Caesarean Delivery

Content provided by the Faculty of the Harvard Medical School

Caesarean Delivery

A Caesarean section is a surgical method of delivering a baby (or babies) through an incision made in the abdomen and then the uterus. The abdominal incision usually is made transversely at the pubic hair line and is popularly known as a "bikini cut" (since the scar usually is below the area that would be covered by a bikini). The uterine incision usually is made transversely across the lower end of the uterus (a low transverse incision). This is the safest uterine incision, because it does not weaken the uterus in subsequent pregnancies. In a few cases, the older vertical incision may need to be used. In this case the scar runs from the lower uterus to the top fundus.

Sometimes the decision to do a Caesarean section is made before labor. Conditions include having placenta previa, diabetes (if the baby is very big), a pelvis that's too small for the baby's head to fit through, certain fetal malformations, or some abnormality or scarring of the uterus.

Caesarean sections may also be done when the baby is not in the typical "head down" vertex position. This could be in the breech position, when a baby is delivered buttocks first (occurring in about 4 percent of births). Actually, there are several variations of a breech birth: The baby may be in a sitting position with both legs crossed (complete breech), have one foot dangling below the rest of the body (footling breech) or have both legs stretched up toward the head (frank breech). The transverse lie is an even rarer position in which the baby lies sideways across the uterus, usually with a shoulder resting on your pelvic opening (also called a shoulder presentation).

Other times, the decision for a Caesarean section isn't made until you're in labor, such as when labor fails to progress, there's an incomplete opening of the cervix, fetal distress, prolapsed cord, active genital herpes or profuse bleeding.

What to Expect

How a C-Section Is Performed

If a Caesarean section wasn't planned in advance, your doctor will explain why it's needed now, as well as the risks of this procedure. Many hospitals will allow your childbirth partner to be present for a Caesarean birth. The operation takes about one hour and involves these steps:

• Inserting an IV into your arms for medications, if needed, to be given during surgery

• Sterilizing the lower abdomen and shaving pubic hair

• Drawing blood for cross-matching and other tests

• Administering anesthesia, which can be spinal, epidural or general

• Inserting a catheter into the bladder to drain urine during surgery

• Making incisions into the abdomen and uterus

• Delivering the baby and placenta through the incision

• Sewing the incision closed

What Are Your Chances of Having a Repeat Caesarean?

About one-third of all Caesarean sections are done on women who have had the procedure in a previous pregnancy. A repeat Caesarean section is usually scheduled at some predetermined point in your pregnancy. However, many women who had a Caesarean section may be candidates for vaginal delivery.

VBAC is short for vaginal birth after Caesarean section, and is now encouraged for most women who previously delivered a baby by Caesarean section. You may be a candidate for VBAC if the condition that necessitated your previous Caesarean section isn't present in this pregnancy (for example, your first baby was in the breech position while your second one is head down); you had a low transverse incision in your Caesarean section; or you haven't developed any new condition that would rule out vaginal birth, such as placenta previa.

Last updated:	September 29, 2004
Reviewed By:	Faculty of Harvard Medical School