What To Expect If You Need a C-section

hoping to check. But let's face this too. Accessarian delivery is something you and every expecting parents should be prepared for. That's because c sections are pretty common in the US, was close to one in three moms ending up with one. The upside to a C section, it's very very safe, and in some cases, it's the safest way to deliver a baby. The potential downside. If you're a mom to be with your heart set on a vaginal birth, the news that your baby needs or may need to be

delivered by C section can definitely be disappointing. Scheduled for a C section, hoping to avoid one, hoping to avoid a repeat, just plain stress about the possibility you might need one, just trying to do your labor and delivery homework. No matter what, We've got your back and your belly. Today we're delivering everything you need to know about C sections. I'm here with my good friend, maternal fetal medicine specialist, Dr Sarah Obachon, who is medical director of Mother to

Baby Florida and Assistant professor at the University of South Florida. Hey, Sarah, Hello, thanks for having me. Oh, it's great to have you back. We always need you for advice. It's clear how much you care about the moms you hair for, and your empathy and your reassurance. And you're easy to talk to um, which is so important when a mom is stressed out about something like having a C section. So let's talk about c sections as if I were your patient. Close to one in three moms in the US end up

having a C section. Now, the w h O believes that rage should be under percent if c sections were only done for medically necessary reasons. Why do you think rates are so high in the US. That's a great question. There's so much struggle with this that we're working on over so many years. I do think they should probably be lower. I don't know if it's possible to be less than in the country, but they certainly seem like

they should be lower than they are. And it's always a really tough emotional discussion with the with the patients because some patients do really need one and it's really the safest for them, and they're maybe if you have a placenta creta, if you have a placenta previous, so it's covering the birth canal, maybe really shouldn't come out

vaginally under any circumstance. But there are sometimes that it was casually that maybe really need to have a cesarean, And that's a question that's being worked on nationally, uh kind of really higher level of work looking at data how to decrease that first cesarean in women. And the reason for that reason that sometimes it's harder to get a b back to have a vaginal delivery after a

C section because some hospitals won't do it. Some hospitals are scared the medical legal aspect of it, or their doctors won't perform it, or I don't for multiple reasons. But if we can decrease the chances that a woman the first time around is going to have a C section. This is where we would be probably winning the most. Yeah, because if you avoid the first c section, then you're

going to automatically reduce the rates. That's right, and we're gonna have a much better chance of having the second one. That generally, do you think they're getting your care from a midwife? Assuming that you are low risk makes it less likely that you'll end up with a C section if all other things are relatively equal. I think that depends. Just like any time you think about doctors, good doctors, you know somebody don't really click with the same with midwives.

I have worked with midwife, some wonderful midwife in my career here at USF and also at George Washington University, and sometimes the criteria to be their patient is rather strict because they know if you're a waking during pregnancy is not very high. If you are otherwise healthy person, if you are a nutritionally doing well, then your chances of having a badge of delivery a higher. So it depends if you have a midwife who is able to guide you in that process and do that with you,

then that is wonderful. But also it like of the way some people from seeing a midwife if they feel a little bit marginalized, like they couldn't keep the weight down for some reason. So it kind of works a little bit both ways. But finding the right fit for you, I think it's been most beneficial for each patient, and that right person could come in the form of maternal fetal medicine specialists, or it could come in the form of a midwife that's right, or a combination, which is

always possible. What are some of the most common reasons for medically necessary c section? You mentioned plus center preview, and of course placentas can do a lot of moving during pregnancy, so you shouldn't assume too early on that you're destined to have a C section if you're placenta is low lying right, well, what are some other reasons

why you might have a planned C section? So for planned c section, the most common reasons are things like fetal mouth presentation, In other words, the baby has just turned the wrong way, it is transverse, or its reach. That is one of the bigger indications for a planned one. Some times twins uh will be more likely to be planned. Sometimes when the baby is very large. Is whether or not it's a good indication for a C section in a different discussion, but oftentimes that will be one of

