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Cesarean Section Procedure, Step by Step

Cesarean section (or c-section) is a very common and well-established surgical incision in the abdomen and uterus that many women undergo during childbirth.

In Western countries, Caesarean section rates have risen rapidly over the last decade. In fact, the number of Caesarean sections performed is about one-third of the total number of births in the United States of America. The reasons for this are multifactorial but are partly related to the increase in medical proceedings, coupled with increased access to medical care, the equipment, and the expertise needed.

Why is it done?

This procedure is often used for many reasons, including high-risk pregnancies, prolonged labor, large babies, multiple babies, fetal distress, miscarriage, un-recommended previous cesarean delivery, placenta previa, and umbilical cord prolapse.

What to expect?

When the decision to make a Caesarean section is made before childbirth, it is often referred to as a planned or scheduled incision. Decisions can also be made during labor. This may be due to labor being painstaking too long, the mother or baby not giving birth properly, or not tolerating labor well. This is commonly referred to as an unplanned cesarean section. In some cases, it is a real emergency, and surgery can be done very quickly, such as placental interruption, severe bleeding, or fetal distress.

Knowing what to expect, you may feel the procedure more comfortable. Here is a step-by-step explanation of the c-section.

Cesarean Section Preparation and Anesthesia

Before surgery, you will be anesthetized, a block of regional pain, such as an epidural or spinal cord block. With regional anesthesia, you can wake up and confirm your child’s birth at the same time without feeling any pain during surgery. General anesthesia is used in some emergencies, which means you will be asleep.

The nurses and doctors occupy the room with equipment and warmers for the baby while under anesthesia. Administration of anesthesia may take 20 to 30 minutes. This will cause a strong, quick, and effective numbness.

Sometimes your arms are tied in a T position away from your side. This is done to prevent accidental interruption of operation. You can also insert a catheter. A cloth is placed on the abdomen so that you do not look directly at the incision. But you can see doctors, and more importantly, babies when they are born. In most cases, the patient’s partner in the operating room provides support and confirms childbirth.

Initial Incision

The mother in the operating room is covered with a sterile curtain while the first incision is made in the abdomen. In most cases, the incision is horizontal (lower abdomen, below the navel, just above or below the onset of pubic hair).

Vertical incisions are usually used only in emergencies or complex situations where better access to the baby is needed. The disadvantage of a vertical incision is that VBAC is not possible in subsequent pregnancies due to uterine rupture, and the scar is more noticeable. On the plus side, this type of incision usually reduces maternal bleeding.

Also, note that you do not need to shave in advance. Hospital staff will do this as needed, but it may not be necessary.

Follow-Up Incisions

There are various layers that the surgeon must pass through before reaching the baby. These include amputations of the skin, fat into the abdomen and uterus. The abdominal muscles are not cut but are pulled apart to access the uterus. The bladder and intestines may also need to be separated.

Doctors use a variety of instruments during surgery as they pass through each layer of the body. You may also hear the noise of a machine used to burn small blood vessels to prevent excessive bleeding. There may be an offensive odor due to disinfectants, which is a burning odor. Cesarean section is the major surgery (invasive surgery that enters the body cavity such as the abdomen), but it is very safe and effective.

However, as with surgery for infections, blood clots, and bleeding, there are risks but serious complications are rare.

Suctioning of Amniotic Fluids

When the doctor reaches the uterus, you will hear a suction sound. After the uterus is cut, amniotic fluid is aspirated, leaving a little more space in the uterus for the doctor’s hands and instruments such as forceps and vacuum cleaners that are sometimes used to facilitate the removal of the baby. Forceps are less frequent than vacuum cleaners.

Delivery of Baby’s Head

Babies are often tied to the pelvis, usually with their heads down. The doctor lifts every part that enters the pelvis. Women may feel pressure, tugging, or pulling at this point. Others may feel nauseated in this intense but short time.

Mother feels pressure, but she doesn’t feel pain. Anesthesiologists usually stand beside the head to monitor pain and general health. When the head comes out, the doctor suction the baby’s nose and mouth to get rid of these fluids. During a Caesarean section, the baby needs additional help to get rid of these waters.

Delivery of Baby’s Body

When the baby is properly suctioned, the doctor will help the rest of the body be born. The surgeon needs to move the baby back and forth to help the baby lift. You may feel it is debilitating, while you may experience sensations of tugging or pulling, this should not be painful.

Doctors entangle the umbilical cord and look for other complications during the body’s birth. You can also ask the treating surgeon to put pressure on the upper abdomen to facilitate childbirth.

Baby Is Born

That’s the moment you were waiting for – the birth of your baby! It is 5 to 10 minutes from the start of operation. Usually, the baby is kept over the drape to show you the baby. Depending on the surgical setting, the umbilical cord is amputated and taken to the warmer by a neonatal nurse or neonatologist.

The baby goes to the warmer; it is usually in the same room as the surgery. Make sure the baby is suctioned to get rid of the amniotic fluid. Babies can also receive essential care such as weighing, measuring, cleaning, and vitamin K.

With a bit of advance planning with participating doctors and hospitals, you can request a “soft” Caesarean section if you and your baby are fine. This is also called a natural cesarean section. The surgery remains the same with a gentle cesarean section, but the difference is that efforts are being made to personalize the experience and mimic vaginal delivery.

Once the baby’s head is out of the abdomen, the rest of the body is brought out slower (helps to squeeze out fluid from the baby’s lungs), and skin-to-skin contact with the baby is prioritized shortly after birth.

Delivery of the Placenta

The next step is to remove the placenta, then to suture the uterus and all layers cut during surgery. After the placenta has been removed, your doctor will examine it. Closing up everything that’s been cut through to get to the baby usually takes 30-60 minutes.

During this time, you can usually breastfeed or hug your baby. However, don’t feel the pressure to start breastfeeding right away. You can begin at any time during the first few hours of your baby’s birth. There is no harm in delaying a little. However, just having fun with your baby is effective. If you can’t hold your baby, your support staff can also bring your baby closer to your face.

Closing the Incision

After everything is surgically completed, the surgeon sews the incision. The uterus is usually sutured with stitches, but doctors may decide to close the abdominal incision with staples or stitches.

Both methods have their advantages. Staples are faster (saving about 7 minutes), while stitches reduce wound separation and infection rates, generally giving finer scars. The type of wound closure used depends on the doctor’s preference and the details of the particular surgery. Once closed, the wound will be covered with a bandage.


They monitor you in the postoperative area for at least an hour to ensure your vital signs are stable and not too bleeding. However, everyone bleeds from the vagina for several weeks to heal the uterus.

Then they take you to the delivery room. Usually, the baby and the support person can be together. There you will spend 2-4 days. Stitches and staples appear about five days to 1 week after surgery. During the first few weeks of recovery, do not lift anything heavier than your baby to prevent the wound from growing. However, it is recommended to walk out of bed to promote healing.

Many are nervous, and some are disappointed with the Caesarean section, but it is most important, the safe delivery of the baby. It’s all you think that your bunch of joy is in your arms.

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