The More You Know
A Moment-by-Moment Guide To Everything That Happens During A C-Section
From pre-op to recovery.
So, you’re going to have a C-section. We should start with congratulations! You're having a baby and you're going to do it the way your doctor believes is safest.
On to business: Whether the procedure was planned or not, it’s good to know what you’re getting into (and either way, most of what happens in the operating room will be the same). Here’s everything to expect right before, during, and after a C-section.
Before The Operating Room
With a scheduled C-section, you’ll receive instructions from your doctor and the hospital about what to do ahead of time to prepare. Often, that involves bathing with a special type of antibacterial soap to prevent skin infections at the site of the incision. Historically, people weren’t supposed to eat or drink within eight hours of their surgery, but that’s changed in recent years, and some hospitals now recommend that you have a special pre-op carbohydrate drink like ClearFast or Ensure Pre-Surgery a couple of hours before you go to the hospital. You may also be given pain, nausea, or anti-inflammatory medication to take beforehand to help with your recovery after the surgery.
Once you arrive at the hospital, you’ll meet your doctor, nursing staff, and the anesthesiologist who will be present for the procedure. They’ll talk to you about the risks of the surgery, what the risks are if you don’t have the surgery, and have you sign a consent form. Before you enter the operating room, the nurses will also take your blood and hook you up to an IV to deliver pain, anti-nausea, and antibiotic medications.
In The Operating Room
“The thing to know about the OR is it's cold, so that can be scary,” says Amber Samuel, a maternal-fetal medicine specialist based in Houston. “There also tends to be a fair number of people in the room, and that can be a little bit overwhelming for some patients.”
The team typically includes your surgeon, their assistant, a scrub tech who hands the instruments to the doctors, an anesthesiologist, and nurses for both you and your baby. That means at least six people and maybe even more if there are any complications.
Once you’re in the OR, you’ll lie down on a narrow table (it’s narrow so that the medical team can be as close to you as possible), and nurses will attach a blood pressure cuff, pulse oximeter, and heart monitors for you and the baby. Some hospitals will also use a safety strap on your arms or legs to prevent movement that interrupts the surgery.
Next, it’s time for the anesthesia.
For most scheduled C-sections, you’ll receive what’s called spinal anesthesia (or sometimes just “a spinal”), which is similar to an epidural but is given in one big dose rather than gradually over time. If you’ve already been in labor and have an epidural in, they’ll just use that and increase the dose. In either case, it means that you’ll be awake for the entire procedure. For spinal anesthesia, the anesthesiologist will have you sit or lie on your side hunched over so that your spine sticks out. They’ll clean off your back and first do a shallow injection with a numbing, local anesthetic like Novocain. Then, they’ll stick you with a longer needle that will go into the cerebral spinal space and deliver a large dose of medication. In a few minutes, you’ll feel numb from roughly your abdomen down to your toes, which will last for a couple of hours.
One important thing to note: Feeling numb is not the same as feeling nothing. “It's not painful, there's nothing sharp or hot or anything like that, but you are not completely without any sensation,” Samuel says. You’ll probably feel some pressure or tugging around your abdomen, especially when the doctor is pulling out the baby or sewing you back together.
Perhaps the biggest difference between a planned and an emergency C-section is that in a true emergency, you might receive general anesthesia to completely knock you out. That’s mostly because it’s faster acting, and if something is wrong, they want to get the baby out as soon as possible. From the moment the doctor decides surgery is necessary to when they deliver the baby can be as fast as 15 minutes. In that scenario, every second counts.
Final Steps Before The First Cut
After anesthesia, the doctors and nurses will check your vital signs and the baby’s heart rate and make sure you’re properly numb. They’ll also insert a catheter into your bladder to keep it empty throughout the surgery. Next, the skin on your abdomen where the incision is going to be is cleaned and prepped. Sterile paper drapes are put up so that you can’t see the surgery and your whole body is shielded except for the area where the surgeon will make the incision.
