is low.
•   The baby is a normal size.
•   The baby is in the normal head-down position.

If I want to try a vaginal delivery after a C section, what should I do?
The most important thing to do is to discuss it with your doctor well in advance of labor, so plans can be made. It may be helpful to get the records from your other delivery. Discuss the benefits and risks, and ask your doctor for his or her opinion as to your chances of a successful vaginal delivery. He or she knows your health and pregnancy history. Include your partner in this decision-making process.