Cesarean Delivery

Birth by cesarean section is sometimes necessary to ensure a patient's health or that of the baby. A cesarean delivery may be needed because of:

• the baby's position (breech)
• an abnormal location of the placenta (placenta previa)
• a prior cesarean section with a vertical uterine incision
• multiple gestations (twins, triplets)
• an active genital herpes infection
• an exceptionally large baby (macrosomia)

In the above cases, the cesarean section is often planned ahead by the patient and provider. At other times, the decision to do a cesarean section is made during labor. This may occur when the baby is too large to pass through the pelvis, when the fetal heart rate monitor or blood tests indicate that the baby is not tolerating labor, or if the patient or baby’s life are at risk.

• You will be instructed to shower with a special chlorhexidine (CHG) soap the evening before your procedure, as well as the morning of. You only have to wash your body with this special soap, not your scalp or face.
• If you need to take morning medications the day of the procedure, please take them with a small sip of water.
• The top of your pubic hair will be clipped when you arrive to labor and delivery. Please do not shave or wax groin/stomach area one week prior to surgery.
• Remove all jewelry and leave valuables at home. Please do not wear nail polish or artificial nails.
• You should not eat or drink 8 hours prior to your planned procedure.

You will arrive to labor and delivery (10th floor) about 2 hours prior to the start time of your scheduled procedure. You will meet your primary nurse and anesthesia staff. An intravenous line will be placed in a vein in your arm. Every patient will get an antibiotic during the procedure to prevent infection. Please let your nurse or doctor know if you have any allergies to certain medications.

Complications from anesthesia can arise when a patients’ stomach is too full. Aspiration of stomach contents into the lungs can be quite dangerous. For this reason, patients should not eat, drink or chew gum 8 hours prior to their planned procedure. Before the procedure begins, you will be asked to drink a salty-tasting antacid called sodium citrate. This medication will decrease the acidity in your stomach.

Your primary nurse and anesthesiologist will walk you to the Labor and Delivery operating room, or you will be transferred by stretcher. During the cesarean procedure, at least two anesthesiologists, two nurses, and two obstetricians will be in the operating room with you. Other health care professionals, such as a pediatrician, and medical and nursing students, may be present as well.

After your anesthesia is administered, a catheter will be placed in your bladder to drain urine during the operation (you will not feel this because it is inserted after anesthesia). Your abdomen will be washed with soap and covered with drapes.

Once you are completely numb, your obstetrician will cut into your skin, either side-to-side (a low, transverse incision) or up and down (a vertical incision), depending on any prior incisions on your abdomen and on the urgency of the operation. Another cut will be made in your uterus, either side-to-side (a Kerr incision) or up and down (a classical incision). A side-to-side incision on your uterus will allow you to attempt to deliver vaginally with a future pregnancy if desired.

Once the operation begins, your baby will be born within 15 to 20 minutes. With regional anesthesia (spinal or epidural), your partner will be sitting beside you during the procedure. You may feel pressure with the delivery of your baby, but you should not feel any pain.

After the birth, your infant will be will be dried off, weighed, and examined. Your baby will then be wrapped and handed to your support person.

The remainder of the cesarean section will take about 40 minutes. The placenta will be removed, the uterus will be stitched closed, and the skin incision on your abdomen will be closed with stitches or staples. The drapes will be removed. Your abdomen will be washed, and a bandage will be placed over your incision.

After your cesarean delivery, you and your baby will be transferred by stretcher to the labor and delivery recovery room, accompanied by your support person. During your stay in the recovery room, your primary nurse will frequently monitor your blood pressure, heart rate, temperature, and oxygen saturation. She will also monitor the firmness of your uterus (fundus), the amount of vaginal bleeding (lochia) you are experiencing, and the condition of your incision. She will monitor your comfort level and assist you in feeding/caring for your baby. If you are not experiencing any nausea, you may be able to try ice chips at this time. Fluids, as well as food you can eat will gradually increase slowly throughout the next few hours.

Your baby will remain with you in the recovery room and then you will both be transferred to the postpartum room together (5th & 6th floors) when you begin to have a return of sensation from anesthesia and have good pain control. You will be evaluated by an anesthesiologist before leaving the recovery room. Most patients are in the recovery room after a cesarean section for about two hours.