What really happens during a C-Section


doctor in mask

Diary Of A C-Section


A moment-by-moment account of one woman’s life-changing surgery

Bent over an exercise ball in front of 20 of my peers, I tried to relax as my husband gently massaged my lower back.  No, I wasn’t in labor.  I was in class preparing to give birth.  Every Thursday evening for four weeks, my husband, Greg, my bump, and I dutifully trekked to class.  At the end of the program, I came out feeling ready.

But there was one tiny problem.  My baby was breech and if he didn’t turn soon, I would be forced to have a scheduled C-section.  How much of my month-long course had been devoted to C-sections?  About a minute.  I asked what would happen if my baby didn’t turn. My teacher assured me, “Many babies are still upside-down at 31 weeks.  Don’t worry.”

Fast forward another month and my health care providers were less convinced my baby would turn.  At 35 weeks, my ob/gyn scheduled an elective Cesarean section even though she remained mildly optimistic that I might be able to deliver vaginally and continued to perform biweekly, in-room, ultrasounds.  No luck.  By 38 weeks my C-section was imminent and I had no idea what to expect.

Well, actually, I learned two details about Caesarean births from a 30-second video shown to us by my labor-class instructor.  The camera never left the mom’s face, so you didn’t get to see what was actually going on, but the neck-up shot told me two important things:

1. She was awake!

2. She could actually feel what was going on!  The woman in the video kept saying, “This feels so weird.”

Maybe I was naive, but I actually thought I would be “put under” with general anesthetic before the doctor sliced open my abdomen. Aren’t you always asleep during major surgery? “There are rare occasions to use general anesthetic— when the mom and/or baby are under great distress,” says Mary Marnach, M.D., an ob/gyn at Mayo Clinic in Rochester, MI.  But for elective procedures, the mom is almost always treated with a spinal epidural and she is most definitely awake.

I thought maybe talking to some local moms who had undergone C-sections would help put my mind at rest:

“It felt like my body was a chest, and someone was opening drawers,” Terri O’Brian says.

“I was bedridden in the hospital for two weeks afterward,” Sue MacDonald says.

“My wound became infected and I had to go back to have it resealed,” Christina Fairhurst says.

These were not the answers I was looking for.

Then finally, I heard something I could live with.  “I had no problem with the procedure. It didn’t hurt at all,” Julie Blackwell says.  “And after a few days of immobility, I was up walking around,” she adds.  “Two weeks later I almost felt like myself again.”

“The most predictable thing about C-sections—and about childbirth in general— is that they’re unpredictable,” says William Camann, M.D., associate professor of anesthesia at Harvard Medical School and author of Easy Labor.  Although it’s great to listen to other women’s stories, know that your experience will be unique.  Even though an estimated 25 to 30 percent of pregnant women will have a C-section birth, it is a serious operation.  “It should not be taken lightly,” says Camann.

That being said, it’s a very common procedure and usually there are no complications. A wound infection can occur about 5 to 10 percent of the time.  There’s a very small risk of blood clots or a hole in the bladder.  Also, there are potential problems for subsequent pregnancies.  Placenta previa (a complication in which the placenta blocks the birth canal) is more common in women who have had a C-section.  And there’s a chance of scar tissue buildup on the uterus after a Cesarean.  This isn’t a problem with women who have one or two C-sections, but if you’re planning to have a large family, the scar tissue can build up and, in severe cases, the mother may have to have her uterus removed after giving birth.

Breech births are one of the major reasons to schedule an elective Caesarean.  Placenta previa and placenta abruption—when the placenta starts to separate from the uterine wall—are also major reasons for an elective C-section.  “There aren’t as many women planning C-sections for cosmetic reasons or convenience as you would think,” Camann says.  Article titles like Time magazine’s “Too Posh To Push?” make sexy headlines, so the few people who do choose C-sections for these reasons get a lot of media coverage. “If you’re considering a C-section to preserve the integrity of your perineal floor, I strongly advise against it,” Marnach says.  “If you go beyond the first trimester, all pregnancies put you at risk of pelvic-floor relaxation.” Having a C-section isn’t going to prevent that.

Coming to Terms With It

Three days before my elective C-section, I found myself driving to the hospital for a oneon- one with a nurse to take my blood and answer any questions.  “We always take blood before any operation,” Marnach says.  “Just in case anything goes wrong, we need to know the patient’s blood type.”

“Will it hurt?” were the first words out of my mouth.  The nurse answered, “Not usually.” Not the two words I was looking for.  “It’s like when you get a filling,” she says.  “It doesn’t hurt, but you can feel something going on.” I hate the dentist!

The comforting part of having an elective C-section is that I knew my ob/gyn would be performing the procedure.  We were able to schedule the surgery when she was on call, so it was reassuring to know the person I’d been dealing with for the last nine months would be delivering my baby.  Also, I knew the date I would be giving birth, which is perfect for my type-A personality.

The day before my C-section, I went to the gym for a final workout.  Then I ran some lastminute errands, went for coffee with a friend, and had a mocktail and steak dinner with my husband.  I wish I could say I had a good night’s sleep, but by 8 p.m. the nerves finally started to kick in and I was restless throughout the night.

