Cesarean section is the surgical delivery of a baby through a cut (incision) made in your abdomen and uterus. It is also called a C-section or cesarean birth. Doctors use it when they believe it's the safer way to deliver the baby.

The incision in the skin may be made in one of these ways:

• Up-and-down (vertical). This incision extends from the belly button to the pubic hairline.
• Across from side-to-side (horizontal). This incision extends across the pubic hairline. It's used most often, because it heals well and there is less bleeding.

The type of incision used depends on the health of you and your baby. The incision in the uterus may also be either vertical or horizontal.

If a vaginal delivery carries a high risk for you or your baby, a C-section allows your baby to be delivered surgically. Your C-section may be planned and scheduled. Or, you may have a C-section because of problems during labor.

Several conditions make a C-section more likely. These include:

• An abnormal fetal heart rate or abnormal heart rate pattern. The fetal heart rate during labor is a good sign of how well the baby is doing. Your doctor will keep track of the fetal heart rate during labor. The normal rate varies between 120 to 160 beats per minute. If the fetal heart rate shows there may be a problem, your doctor will take action right away. This may include giving you oxygen, increasing fluids, and changing your position. If the heart rate doesn't improve, the doctor may do a C-section. An abnormal heart rate can be too fast, too slow, or periodically slow.
• An abnormal position of the baby during birth. The normal position for the baby during birth is head-down and facing your back. Sometimes a baby is not in the right position. This is often called breech presentation. This makes delivery more difficult through the birth canal.
• Problems with labor. The labor fails to progress, or it doesn't progress the way it should.
• The size of the baby. The baby is too large for you to deliver vaginally.
• Placenta problems. This includes placenta previa, in which the placenta blocks the cervix. It may also include placental abruption, in which the placenta separates too early from the uterus.
• Certain health conditions. You may have a C-section if you have certain heart or brain conditions, diabetes, high blood pressure, an HIV infection, or active herpes sores in your vagina or cervix.
• Being pregnant with twins or other multiples.
• Having had a previous C-section.

Your doctor may have other reasons to recommend a C-section.

Some possible complications of a C-section may include:

• Reactions to the medicines used during surgery.
• Bleeding.
• Abnormal separation of the placenta, especially if you've had a previous cesarean delivery.
• An injury to the bladder or bowel or other structures around the uterus.
• An infection in the uterus.
• A wound infection.
• Trouble urinating or urinary tract infection.
• Delayed return of bowel function.
• Blood clots.

After a C-section, a person may not be able to have a vaginal birth in a future pregnancy. It will depend on the type of uterine incision used. Vertical scars of the uterus are not strong enough to hold together during labor contractions, so a repeat C-section is necessary.

You may have other risks that are unique to you. Be sure to discuss any concerns with your doctor before the procedure, if possible.

• Your doctor will explain the procedure to you and you can ask questions.
• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is unclear.
• You will be asked when you last had anything to eat or drink. If your C-section is planned and needs general, spinal, or epidural anesthesia, you will be asked to not eat or drink anything for 8 hours before the procedure.
• Tell your doctor if you are sensitive to or are allergic to any medicine, latex, iodine, tape, or anesthesia.
• Tell your doctor of all medicine (prescription and over the counter), vitamins, herbs, and supplements that you are taking.
• Tell your doctor if you have a history of bleeding disorders or if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. You may be told to stop these medicines before the procedure.
• You may be given medicine to decrease the acid in your stomach. These also help dry the secretions in your mouth and breathing passages.
• Plan to have someone stay with you after a C-section. You may have pain in the first few days and will need help with the baby.
• Follow any other instructions your doctor gives you to get ready.

A C-section will be done in an operating room or a special delivery room. Procedures may vary depending on your condition and your doctor's practices.

In most cases, you will be awake for a C-section. Only in rare cases will a birth parent need medicine that puts them into a deep sleep (general anesthesia). Most C-sections are done with a regional anesthesia such as an epidural or spinal. With these, you will have no feeling from your waist down, but you will be awake and able to hear and see your baby as soon as they are born.

