Cesarean delivery can be a life-saving intervention for both mother and baby if complications arise during childbirth. There are a lot of reasons why doctors might decide a cesarean or c-section is better for a pregnant woman than vaginal delivery. That said, the rate of cesarean sections has increased dramatically without evidence of medical necessity. This has raised concerns that the procedure is used unnecessarily. Knowing the short and long-term effects of a cesarean section is key to preventing the overuse of this potentially life-saving procedure.
A cesarean section is a surgical option for delivering a baby. The surgeon makes an incision through the uterus and manually removes the baby. Sometimes, c-sections are planned, but complications during labor for a vaginal birth can also prompt doctors to perform emergency cesarean sections. About one in three women delivers via c-section, but the procedure is a major surgery and does involve many risks.
Sometimes, a cesarean section is necessary due to problems with the baby. If there are changes in the baby's heartbeat during labor, any problems with the umbilical cord, or if the baby is breech (turned in the birth canal), a c-section is the best option for delivery. These issues may or may not be known in advance of the beginning of labor. The procedures are also common for women expecting multiples, particularly if the leading baby is breech or if the mother is carrying three or more.
Cesarean sections are also necessary if the mother-to-be experiences problems during labor. Stalled labor is one of the most common reasons for a c-section. This happens when the cervix isn't opening enough to deliver the baby, even though the mother has been experiencing contractions for several hours. Anything obstructing the birth canal also results in a c-section, including large fibroids or a pelvic fracture. A c-section is also the safer choice if the mother is experiencing an active genital herpes outbreak, to prevent the baby from acquiring it when it passes through the vagina, or if she has an existing medical condition such as diabetes or high blood pressure that would make active labor difficult or dangerous.
VBAC stands for vaginal birth after cesarean. After you have a c-section, you can attempt to give birth vaginally during future pregnancies. This is referred to as TOLAC or trial of labor after cesarean delivery. If a vaginal birth is possible, the mother has had a successful VBAC. If complications arise, another c-section is necessary. There are some risks to a VBAC. The most serious is uterine rupture, which occurs when the scar from the previous c-section opens during labor. This complication is very rare but life-threatening when it does occur.
Scheduling a cesarean section that is not medically indicated can cause many complications. If the due date was calculated incorrectly, there's a chance the baby will be born too early. For this reason, doctors recommend women wait until 39 weeks to schedule a c-section. It is best to wait for labor to begin on its own because this gives the baby optimal time for lung and brain development. Also, as with any surgery, there are risks and surgical complications to consider. Your doctor will recommend a c-section only if the benefits outweigh the risks.
Women who have multiple pregnancies may wonder if it's okay to have multiple cesarean sections. The truth is that each c-section has more risk of complications than the previous one. Women who have multiple c-sections are at risk for bowel and bladder injuries, heavy bleeding, and placenta accreta or placenta previa with future pregnancies.
After a cesarean section, most women remain in the hospital for two or three days, which is longer than after a vaginal delivery. The medical team monitors vital signs and makes sure your uterus is contracting and becoming firmer as you recover. At first, recovery is painful, but for most women, pain decreases a lot over the first few days. Women are usually encouraged to breastfeed right after surgery, though this can be difficult due to the pain and numbness from the surgery itself.
After returning home from a cesarean section, you will need help caring for yourself and the baby. Vaginal bleeding may occur for up to six weeks. It should slowly get lighter and lighter until it turns yellow or white. The surgical incision will be slightly raised, puffy, and pink at first and become thinner and flatter over time. You will need to care for your incision following the medical staff's instructions.
Recovering from a cesarean section is similar to recovering from other abdominal surgeries. Getting up and moving around is important as it prevents blood clots, but you should avoid strenuous activity like jogging, running, and heavy housecleaning until cleared by your doctor. You should also not lift anything heavier than the baby for up to eight weeks. Expect to tire easily and listen to your body — don't push yourself.
Experts note that concerning risks accompany the increased national rate of cesarean sections. Risks for maternal morbidities (shock, cardiac arrest, hemorrhage, and more) for c-sections are three times higher than for vaginal births. Placenta abnormalities in future pregnancies are also more common after a c-section. For these and other reasons, most doctors suggest only getting a cesarian section if a vaginal delivery poses a greater risk.
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