the reasons that's quoted for the cesarean. And what about reasons that come up during labor for a C section? The two most common ones tend to be later for dystocia, in other words, you've been trying to have a vagine delivery, You've dilated a certain amount and you're not dilating anymore, You're not dilating quickly, or the other reason is that the baby may or may not be tolerating the labor. So there's uh what was previously called non reassuring fetal

heart tracing, so abnormal tracing on the monitor. So in other words, if the baby is not doing well, then it's time to move straight to a safer birth through C section. Yes, one of the things we're looking at in terms of how we define whether or not there's

an abnormal all tracing. And this is the part that I think helps a lot on an institutional basis, um a large number basis, meaning that I can teach a lot of physicians or nurses how to appropriately interpret some of this feutal heart rate tracing so that everybody using the same language. And really what is considered to be a risk is risk versus not having the same kind of communication and maybe misinterpreting some of the fetal heart rate tracing. And is it sometimes just a matter of

changing mom's position. Yes, there's a few things that we can do in labor that can help the fetal heart rate tracing. We can change the mom's position. We can actually sometimes infuse fluid if the mom is already ruptured, we can put a little bit of an amnio infusion, meaning to put a little bit of fluid into the uterus in order to buffer a little bit of that fetal cord so that there has less of these decelerations on the fetal monitor. So the refuse tricks that we

can do one and for all. Let's clear this up to epidurals make a C section more likely. No, epidrows are rather safe. It's one of thost commonly performed procedures. Because c sections are our most common like performed procedures that we don't think it decreases the chance of having a vaginal birth um sometimes and this is sometimes that I dotal too. It's like, well, sometimes it helps just to relax all your muscles to be able to have

avaginal delivery. Honestly, that is a choice every woman can answer for herself whether or not she's interested in something like this, and a good discussion with her doctor and also with her anesthesia. But it doesn't matter at what point in the process you have your epidural. There are no rules, but you can't have it too early. No, No, this is something that every woman should be a part of that conversation. Now, does inducing labor lead to a

greater risk of C section? This is something we were taught even when I was a resident, And there is now really great evidence that an induction doesn't increase the risk of your of your C section And this study was done relatively recently. Um, but when is the best time to deliver? And an induction itself isn't the culprit for the cesarean. I don't think we should really be afraid of inductions as we used to be. And what about being admitted to the hospital too early in labor?

Does that increase risk? That's a great question. I think that one's harder to answer because sometimes you know, when you're looking at so many things, like you're looking at if you don't heart retracing, and if you're acting on it too quickly, then maybe there would be an increased risk for that. But you never want to tell the patient, oh, stay at home for as long as you can, because you then you really don't know how she is or

how that baby is doing. There have been some hospitals who have been putting restrictions on when a mom can come in that you know, I've heard, for instance, ince some military hospitals you have to be six centimeters, which seems like a lot to me. It seems like a lot, yes, because you can go very quickly from six to ten. And also you're right, I mean women progress very differently if you've had a baby before, and just women themselves.

I have patients who, even if it's their fourth baby, it takes them a long time to have a basin of delivery, but they do. And then there's moms who you know, there are two centimeters to senates, two senators, and then then they're called because I'm running to catch the baby. But it's hard, right, It's hard to to make a cut off for every single patient. For sure. Now, if an opie pushes first C section and Mom's kind of like, I wish there's some way out of this.

What are the right questions for her to ask? That's great question. I think one is really important to have a good communication with your doctor, right, make sure that you obviously trust their judgment, and then you know them and they know you. While you're having that discussion, you know some things even if you don't maybe understand if you trust their judgment, Like my goodness, it's easy to say yes because if it's the right thing to do,

it's the right thing to do. But thanks to ask like, Okay, is this really necessary? What do you think the risks are to me and my baby? Um? You know, could I try a little bit longer? And you can read the person too if they're like, look, I'm really worried about this for this reason, and they give you really good reasons. I mean, you really need to trust the doctor that's helping to take care of you, too, especially if you've chosen that person you feel most comfortable with.