The Procedure

I arrived at the hospital at 6:45 a.m. for my scheduled surgery at 8 a.m., having been told to have no food or drink for 8 hours before. The waiting room was filled with uncomfortable women, grasping their husbands’ arms in pain.  Greg leaned over and whispered, “That’s what I thought it would be like.  I’m a little glad it’s not.” I was too.  A half hour later, I was moved to a private room and given my hospital blues to slip into.  I was also told an emergency C-section had arose and mine would be pushed back an hour.  I was a little relieved.  I needed more time to prepare.  Labor, although excruciatingly painful, helps to prepare you emotionally for the miraculous event to come.  Without the contractions, this all felt a little surreal.

“There is an emotional effect to Cesareans,” Camann says.  Every woman should prepare herself for a C-section before she goes into labor, just in case it becomes necessary.  Camann advises to focus on wanting a healthy baby and putting your expectations on the outcome, not the procedure.  “People are usually happy when they get what they want,” he says.

Around 9 a.m. a nurse came in to give me an IV.  Most hospital labors require an IV.  “It’s a great way to keep mom hydrated, and we can deliver anti-nausea and pain medication through the IV,” Marnach says.

Ten minutes later, it was time to head to the operating room.  I parted ways with Greg—for now.  He was taken in the other direction to don his scrubs.  As I walked down the stark hall, holding my own IV, I still couldn’t quite believe I would have a baby in less than an hour.

At the end of the hall, we turned into the procedure room.  My only visions of operating rooms came from the chaos seen on the TV show ER. This room was clean, sterile, and empty.  I was asked to get up on the table and wait.

A few minutes later, the anesthesiologist came in and a pillow was put over my lap.  I bent forward to receive my spinal.  An epidural, which is given to moms during vaginal labor, is diffused through a plastic tube so the medication can be adjusted throughout labor.  With a C-section, the length of the procedure is known, so women are given a single injection to numb the area from mid-chest downward.  “It is a nerve block, so very little medication gets into the blood stream,” Camann says.  “You won’t be sleepy and the baby gets very little effect.” A spinal is stronger than an epidural and takes away every sensation except for some tugging.  With an epidural you can still move your legs, but with a spinal you will not be able to move anything.

Although I’ve heard some women feel a quick electric shock sensation down their limbs when the needle is inserted, my spinal didn’t hurt at all. In fact, my IV was far more intense.  I was quickly laid down on the table before my legs lost all feeling.  My arms were brought out to my sides and strapped down.  Monitors were attached to my wrists and a blue sheet was placed at midchest level so I couldn’t see what was happening.

At that point, a wave of intense nausea came over me and I was certain I would throw up.  My body started to shake, and I became very cold.  “Low blood pressure is a very common side effect to anesthesia,” Camann says. “A doctor will monitor your blood pressure every minute, and if it drops, he will give you medicine to correct it in 5 to 15 minutes.” My blood pressure was regulated in a few minutes, and then I felt fine.

The nurse then inserted a bladder catheter, because I wouldn’t be able to walk for a while, and my doctor started to prepare.  Greg came in and stood next to my head.  Everything was about to start; it was just before 10 a.m.

The doctor poked my belly to make sure I was numb, and I didn’t realize she had cut open my stomach until I started to feel my baby moving at the top of my belly.  I also felt the doctor pushing down on the top of my belly to coax the little one out.  It was a little uncomfortable, but five minutes later I had a new baby.

I was overwhelmed with love, amazement, and shock.  But why was my baby so blue? C-section babies sometimes need a little help getting the fluid out of their airways, so they may appear bluer than other newborns.  But after a quick suction by the nurse, my son turned a healthy pink.  I rested as the doctor sewed me back together, and it was reassuring to know the doctor did not cut through the abdominal muscle.  Instead, the doctor separates the abdominal muscle and makes a small incision in the uterus.  “There will be a lot of blood,” Camann warns.  “It’s normal to lose a lot of blood from the placenta, so don’t be alarmed if you look down and see blood on the floor.”

After the surgery, my baby was placed on my chest and I was taken to a recovery room for a few hours prior to going to my overnight room.  My wound had to be redressed once, and I shook uncontrollably for the next half hour and was so cold.  “Shivering and shaking is very common in Cesareans,” Camann says. The IV fluids are colder than body temperature, so they can make you feel cold.  Also, small pieces of amniotic fluid can seep into the blood stream during surgery and cause shivering or shaking.  “It’s harmless and will pass in a few minutes to a few hours.”

A Great Result

I couldn’t even roll over in my bed without help for the rest of the day, but by day two I was walking around.  And when I left the hospital the following day, I could walk up stairs very slowly and get around holding my baby.  Because it was my first baby, I will now have to make the decision to attempt a VBAC (vaginal birth after Caesarean) or have another C-section with any subsequent pregnancies. But in the great scheme of things, it really doesn’t matter.  A year later, I have a tiny scar below my bikini line and a healthy little one, so everything turned out perfectly.


— Nancy Ripton

Nancy Ripton is co-founder of JustTheFactsBaby.Com.  She found it helpful to hear other women’s stories prior to her C-section and hopes telling her experience will prepare moms for what to expect should they need to have a Cesarean birth.


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