Around this time, your support person can enter the room (except in rare cases where you need general anesthesia or have complications). “It's super common that a woman is allowed one support person with her through all of this. It's usually the father of the baby, but it can be any one person she picks,” says Cyndy Krening, a perinatal clinical nurse specialist based in Colorado and president of the Association of Women’s Health, Obstetric, and Neonatal Nurses. “They're given a chair or a stool to sit on up near the mom's head so that they can be there to support her and witness the birth too.”
The Surgery Itself
Now it’s time to start the surgery. The surgeon will make an incision roughly between 4.5 and 6.5 inches on your lower abdomen, right about where the top of a bikini usually hits — in fact, it’s often called a bikini cut. They’ll go down through your skin first, then the layer of subcutaneous fat, and then they’ll reach what’s called the fascia, which is a tough, canvas-like layer that keeps everything inside. (Because it’s a denser tissue, surgeons sometimes switch from a regular scalpel to an electric one that uses heat to cut the fascia, so if you hear an electrical sound, that’s why.) Next, they’ll go between the two abdominal muscles that run on either side of your belly button and cut through the peritoneum, which is a thin layer of tissue that lines your abdominal cavity.
At this point they’ve arrived at the uterus, which is about the size of a basketball when you’re full-term (normally, it’s the size of a fist). Most surgeons will make the same low horizontal cut across the uterus, although historically C-sections used a vertical incision. (If you know you’ve had a vertical or “classical” C-section before, be sure to tell your doctor.) Once they’re in, the surgeon will break the amniotic sac, reach in, and pull out the baby! While it’s the happiest moment of the procedure, it can also be the most uncomfortable part because there’s some pushing and pulling and maneuvering that has to occur to get the baby out of the uterus.
The Baby’s Here!
Once the baby’s out, the surgeon will cut the umbilical cord and pull out the placenta, and a nurse will take your baby to a warmer in the operating room to dry them off and make sure they’re healthy. If everything looks good, in most hospitals you can hold your baby for the first time. “In all deliveries of healthy babies now, we are putting that baby onto the mom's chest as soon as we can,” Krening says.
Then comes the longest part of the surgery: sewing everything back together. The uterus is a large muscle with a lot of blood vessels, so the surgeon will work to close the incision as quickly and safely as possible, being careful to look for any blood clots. Then, they’ll work back up through the different layers of tissues they’ve cut, using stitches that will dissolve over time. This process typically takes about 30 to 45 minutes, and Samuel and Krening say the mom often falls asleep. Your baby will be snug in the warmer or being held by your support person while this is happening.
To help the healing process, the anesthesiologist may give you some more medication, including a drug called Pitocin that triggers uterine contractions and will help the uterus shrink back down to its normal size after delivery.
After your uterus and incision are sewn back up, you’ll be moved to a bed and wheeled to a recovery room for a few hours. Nurses will continue to monitor your heart rate, blood pressure, and oxygen levels, as well as check for any bleeding or serious pain. Your baby will be there with you too, and the nurses might try to get you to breastfeed for the first time.
Most people stay in the hospital for two to three days after a C-section, although if there are any complications, like a skin infection or high blood pressure, they’ll keep you for longer. There are a few milestones you have to hit before you can be discharged: You have to be able to get up and walk around, pee, have your pain managed with medication, eat, and pass gas (seriously, it’s an important sign that your bowels are OK). You may receive narcotics for a few days after surgery to help with your pain, but once you go home, most people can manage with Tylenol.
“We do a lot of C-sections, and the vast majority of women tolerate them fine and don't have complications,” Krening says. “And they get a big prize, which is a beautiful newborn.”
Amber Samuel, a maternal-fetal medicine specialist based in Houston
Cyndy Krening, a perinatal clinical nurse specialist based in Colorado and president of the Association of Women’s Health, Obstetric, and Neonatal Nurses