That's a great place to start. Yes, what are some ways of reducing the chances that you'll have a C section? Things that you can do during your pregnancy or even before so being an optimal health is really important. That

is just for good pregnancy outcomes in general. Taking care of yourself, making sure that you are managing your diabetes or your high blood pressure, to make sure that you're managing your eight It's important that you have an appropriate weaking and talk to your doctor what that appropriate weight gain is. We know gaining too much weight during the

pregnancy may increase the rest for our ces areanum. Being obese may increase the risk for cesarian So those are the things that we may have some power to help ourselves in our pregnancy outcomes. Douels research has shown that having a duel at your birth may reduce the risk of a C section. Why do you think that is? It's so interesting. I think it's wonderful to have a continuous labor support right, somebody who's really in your corner, who had some training, is really there to be your

helping your voice through the process. And just like with anything, you know, good doctors, bad doctors, good miitherwise bad. You know, it's not good or bad. It's just that you have to click with somebody well right, And if you do and you have the right support person, I think that's wonderful.

To be a part of that that labor process, and I think that well, clear the doctors and nurses aren't there with you, but just having someone there by your side the entire time can reduce your stress level and hopefully that makes a difference. But also, you know, just positive affirmations getting you into a position that's perhaps going

to help the baby move down. Massage doesn't hurt right, right, right, Absolutely positive affirmations, you know, even imagery and position they like you said, massage, all those things are really positive. Do you think that it's important to have childbirth education class? Take a class even if you know you're having a scheduled C section? Yes, I think that is a good idea, especially if they cover c sections right. C sections can

be scary. I think some of the some of the concern my patients have is that obviously they haven't had one, and they don't know a lot about people that have. Maybe they don't have positive stories about people having c sections and there really are mean someone men tell me when they have done both that they prefer the season. Actually, I mean, who would have known, right, But just understanding and knowing what to expect really does kind of change

your outlook. On what's to come. Definitely, knowledge is power. Have you ever had a patient use hypno birthing? Yes, I've been part of that too. Um. I think anything that helps a patient in in terms of relaxation is important. I don't know that hypno birthing will take care of all that pain. It's kind of really hard. I think the best thing that works is an ever dural if pain and pain management is your main concern. But something

for anything that positively affects you. Imagery, meditation, massage I think are all helpful during labor. Yeah, we definitely don't want to rely on hypno birthing to deliver during a C section, right, correct, You don't want me to do that? No, no, no, Um, let's talk about v back a little more. Tell us who might be a good candidate for v back and

who might not. B three candidates for a feedback are those women who have had a vaginal deliberate or we've had a C section and then had a second vaginal birth. Um that makes things a lot easier, b am. I um comes into that equation, our age comes into that equation. So there's a few parameters that are really important, and these things can be calculated by their healthcare provider. And you had mentioned that some hospitals are not big fans

of feedbacks or perhaps won't allow one. So this is the conversation you need to have with your doctor well ahead of time. Absolutely, this is a conversation early in your pregnancy that you should discuss. Do you, guys offer a vaginal birth? Actors is are and how is that done? Do you have anesthesia at your hospital? Two seven? Am I good candidate? How can you help me understand that?

And if that's not the right pctory, then trying to find somebody in your community that would be able to do that safely and an option if your baby is your mentioned transverse, which is side to side or in a breach position that wouldn't be favorable for a vaginal birth, having using procedure like external cephalic version, which is turning

the baby, or possibly other spinning baby techniques. I don't know how you feel about those, but the idea that maybe you can get the baby to move into position so that a v back or just a vaginal birth in general is more likely. Yes, agree, I think that

all those things are an option. Um, definitely speaking to your doctor about doing an ECB and explaining to you what it is, what are the risks and benefits of that, how that is done in their institution, and do you feel safe about that being done in the hospital setting? And if it was an emergency, what would be done next? All those are a good questions to ask for the external symphalic version, which are usually done before term, like

