What Is a Cesarean?

Cesarean section is a way to deliver a baby surgically, through the mother's abdomen. Epidural, spinal, or general anesthesia is required. The abdominal incision is usually a "bikini" cut, crossways just above the pubic bone. Before cesarean, they may clip or shave the top of the pubic hair. When very rapid delivery is needed, a vertical incision extending down from the belly button may be faster than a bikini cut. An incision is then made into the uterus, and the surgeon reaches in and brings out the baby.

The incision that is made in the uterus is important for future risk: a "low transverse" incision is the strongest, with the lowest chance of rupture (bursting open) in a subsequent pregnancy. Fortunately, low transverse is also the most common type of cesarean. The weaker types of incisions, called classical or vertical cesareans, run up-and-down along the front of the uterus, and are generally only needed for babies that are in unusual positions. The risk of uterine rupture after a classical cesarean may be as high as ten percent, so labor is prohibited and all future babies are born by cesarean. The direction of the incision on the skin has nothing to do with the incision on the uterus, so looking at the scar doesn't tell you anything: the doctor who did the surgery or the operative note from the chart are the best sources to find out which type of cesarean was done, and if vaginal birth is an option for the future.

From the time cesarean surgery starts until the baby is born takes anywhere from a minute to about fifteen minutes. The umbilical cord is clamped and cut, and the baby is handed off the surgical field to a nurse or doctor to dry off and examine. Then the placenta (afterbirth) is delivered, and the incisions are closed in layers. The baby may be brought to the parents at this time, or kept warm by the nurses until surgery is over. The skin may be sutured, or closed with surgical staples. From start to finish, cesarean can take anywhere from twenty minutes to several hours, depending on the urgency of the situation and technical factors in the surgery.