Cesarean (C-Section) Delivery
Preparing for cesarean birth surgery
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Expertise in Planned or Unplanned C-Sections
Beth Israel Deaconess Medical Center (BIDMC) provides comprehensive care for you and your baby during your pregnancy, through labor and delivery, and into the postpartum period. As part of these offerings, our team has expertise in both planned and unplanned C-section births.
Pain Management During C-Section
Depending on how quickly your provider has to perform the cesarean section, you will receive spinal, epidural or general anesthesia. If you have spinal or epidural anesthesia, your partner may be present during the delivery in the operating room. If you have general anesthesia, your support person may wait in the recovery room. Learn more about pain management during labor and delivery.
Planned C-Section
Birth by cesarean section is sometimes necessary to ensure a patient’s health or the health and safety of the baby. Your care team may recommend a C-section delivery for these reasons:
- 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 or more)
- An active genital herpes infection
- An exceptionally large baby (macrosomia)
Unplanned C-Section
In some cases, cesareans are unplanned. Your doctor makes this decision together with you during the course of labor. Your doctor may suggest an unplanned C-section in these situations:
- Your baby is too large to pass through the pelvis.
- Cervical dilation or descent of the baby’s head stops during labor, called cephalopelvic disproportion.
- Your baby isn’t tolerating labor or is showing concerning changes in their heart rate.
Repeat Cesarean Delivery
If you had a cesarean birth in the past, you and your obstetrician may decide on a repeat cesarean delivery for this pregnancy. Situations for repeat cesarean include previous cesarean delivery with vertical incision (cut) or extensive prior uterine surgery.
Vaginal Birth After Cesarean (VBAC)
If you’ve had a cesarean delivery in the past, talk with your obstetrician ahead of time about whether trying a vaginal birth is a good choice for you. The decision to select VBAC is personal. Our medical center has the expertise and required equipment to safely offer VBAC.
Care in the Labor & Delivery Recovery Room
After your C-section delivery, your care team will transfer you and your baby by stretcher to the labor and delivery recovery room. Your support person will accompany you. During your stay in the recovery room, your primary nurse will frequently monitor these issues:
- Amount of vaginal bleeding (lochia)
- Blood pressure
- Comfort level (pain)
- Condition of your incision
- Firmness of your uterus (fundus)
- Heart rate
- Oxygen saturation
- Temperature
Your primary nurse can help you with feeding and caring for your baby, as needed. If you don’t feel nauseous, you can try ice chips while in the recovery room. Over the next few hours, you will gradually increase the fluids and foods you can eat.
Your baby will remain with you in the recovery room. After about two hours, we will transfer you both to your postpartum room (5th and 6th floors). This transfer occurs when you have a return of sensation from anesthesia and have good pain control. An anesthesiologist will evaluate you before you leave the recovery room.
For more information on cesarean delivery at BIDMC, review our guide on your cesarean delivery.
More About C-Section Delivery
If you are scheduled for a C-section delivery, here are some tips on what to expect:
- You will shower with a special chlorhexidine (CHG) soap the evening before your procedure. You will shower with this soap again the morning of your C-section. 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.
- A member of your care team will clip the top of your pubic hair when you arrive to labor and delivery. Please do not shave or wax your groin or stomach area one week prior to surgery.
- Remove all jewelry and leave valuables at home. Please do not wear nail polish or artificial nails.
- Don’t eat or drink for eight hours before your planned procedure.
Arrive at the labor and delivery unit (10th floor) about two hours before your scheduled delivery time. You will meet your primary nurse and anesthesia staff. A member of your care team will place an intravenous (IV) line in a vein in your arm. You’ll get an antibiotic during the procedure to prevent infection. Please let your nurse or doctor know if you have an allergy to any medication.
Complications from anesthesia can arise if your stomach is too full. Aspiration of stomach contents into the lungs can be dangerous. For this reason, don’t eat, drink or chew gum eight hours before your scheduled time.
Before the procedure begins, you’ll 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 your care team may take you 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 you receive your anesthesia, a member of your care team will place a catheter in your bladder. The catheter will drain urine during the operation. (You will not feel the catheter because your care team inserts it after you’ve had your anesthesia). Your care team will wash your abdomen with soap and cover it with drapes.
Once you are completely numb, your obstetrician will make an incision in your abdomen. This incision will be either side-to-side (a low, transverse incision) or up and down (a vertical incision). The type of incision you have depends on if you’ve had any prior incisions on your abdomen and the urgency of the operation.
The doctor will make another incision 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 you wish.
Once the operation begins, your baby will be born within 15 to 20 minutes. With regional anesthesia (spinal or epidural), your partner can sit 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, the care team will clean and dry off your baby, as well as weigh and examine them. They will swaddle your baby and hand them to your support person.
The remainder of the cesarean section will take about 40 minutes. The doctor will:
- Remove the placenta.
- Stitch the uterus closed.
- Close the skin incision on your abdomen with stitches or staples.
- Your care team will remove the surgical drapes. They will wash your abdomen and place a bandage over your incision.
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