What to Expect with a C-Section (As Explained by Penny Simkin)

C-Sections are a possibility with any pregnancy, but are typically not expected, unless there are conditions that suggest it should be. In some of these cases, a C-Section–most likely an emergency C-Section–saved baby’s or mom’s life, or both.

In one of my favorite books (okay, one of my favorite manuals), The Birth Partner, Penny Simkin writes about the expectations one can have if a C-Section should occur or is planned.

Who to Expect to Be There
Obviously, the doctor performing the surgery will be there to, well, perform the surgery. You can also expect the anesthesiologist and an assisting doctor or midwife. There will also be a scrubs nurse who hands the doctor different tools needed, a floating nurse who prepares the operating room and “looks after” the team, one or two pediatric nurses to help with baby once he’s arrived, and sometimes a pediatrician will be there if problems with baby are anticipated.

Your partner and/or doula will typically also be there, but be sure to include that you’d like them there in the birth plan (if you know you’re having a C-Section) or let someone know, so that they can do their best to have them there.

What to Expect During Preparation
Okay, so now you’ve either been told you need a C-Section or you’ve been admitted for your C-Section. Now, the prep work begins. After you’ve signed the consent form, a nurse will start you on IV fluids and will be checking your blood pressure fairly often. Once IVs are going, you can decide whether or not you want a sedative, but keep in mind, you can refuse it if you’d like to stay cognitive during the surgery. Local anesthesia, whether general or neuraxial (depending on how much time is given, i.e. emergency vs. non-emergency) is given and you will likely receive oxygen either through a mask covering the nose and mouth or a tube that is only for the nose.

After you’ve been given your different substances, you’ll then be monitored with a pulse oximeter and electrocardiogram which measures your pulse and heart function, respectively. Your partner and/or doula (or whoever else you’ve decided to attend the surgery with you) is usually sitting by your head during the surgery to keep you calm. It can also typically be arranged that the surgery be filmed or photographed, so speak to your partner, doula, and care providers for accommodation.

Lastly for preparation, a large sheet is draped over your body between your chest and the where the doctors will be working, and your abdomen is scrubbed and shaved where the incision will be made. A catheter will also be put in place so that your bladder can remain empty for the surgery.

What to Expect During Surgery
Now the procedure begins. The anesthesia has kicked in, and the doctor makes his incision. Typically, these incisions are transverse, or low and horizontal, but there are times in which a higher and vertical incisions are made, such as with a premature baby, multiples, or an unusual presentation (i.e. breech).

As the doctor makes his or her incision, the muscles are not cut; they are actually separated from each other and spread apart, which promotes more efficient healing. Once the uterus is reached, the surgeon will suction away the amniotic fluid and cut blood vessels are cauterized. Keep in mind that when these blood vessels are being cauterized, you and your partner may smell a slight burning odor, but you will not be able to feel it.

*However, if at any time should you feel any pain (other than the slight pressure of tugging and pulling), let the doctor know so he or she can stop working until more anesthetic can be administered.* This is a fairly rare occurrence, but there are some times in which in the anesthesia can be spotty and you may not be numb where you need to be. Don’t be scared if this occurs, just be sure to let your surgeon know, or let your partner or doula know so they can pass the word along.

What to Expect for the Birth of Baby
And the moment we’ve all been waiting for, baby is born. In order for baby to be born, the doctor must be able to grab along his head or buttocks and gently work him out of the uterus. This is done by pushing your abdomen to move baby toward the incision, which is usually done by the assisting doctor. After baby has been born, the doctor or nurse suctions his airways and clamps and cuts the cord. You may want to discuss delayed cord clamping before surgery to allow as much placental blood to be carried to baby as possible. You can read more about delayed cord clamping here.

Baby may be presented to you over the drape, but skin to skin contact is becoming more common practice after C-Sections. You can request to have skin to skin contact immediately after birth in your birth plan. Sometimes, baby may be taken to a corner in the room or a separate room adjacent to the OR for evaluations and any treatment that may be necessary.

Now that baby is born, the placenta must also be “born” by separating it from the uterine wall. This part of the procedure may be uncomfortable for you, as you may feel nauseous and vomit, but it also may not. Some women have reported feeling uncomfortable during this stage, but there will be a basin available should you feel sick, typically held by your partner, doula, or anesthesiologist.

What to Expect for Repair
After you placenta has been removed, and possibly evaluated, repair begins so you can start prompt recovery. Your surgeon will use an absorb-able thread and suture with a single or double layer repair. A single layer repair is quicker, but it has been shown to leave a weaker scar, possibly causing complications with separation in future pregnancies. Consider asking for a double layer repair in your birth plan. After you are stitched up, a bandage is placed over the incision.

You may also feel some pain in your shoulder after the surgery. This is called “referred pain,” which is essentially pain that is felt elsewhere in the body from where the surgery was performed, and is caused by air entering your pelvic area. But, don’t worry. The anesthesiologist can help reduce discomfort by slightly lifting the head of the operating table. However, should you experience this pain, there is likely little can be done to help it subside until the air finally disperses.

When you are coming down from the anesthesia, expect to feel some nausea, trembling, or even shaking. This is a fairly common occurrence, and you can be administered medication to help ease the discomfort. You may even be given a sleep-inducing medication through your IV. You should be asked whether or not you want this anti-nausea medication, since you are able to refuse it and you can receive it later if you decide you do want it. Once administered, the nausea and trembling should subside within a half hour, and you are taken to a recovery area.

*Note: Versed has been used in the past, but is considered an amnesiac, meaning it causes memory loss of the birth and the events afterward. It is very likely that with this medication you will not remember the birth of baby, your first impressions, or your first feedings. If at all possible, request Zofran, as it is an effective anti-nausea medication that does not cause this memory loss or grogginess.*

What to Expect During Recovery
Recovery after C-Sections has been said to be much more difficult and lengthier than that of a vaginal birth, as a C-Section is considered to be major abdominal surgery. However, a pain medication regimen is implemented and you are in the hospital for the first couple of days, so any discomfort or concerns can be acknowledged quickly. During your hospital stay, nurses will be frequently checking your blood pressure, temperature, uterine tone, and state of anesthesia.

Depending on the conditions of you and baby, he will either stay with you or go to the nursery. Should you choose to breastfeed, you can do so while he is with you or when he returns from the nursery. However, keep in mind two things: 1) breastfeeding may be more difficult if you are groggy from medication, and 2) it may be easier to begin breastfeeding before the anesthesia wears off, as it will be easier to get started when you are not in pain.

If you are in pain, skin to skin contact can still be accomplished with your partner, if at all possible. He or she can talk and sing to baby, rock baby, and gently pat baby for comfort until you are feeling well enough to enjoy skin to skin as well. You can read more about skin to skin contact after birth here and here.

You should expect nurses to continue to check on you and baby (breathing, skin color, temperature, and heart rate) frequently, and if there are any issues or concerns, they will be addressed. After your anesthesia has worn off and you and baby are stable, you will be taken to a postpartum room until you are ready to go home.

All in All
C-Sections can seem like a scary situation, and sometimes they can be. However, it is important to remember that even though we can plan for a natural birth, some emergencies can arise that result in a C-Section. Even though it may seem disappointing, sometimes a C-Section is what can save yours and/or your baby’s life. Trust your doctors, midwife, partner, doula, and yourself.

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