Generally, a C-section follows this process:

1. You will be asked to undress and put on a hospital gown.
2. You will be positioned on an operating or exam table.
3. A urinary catheter may be put in if it was not done before coming to the operating room.
4. An I.V. (intravenous) line will be started in your arm or hand.
5. For safety reasons, straps will be placed over your legs to hold you on the table.
6. Hair around the surgical site may be shaved. The skin will be cleaned with an antiseptic solution.
7. Your belly (abdomen) will be draped with sterile material. A drape will also be placed above your chest to screen the surgical site.
8. The anesthesiologist or nurse anesthetist will continuously watch your heart rate, blood pressure, breathing, and blood oxygen level during the procedure.
9. Once the anesthesia has taken effect, your doctor will make an incision above the pubic bone, either transverse or vertical. You may hear the sounds of an electrocautery machine that seals off bleeding.
10. Your doctor will make deeper incisions through the tissues and separate the muscles until the uterine wall is reached. They will make a final incision in the uterus. This incision is also either horizontal or vertical.
11. Your doctor will open the amniotic sac and deliver the baby through the opening. You may feel some pressure or a pulling sensation.
12. They will cut the umbilical cord.
13. You will get medicine in your I.V. to help the uterus contract and expel the placenta.
14. Your doctor will remove your placenta and examine the uterus for tears or pieces of placenta.
15. They will use stitches to close the incision in the uterine muscle and reposition the uterus in the pelvic cavity.
16. Your doctor will close the muscle and tissue layers with sutures. They will close the skin incision with stitches or surgical staples.
17. Finally, your doctor will apply a sterile bandage.

In the recovery room, nurses will watch your blood pressure, breathing, pulse, bleeding, and the firmness of your uterus.

Usually, you can be with your baby while you are in the recovery area. In some cases, babies born by cesarean will first need to be watched in the nursery for a short time. Breastfeeding can start in the recovery area, just as with a vaginal delivery.

After 1 or 2 hours in the recovery area, you will be moved to your room for the rest of your hospital stay.

As the anesthesia wears off, you may get pain medicine as needed. This can be either from the nurse or through a device connected to your I.V. (intravenous) line called a PCA (patient-controlled analgesia) pump. In some cases, pain medicine may be given through the epidural catheter until it is removed.

You may have gas pains as the intestinal tract starts working again after surgery. You will be encouraged to get out of bed. Moving around and walking helps ease gas pains. Your doctor may also give you medicine for this. You may feel some uterine contractions called after-pains for a few days. The uterus continues to contract and get smaller over several weeks.

The urinary catheter is usually removed the day after surgery.

You may be given liquids to drink a few hours after surgery. You can gradually add more solid foods as you can handle them.

You may be given antibiotics in your I.V. while in the hospital and a prescription to keep taking the antibiotics at home.

You will need to wear a sanitary pad for bleeding. It's normal to have cramps and vaginal bleeding for several days after birth. You may have discharge that changes from dark red or brown to a lighter color over several weeks.

Don't douche, use tampons, or have sex until your doctor tells you it's okay. You may also have other limits on your activity, including no strenuous activity, driving, or heavy lifting.

Take a pain reliever as recommended by your doctor. Aspirin or certain other pain medicines may increase bleeding. So, be sure to take only recommended medicines.

Arrange for a follow-up visit with your doctor. This is usually 2 to 3 weeks after the surgery.

Contact your doctor right away if any of these occur:

• Heavy vaginal bleeding
• Foul-smelling drainage from your vagina
• Fever or chills
• Severe belly (abdominal) pain
• Increased pain, redness, swelling, or bleeding or other drainage from the incision
• Leg pain
• Trouble breathing, chest pain, or heart palpitations

Your doctor may give you other instructions, depending on your situation.

Before you agree to the test or procedure, make sure you know:

• The name of the test or procedure.
• The reason you are having the test or procedure.
• What results to expect and what they mean.
• The risks and benefits of the test or procedure.
• What the possible side effects or complications are and when they should be reported.
• When and where you are to have the test or procedure.
• Who will do the test or procedure and what that person's qualifications are.
• What would happen if you did not have the test or procedure.
• Any alternative tests or procedures to think about.
• When and how you will get the results.
• Who to call after the test or procedure if you have questions or problems.
• How much you will have to pay for the test or procedure.