What to expect during and after C-section surgery

Even if a C-section is planned, the preparation phase is crucial. For urgent or emergency C-sections, this phase is significantly compressed, focusing on immediate medical stabilization.

Pre-Operative Assessments and Consent

Prior to the surgery, a comprehensive medical assessment is conducted. This typically includes blood tests (to check blood type, complete blood count, and clotting factors), urine tests, and a review of the mother’s medical history. An anesthesiologist will discuss anesthesia options, usually a regional anesthetic like an epidural or spinal block, which numbs the lower half of the body while the mother remains awake. General anesthesia is less common but may be used in emergencies.

Crucially, informed consent is obtained. The medical team will explain the procedure, potential risks (such as infection, bleeding, blood clots, injury to organs, and complications from anesthesia), and benefits. This is an opportunity for the mother to ask any questions and voice concerns.

NPO Status and Pre-Op Hygiene

Patients are typically instructed not to eat or drink anything (NPO – nil per os) for several hours before the surgery to reduce the risk of aspiration (inhaling stomach contents) during anesthesia. Showering with an antiseptic soap may also be recommended to minimize skin bacteria.

Preparing the Surgical Site

Upon arrival at the hospital, an IV line will be inserted to administer fluids and medications. A urinary catheter is usually placed to keep the bladder empty during the surgery, which is vital because the bladder sits close to the uterus and needs to be out of the way. The abdominal area will be cleaned with an antiseptic solution, and often, hair around the incision site will be clipped, not shaved, to prevent skin irritation and infection.

The C-section itself is a relatively quick procedure, often lasting between 30 to 60 minutes from the first incision to the final closure, though preparations and recovery in the operating room add to the overall time.

Anesthesia Administration and Draping

Once in the operating room, the chosen anesthesia is administered. With regional anesthesia, a drape is typically placed across the mother’s chest to shield her view of the surgical field, though she will be aware of sounds and sensations like pressure or pulling. A support person, such as a partner, may be allowed in the operating room, seated near the mother’s head, depending on hospital policy and the surgical circumstances.

The Incisions

The surgeon makes two main incisions:

1. Abdominal Incision: Most commonly, a horizontal incision (bikini cut) is made across the lower abdomen, just above the pubic hairline. This incision is typically 4-6 inches long. In some emergency situations, or if there’s extensive scar tissue, a vertical incision (from the navel to the pubic bone) may be used.
2. Uterine Incision: Once the abdominal layers are separated, a second incision is made in the uterus. The most common is a low transverse incision, which is horizontal across the lower part of the uterus. This type of incision heals well and is less likely to rupture in future pregnancies, allowing for a trial of labor after C-section (TOLAC) in some cases. Less common are vertical uterine incisions (classical or low vertical), which carry a higher risk of rupture in subsequent pregnancies and often necessitate repeat C-sections.

Delivery of the Baby and Placenta

After the uterine incision, the amniotic fluid is suctioned, and the surgeon gently guides the baby out. This typically involves some pressure sensation for the mother. The baby is usually delivered headfirst, followed by the rest of the body. The time from the initial incision to the baby’s birth is often less than 10-15 minutes.

Once delivered, the baby is often immediately brought to the mother for skin-to-skin contact, if medically appropriate, fostering early bonding. The umbilical cord is clamped and cut.

The placenta, which nourished the baby during pregnancy, is then manually removed from the uterus. This may involve a final push on the mother’s abdomen.

Closure

After the placenta’s removal, the surgeon inspects the uterine cavity and usually gives medication (like oxytocin) to help the uterus contract and reduce bleeding. The uterine incision is then meticulously sutured in one or two layers with dissolvable stitches. Subsequently, the abdominal layers (muscle, fascia, fat, and skin) are closed with various techniques, including sutures or staples for the skin.

Post-C-section recovery varies for each individual, but generally involves a hospital stay of 2-4 days and a full recovery period of several weeks.

Immediate Post-Operative Period (Hospital Stay)

• Monitoring: In the recovery room, vital signs (blood pressure, heart rate, oxygen saturation), uterine tone, and incision site are closely monitored for several hours. Pain levels are assessed regularly, and pain medication is administered.
• Pain Management: Pain is a significant aspect of C-section recovery. A combination of oral pain relievers, sometimes accompanied by stronger narcotics in the initial days, is used. Non-pharmacological methods like ice packs or abdominal binders can also provide relief.
• Mobility: Early ambulation is encouraged as soon as medically safe (often within 6-12 hours). Walking helps prevent blood clots, aids in gas relief, and promotes circulation. This initial movement will be slow and may involve discomfort.
• Catheter and IV Removal: The urinary catheter is usually removed after 12-24 hours, and the IV line once the mother is tolerating oral fluids and medications.
• Lochia: Vaginal bleeding, known as lochia, similar to a heavy period, will continue for several weeks. This is normal as the uterus sheds its lining.
• Gas and Bloating: Many women experience significant gas pains and bloating due to trapped air in the abdominal cavity after surgery. Walking and peppermint tea can help.
• Caring for Your Baby: While recovering, it’s essential to accept help with baby care, especially lifting the baby, which puts strain on the incision. Positioning for breastfeeding may require pillows to protect the incision.

Home Recovery (First 6 Weeks)

The first six weeks at home are crucial for healing and adapting to life with a newborn.

• Incision Care: Keep the incision clean and dry. Follow specific instructions regarding showering and dressing changes. Watch for signs of infection such as increased redness, swelling, pus, fever, or worsening pain.
• Pain Management: Continue to manage pain with over-the-counter pain relievers as needed. Avoid lifting anything heavier than your baby.
• Activity Restrictions: Strenuous activities, heavy lifting, driving (while on narcotic pain relievers or if uncomfortable), and sexual intercourse are typically restricted for 4-6 weeks, or until cleared by a doctor.
• Emotional Well-being: The physical recovery from a C-section, combined with hormonal changes and the demands of newborn care, can be emotionally challenging. Postpartum depression or anxiety can affect mothers after any birth, including C-sections. It’s important to seek support from partners, family, and healthcare providers if struggling.
• Scar Healing: The incision will heal to form a scar. Initially, it may be raised and reddish but will typically flatten and fade over time, becoming less noticeable. Massaging the scar (once fully healed) with lotions or oils can sometimes help with flexibility and appearance.
• Follow-up Appointment: A postpartum check-up, usually around 6 weeks after delivery, is essential for the doctor to assess physical recovery, check the incision, and discuss contraception and any lingering concerns.

A C-section is a major abdominal surgery. While it allows for the safe delivery of a baby when vaginal birth is not advisable, it requires careful preparation, a well-executed surgical procedure, and a dedicated recovery period. Understanding these stages can empower expectant parents to feel more prepared and confident in their journey.