thirty six thirty seven weeks. Great. I feel like every mom should be prepared for the possibility of a C section. Even if all systems seem to be a go for vaginal birth, you never know how labor is going to progress or not progress, And even if you're being scheduled to deliver at a birthing center by a midwife, it's always a possibility. So knowledge is power. We're going to

get empowered about c sections. First of all, what kind of anesthesia well you probably have if you have a C section, If you're come to have a C section, there's a few ways to do this to make sure you have appropriate pain control. The usual is something we call spinal anesthesia or an epidural anesthesia. UM. Spinal is just something that happens go at one time, needle goes the medicine goes in and it's good for a couple of hours, which should be sufficient time for a cesarean.

An epidural will give you a little bit more of pain control afterwards, uh with maybe like a pump that you can do yourself, so you have a little bit more control there. And then in some cases, depending on the high risk cases of the pregnancy, that may have to do general honest esure where the woman has to go to sleep, but those are less common. Will you be allowed to have your partner with you during a

land sea section? In our institution, we are allowing a partner to be there during the time of delivery, either a vagin deility or cesarian, to have that support for us present. And you should always check with your specific hospital and your specific guian group to discuss who is available, who's able to come to your delivery. How many hospitals are making cesareans more mom breastfeeding friendly. Some hospitals call them gentle cesareans, so you have immediate skin to skin

and breastfeeding if it's possible. Yeah, that's a really good, big trend that's happening, and I think it's a positive one. The idea of just even though this is surgery and you know it's very technical and we're all trained to do this, to make this more of this loving environment

of this is actually the birth of a child. And in our institution we do things like a clear drape where the there's a clear drape that is put up and the blue one comes down when your baby is being born, so you are able to see part of that process. Your see your baby immediately as I am cleaning up the baby for you and the baby is being necessitated, the baby is there with you. And then as soon as the baby is given off to be checked quickly, but it's put on your your chest and

we encourage breastfeeding early. Um. There are a lot of these different mechanisms that are happening in different hospitals that are helping moms feeling more connected more quickly with their scaria. I think that's so great. I've even seen a drape with a portal in it that a couple of nurses invented. Have you ever seen that? I have not actually seen them, so curious. That would be so wonderful. I think it'd be an interesting um thing too, just to watch. I

would be fascinating. But I have not seen that yet in our hospital. What happens during necessarian your baby is born. Hopefully you're not going to feel anything in terms of pain, but what will you feel and here and possibly see? Yes. So one of the things I try to explain to patients is that, look, you're gonna be on this table. There's gonna be a lot of people on you, uh,

And I trying to empower them. And I was saying, look even at your instigia team right next to you, and I am literally a blue drape away like it's so thin, and you and I can actually talk during it if everything is going safely, and I can have a conversation and as I talk to your baby, and when your baby is ready to come out, I'll let

you know. And so they don't have pain, for say, but they may still experience some pressure because I still need to push on their belly a little bit to get that baby to come out of that decision and show the mom obviously, but um, there might feel some pressure that kind of feels odd because there are paints. Sensation is very different with that type of anesthesia. Um. I tell them about the stark lights sometimes that people

are like wow, just so bright. And here it is because we're doing surgery, so it's a little bit tough. But we try if they make things a little bit more calm by picking the music that they like to hear, what they want their babies to be born too. So we have these little tricks that are being implemented, but I try to warn them of all the things are going to be experiencing. Well, I'm sure you are so reassuring. That makes a huge difference. Oh, I hope. So I

think any birth is really a positive one. Getting a healthy amount and healthy babies really what we can all hope for. About how long does the C section take from start to finish? That's the great question. So if we're doing it for the first time, in other words, we've never had abdominal surgery, that means we are not really going to anticipate having scarring during necessary And the

