A cesarean section is an operation that is performed to deliver a baby through an abdominal incision. There are many reasons why a woman has a cesarean section. Some of these reasons are known in advance of your delivery date, but most are not encountered until labor.
Indications for Cesarean Section
The breech presentation is when the buttocks or feet rather than the baby’s head is the presenting part in the mother’s pelvis.
Fetal Intolerance of Labor
A fetal monitor is used during labor to monitor your baby’s heart rate. If your baby is not tolerating labor well, the fetal heart rate may be abnormal. If treatments to correct the abnormal heart rate are not successful, your doctor might recommend a cesarean section.
No Progress in Labor
Once you are in active labor (~4cm), you should dilate about 1 cm per hour thereafter. Your labor may not progress normally if your baby is too big for your pelvis, or your pelvis is too small to allow passage of your baby. You may reach 10 cm dilatation, but may be unable to push your baby out because of its size or head position. If your labor does not progress because of these abnormalities, your doctor may recommend a cesarean section.
If your water bag has been broken for many hours you can develop a uterine infection that can affect your baby's health. If your baby shows signs of infection and you are far from delivery, your doctor may recommend a cesarean section delivery.
If you have an active Herpes outbreak at the time of labor, your doctor will recommend a cesarean section to reduce the risk of transmission to your baby. Medication will be prescribed to take at least 4 weeks before your due date to decrease the risk of an active herpes outbreak at the time of labor.
HIV positive mothers may be offered a cesarean section to reduce the risk of neonatal transmission.
Placenta previa occurs when the placenta partially or completely covers the cervix, thus blocking the passageway of the baby. A placenta that attaches to the cervix can bleed if it becomes detached or if you have contractions. There are times when vaginal bleeding is so severe that it threatens the lives of mother and baby. In this case an emergency cesarean section may be performed even if the baby is premature. If a placenta previa has not caused problems with the pregnancy, a cesarean section will be scheduled 2-3 weeks before your due date.
Twins are often delivered by cesarean section if one or both of the babies are not head down.
Previous Cesarean Section
If you have had a cesarean section, you may choose to have another for subsequent deliveries. Your doctor will provide you with statistics about the risks and benefits of attempting a vaginal delivery after a cesarean section. If you are not a candidate for a vaginal delivery after a cesarean section or if you choose to have a repeat cesarean, your doctor will schedule your surgery for 39 weeks or later.
Recovering From a Cesarean Section
Most women stay in the hospital for 3 days after a cesarean section. You will be discharged with prescription pain medicine. During your first week at home you should not participate in any strenuous activity. You may not have an appetite, but you need to drink a lot of water to stay well hydrated.
You should have a bowel movement within the first week after a cesarean section. Unfortunately the narcotic medicine that you are prescribed (Percocet, Vicodin or Lortab) may slow down your bowel function causing constipation. To decrease constipation, you may decrease narcotic use and/or use a stool softener such as:
- Colace (Docusate): 1 tablet 2-3 times a day
- Pericolace: (Docusate + Sennosides) 1 tablet 1-3 times a day
- Laxatives: Milk of Magnesia, Correctal, Fleets enema, Miralax
Your incision will be tender and swollen for 2-4 weeks. As the pain subsides you can increase your physical activity. Refrain from heavy lifting, thus do not lift anything heavier than your baby in its car seat.
Do not drive for 2 weeks or if you have taken narcotic medication.
You should call your doctor if you:
- Have fever >100.4 on two occasions in the same day
- Have drainage for your incision
- Have an increase in vaginal bleeding or pain (even with using pain medication)