What is it?
Cesarean birth, often called a C-section, is a surgical procedure that involves delivering an infant through an incision in the lower abdomen.
The incision cuts through seven layers of skin and underlying tissue and muscle, the abdominal wall and the uterus. The newborn is removed from the uterus and, typically, the uterus is then taken out of the body to be stitched shut. This open abdominal procedure is performed by an obstetrician and is considered major surgery with intense physical recovery (think heart surgery) — far more intense and lengthy than uncomplicated vaginal births.
When medically necessary, cesarean birth can save lives. However, it is major surgery and should be weighed with all the risks and possible outcomes in mind. There is significant recovery time and, especially with the demands and routines of a newborn, it may take even longer than expected to fully heal and get back to your “normal.”
If you’re considering a planned cesarean birth, talk with your doctor about recovery, as well as with other people who’ve had the surgery to get some honest, real-life perspectives of what to expect.
Scheduled vs. emergency C-section
- Scheduled cesarean births are performed when you come to the decision with your healthcare provider that vaginal birth is not indicated for you, based on various risks or complications.
- An emergency cesarean birth is the result of high-risk complications that develop during labor. If the health of the baby or the person in labor becomes compromised, it can be determined that a surgical birth is the safest option. While the word "emergency" sounds extreme, every emergency cesarean isn’t always a quick whisk off to the operating room. Depending on the severity of the complications, it can mean that the procedure will happen immediately or within a few hours.
If your provider recommends a scheduled cesarean birth for nonmedical or emergent reasons, it’s completely within reason to ask questions about their recommendations or see another doctor for a second opinion.
How common is it?
The C-section rate in the U.S. is 32%, according to the latest data available from the CDC, with more than 1.2 million babies were born by cesarean. It is the most common surgery performed in the United States. Globally, the countries with the highest maternal survival rate have an average cesarean rate of around 19%. Recent studies suggest that cesarean rates higher than 19% did not correlate to improved maternal survival rates, and that rates below this correlate with higher maternal mortality.
In the U.S., the rate of cesarean birth varies dramatically from practice to practice, hospital to hospital, and state by state. You can also look at cesarean rates by state. Your obstetrician should also be able to provide you with their practice’s cesarean birth rate, as well as the hospital’s cesarean birth rate.
How long does recovery last?
After the surgery, you’ll stay in the hospital for three to four days for immediate recovery, pain management and post-surgical care. Even though your baby wasn’t born vaginally, you’ll still shed lochia, the buildup of uterine tissue, which looks like heavy bloody vaginal discharge. This can last at least four to six weeks.
When you go home, you’ll be given directions on how to keep the incision clean, and not to pick up anything heavier than your baby to prevent stressing the incision site. Cesarean patients are at risk for hemorrhage and infection in the first few weeks post-surgery, and it’s important to follow recovery directions explicitly. Short-term recovery is generally about six to eight weeks, although this can vary, depending on any complications and how much rest you have.
Keep in mind, though, that this is the bare minimum. Many women are able to get back to everyday activities by this time, although they may still be uncomfortable. Driving is not considered safe until about four to six weeks post cesarean birth, because twisting to see blind spots and oncoming traffic can be restricted, and pain medication might interfere with your safety. Sexual intercourse should be avoided until you’ve had your six-week postpartum visit with your doctor and you get the go-ahead to do so, and until you feel physically and emotionally ready for it.
You should call your doctor if you have any of the following symptoms:
- Redness, pain, oozing or warmth near or around the incision
- Foul-smelling vaginal discharge
- Pain with urination
- Breast pain in one or both breasts
- Heavy vaginal bleeding
- Pain, swelling or redness in legs
- Difficulty breathing or chest pain
- Feelings of depression or hopelessness
- Feelings or thoughts of wanting to hurt yourself or the baby
Recovery from major surgery is difficult on its own — recovering from major surgery, plus caring for a newborn, adjusting to all the postpartum changes in your life and battling sleep deprivation can make it even more difficult. If you’re having a hard time, don’t be afraid to call your doctor or lean on your support circle for extra help. This is hard stuff.
What does recovery look like, long term?
While the standard suggestion is that recovery takes six to eight weeks, everyone is different, and many women report much longer cesarean birth recovery times. Some studies have found that 60% of women have pain in the incision site 24 weeks after birth.
Individuals may also have pain deep in the abdomen, as well as back pain as part of the cesarean birth recovery process. Remember, this is major surgery. All the layers of fat, muscle and tissue that were separated need to heal, along with a bodily organ (the uterus). Full recovery should be thought of in terms of months and even longer.