c sections are relatively easy to do. I mean, even though it's a lot of training goes into that, it's not a very difficult surgery if we've been trained well, and so it can take only like thirty minutes to forty five minutes um. And a woman who has not done that before and women have had priority sections. There might be a lot of scoring and which basically be very damtic about how we do things and make sure we put back things the way exactly what we were

um and delivering the baby safely. But in that case it might take longer an hour and a half two hours, depending on how much trouble we may liked. He could be there for a while. Yes, what is your partner going to see if he looks during the procedure. There is a lot of blood flow in the interus during the time of pregnancy, so in a lot of water, and when water is mixed with even a little bit of blood, it's gonna look very bloody, even though it's

actually lots of fluid from the baby. Right, So if somebody is squeamish, they ain't feel like busy when they see it, So we try not to have them look during the time, I heard all this fluid is coming out. What depends you know, some people are physicians or nurses and they feel comfortable you can king or something like this, So I think that's fine. How will you be closed up after the surgery? So as soon as the baby comes out, we take care to close the uterine incision. First,

it is that muscle that's closed. Usually the incision is what we call like a very low transversion decision, so it goes down almost where your bladder is that is closed up. It's contracts nicely. The uns become smaller, so we have decreased bleeding. After that, depending on the surgeon, they may crowse some smaller layers, but everybody closes the fashion, which is that big, tough, kind of very thin layer that is holding all our organs inside or abdomen um

that is always closed up. Sometimes some of the fat is closed up, so we decrease the chance of having what we call like a currona, which is basically a little inflammation and infection of the fact tissue. And then we close the skin and we usually do that now more with suture. What are some surprises about recovery? Swelling is one that I hear a lot, a lot out

of swelling as well as vaginal bleeding. Moms don't expect because they didn't deliver vaginally that they would have vaginal bleeding, which they do just as if you had a vaginal birth. Gas pain referred pain, hard time peeing, Yes, all of that, So you're right just because we delivered it a different way. You still may have some swelling. Swelling of the labia might be their lower extremity, meaning your your feet might

be still more swollen. That's all expected as the fluid that's in your body is now going back into your vessels. That takes time, and then it's getting processed by their kidneys and then essentially you are urinating that out, so that all takes a little bit of time to settle. In the same for bleeding, that uterus was still had a baby, and it's still it's contracting, and the natural kind of system of things is that it's going to go down in size, and as it's doing that, it's

letting go of some of that blood. Still may have some vaginal bleeding for even a few weeks, slight. It shouldn't be a lot, and if you do have a lot of bleeding, we actually want to know about it. But slight bleeding for the next few days, even a few weeks is normal finding so wearing a pat is important. Sometimes women have this funny sensation where they have an incision for the C section and their skin feels numb, and that is often the time where we have a

c section. Some of those nerve endings are cut because you don't see them, so it's impossible to not do that, and you may have some dumbness there for a while, and that takes a few few weeks to come back even months. Sometimes. Also a pretty normal finding maybe inflamation that should be checked out or infection. Making sure that it's always nice, clean and dry, but if it looks inflamed or angry, it's always a good reason to visit

your doctor. I wanted to mention a few suggestions that mom's had on my Facebook page after c section, because nobody knows what to expect better than mom moves out a c section, And they said for packing for the hospital, even if you don't know if you're going to have a c section, high wasted, very loose underwear as well as high wasted, very loose lounge pants so that there's no pressure on the incision. A belly band and a pillow to hold against your incision. Definitely for the ride home.

