Cesarean Delivery: When It's Needed, How It's Done, and the Risks

A cesarean delivery — also called a cesarean section or c-section — is surgery to deliver a baby through the abdomen. In the United States, almost one in three babies are born this way. Some are planned; others are emergencies, done when unexpected problems arise during delivery.

When it may be needed

• the mother has health problems, including infection;
• she is carrying more than one baby;
• the baby is too big;
• the baby is in the wrong position;
• the baby's health is in danger;
• labor isn't progressing as it should;
• there are problems with the placenta, the organ that brings the baby oxygen and nutrients.

Having had one cesarean doesn't necessarily mean needing another. A vaginal birth after cesarean (VBAC) may be possible; a health care provider can advise.

How it's done

Pain relief comes first, depending on the circumstances:

• an epidural block, which numbs the lower body through an injection in the spine;
• a spinal block, which numbs the lower body through an injection directly into the spinal fluid;
• general anesthesia, which makes the mother unconscious — often used in emergencies.

During surgery, the surgeon:

1. makes a cut in the abdomen and uterus — usually horizontal, sometimes vertical;
2. opens the amniotic sac and lifts out the baby;
3. cuts the umbilical cord and removes the placenta;
4. closes the uterus and abdomen with stitches that later dissolve.

Risks

A cesarean is relatively safe for mother and baby, but it is major surgery. Risks include:

• infection;
• blood loss;
• blood clots in the legs, pelvic organs or lungs;
• injury to nearby organs such as the bowel or bladder;
• a reaction to medicines or anesthesia.

Some of these risks also apply to vaginal birth. But recovery from a cesarean takes longer, and it can raise the risk of problems in future pregnancies — a risk that grows with each cesarean.

Sources

• MedlinePlus, National Library of Medicine: "Cesarean Delivery," with information from the National Institute of Child Health and Human Development, National Institutes of Health.