Get lots of rest
Your body needs time to rest and repair itself from surgery. Try to rest and sleep as much as possible: Ask your partner or friends and family to help out, especially in those early days and weeks. Your job is to recuperate and take care of yourself and the baby — while remembering that it’s also OK to let others care for your baby, too.
Manage your pain
You don’t have to be in pain. Ask your doctor which medications are safe for you to take, especially if you are breastfeeding, and take them to relieve your discomfort. You can also look into non-drug approaches to managing pain, like heating pads or using pillows for positioning.
Nursing after a cesarean birth
Sometimes a stressful birth, whether it’s vaginal or cesarean, can cause a slight delay with milk coming in. Milk typically comes in between two and six days post-birth, with colostrum, a thick, sticky, nutrient-rich fluid, coming in first.
Ask to see a lactation consultant (LC) at any time during your hospital stay if you have concerns about your milk coming in. If your cesarean birth is planned, ask your doctor to set up a lactation consultant meeting right after birth to give you early instruction and assistance with nursing your baby. The LC can also show you ways to nurse your baby to minimize any discomfort to your incision area (like lying on your side or using the “football” hold). Ways of holding your baby to nurse are a little different post-cesarean birth in order to minimize use of the abdominal muscles that are healing and minimize any pressure on your incision.
How to prepare
If your cesarean birth is a scheduled one, there are some things you can do to prepare. Even if you are planning for a vaginal birth, it’s always good to keep in mind the possibility of an emergency cesarean birth, and have these in your back pocket if needed.
Be medically prepared
Your doctor may suggest you speak with the anesthesiologist ahead of time — to go over any possible complications or reactions, and check with you about any medical conditions you might have. There may also be blood tests recommended to determine your blood type and hemoglobin levels, which will be helpful in the unlikely event of hemorrhage.
Ask for help
Set up help through friends, family, co-workers, and your extended support system. Similar to what people do during wedding preparation — select a group of your closest friends and family who you can ask to be there for you and support you during this period of intense physical recovery.
Get an app to help you
Apps like Meal Train can be helpful organization tools to identify times when people can come by to help with laundry, food preparation, caring for you and the baby, cleaning the house or running errands.
Get appropriate underwear ahead of time
Pick up undergarments ahead of time! After a cesarean birth, you want to avoid underwear that hits below the navel as there is risk of it rubbing against the incision, especially when moving from sitting to standing. Higher-waisted underwear will help you avoid discomfort from this rubbing and, when combined with compression, can even help reduce swelling and provide extra support and protection.
Many find belly bands (abdominal binders) helpful
Talk with your doctor about whether a belly band is right for you. Belly bands, also called abdominal binders, are commonly provided by hospitals after cesarean birth as they can help with providing support to your healing incision and weakened stomach muscles and increase your comfort. While there is limited quality research on specific medical benefits associated with their use, studies do find that there is a reduction in psychological distress. They can also offer secondary lumbar support, which can prove useful given weakened and healing abdominal muscles.
What are the most common reasons a cesarean is required or recommended?
Labor isn’t progressing
If you’ve been in labor for a long time and your cervix isn’t dilating, despite strong contractions that are getting stronger, a cesarean birth might be recommended. The common hospital term for this is "failure to progress."
If you have placenta previa, where the placenta covers the cervical opening, cesarean birth is recommended.
The baby is in distress
If there are changes in the baby’s heartbeat at any time, or if the umbilical cord becomes prolapsed (it goes through the cervix before your baby does), a cesarean may become necessary for the safety of your baby.
Abnormal position of the baby
Depending on the position of the baby, a cesarean birth may be indicated, especially if the shoulder is in a presenting position (transverse). While it is possible to vaginally deliver a breech (feet- or buttocks-first) baby, many obstetricians may prefer to perform a cesarean birth.
If you are having three or more babies, a cesarean birth may be indicated. If you’re having twins and the first baby is in a challenging position, it may also be recommended.
If you have a significant health problem like a heart condition or neurological condition, a cesarean birth might be recommended. An active genital herpes outbreak might also result in a cesarean birth.
If you have a fibroid that is interfering with the birth canal, your pelvic structure is preventing the baby from going through the canal, or if your baby has severe hydrocephalus causing the head to be very large, you might have a cesarean birth.
Previous cesarean births
If you’ve had a cesarean birth before, depending on the kind of incision and physical recovery, it might be possible to have a vaginal birth after cesarean (VBAC). Some people opt to have a repeat cesarean birth, or their medical provider may recommend it.