A lot of moms find it helpful to clutch when they're getting out of bed, but also in the car and for nursing to avoid putting pressure on the incision. One mom actually suggested mcg ivering a Maxi pad to cushion the incision, which I thought was ingenious. Right, Yeah, we do that a lot of curvacients. I think anything like that can give a little bit of a buffer between your clothes that might be chugging on it, it

would be helpful. I think the belly band idea is really nice idea because it gives you a sense like something is helping to hold you in, you know, and it gives you a little bit more support when you're taking your first few steps that are getting out of a chair into a vent and so forth. The first

day after sea section usually isn't so bad. It's the first thing the third or fourth day that it's a little bit tougher, and that's kind of your like you hit your bottom, you know, and then you get better and better with time, and it takes couple of weeks to really feel yourself again, maybe even a little bit longer, but every day does get better. So how much pain would you expect to have? Do you think moms have more than they expect to have? More less? And how

do you feel about medications? Would you suggest they try um alternatives to prescription pain meds or should they go for the prescription ones. I think pain is very very individualized and we have to be really open to having that one on the discussion with patients. I do think you shouldn't be getting opis to every single person, but it is still a surgery and it might be needed

in the first few days. It doesn't mean you have to do this and you shouldn't be doing taking opio it's for a long long time, but you maybe you would consider that in the first few days to really get you through that. I think the combination of an anti inflammatory and as an opioid and thailan all are all helpful. Right, So a combination of this that works from different angles helped to manage that pain. Sometimes even light a king patches that we put on the skin

just above the incisions are helpful to the patients. So there's there's different modalities to do it. And again, like the combination might be the best. Is breastfeeding different with a C section. I know that a lot of moms find that their breast melt takes a longer time to

come in. What's your experience, Yeah, it probably is true, but I think really understanding that and really having a good support team with you, where the baby is going to be put on the breast early on, maybe even in the operating room while we're closing up or soon after when you get to your recovery um or if the baby is being tended by the nick you team, let's say, then really putting on on the breast club and initiating that simulation early, all those things are really helpful.

And reaching out to lactation consultants within your hospital or outside. I think it's always a really good investment of time and money, even if you have to cancel it because you're doing great, you know it. That's one of those things where we don't get a lot of training in this uh as new moms, right like, we don't get a lot of teaching in this, and to get a

lot of support for that is really important. Totally taking a breastfeeding class ahead of time is a great place to start, But I feel like lactation support is critical and you won't necessarily have those problems immediately. It's more likely to happen once you get home from the hospital and your your mouth comes in and you know you're a little overwhelmed by everything going on around you, that's

when you might need the support most. Right, right, how much harder is postpart and recovery for a scerian delivery as opposed to have abdual delivery once you get home? Are there more restrictions? Probably on average? Now, you have some women who have had really difficult badge and deliveries in there and pain for a long time, But an average women who have a C section do have paid for longer, and they may have incisional pain that it's just obviously because it doesn't exist in a badge and

delivery is just different. So it is a longer process of recovery. You know, it does make me require more pain medication, it does require more care, it's harder to get back to driving, and probably need a little bit more time before you do operate any kind of machinery. And that's usual far your baby. That's like it's complicated,

gets right, and it is called that's a complicated part. Finally, what's your message to moms who are understandably disappointed, scared that they need to have a C section, disappointed afterwards. I mean my message is always when it's all said, done and snuggled, the only part of your labor and delivery story. That really matters is the happy ending. That's the healthy mom and healthy baby. And really any way

that you get there is pretty much okay. In my book, what do you say to mom's Yeah, you can't really stress that enough. I agree, I mean, really, the safest way is the best way to go. Whatever gets you home safely with your baby, that's the that's the way to do it. Sure, I agree. We should decrease our c section right safely if we can, and we should work on that not only individually amongst ourselves as physicians

but as patients, but also as institutions and nationally. But in the end, until we we fight that fight, it's important that you take care of yourself and that you really feel like you've done everything you can and you have. You've delivered that baby safely, You've done all that hard work and coming home safely with your baby. That that's what that's our goal, that's everybody's goal. That's an unqualified success.

I would say, yes, for sure. Well, thank you so much, Dr Obanton, and for so much more on c sections and recoveries, go to what to Expect dot com baby below my baby Belove, I need you. Oh how I need you. Thanks for listening. Remember I'm always here for you. What to Expect is always here for you. We're all in this together. For more on what you heard on today's episode, visit what to Expect dot com slash podcasts.

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