Cesarean delivery (C-section) is a common way to give birth and may be planned in advance or recommended during labor if concerns arise about the health or safety of you or your baby. Many women who have had a previous cesarean birth may also be candidates for a vaginal birth after cesarean (VBAC), depending on their individual circumstances.
Knowing why a C-section may be recommended and what to expect can help you feel more prepared if cesarean delivery becomes part of your birth experience.
A cesarean delivery may be recommended when we believe it is the safest way for you or your baby to deliver. Sometimes we know before labor that a C-section will likely be needed, while other times the recommendation arises based on how labor is progressing or how your baby is tolerating labor.
Common reasons for cesarean delivery include:
Breech or other non-head-down presentation
Placenta previa
Concern about your baby's wellbeing
Labor that is not progressing as expected
Concern about a large baby
Certain multiple pregnancies, such as some twin pregnancies
Certain prior uterine surgeries
A planned repeat C-section after a previous cesarean delivery
There are other reasons a C-section may be recommended, and the safest approach depends on your individual pregnancy and circumstances. We'll discuss the reason for the recommendation and your options with you.
Most C-sections are performed using spinal or epidural anesthesia, which allows you to be awake for your baby's birth while keeping you comfortable during surgery. A member of the anesthesia team will be with you throughout the procedure.
Once you are comfortable, your abdomen will be cleaned and prepared for surgery and a drape will be placed so that you do not see the surgical procedure. Your support person can usually be with you in the operating room once we are ready to begin.
Your baby is usually delivered within the first several minutes of surgery. You may feel pressure, pulling, or movement, but you should not feel sharp pain. After delivery, your baby will be evaluated by the newborn team.
After your baby is delivered, the remainder of the surgery takes longer while we deliver the placenta and close the incisions. Most C-sections take approximately 45–60 minutes from start to finish, although timing can vary. You will then be taken to a recovery area for monitoring after surgery.
If you are certain that you have completed childbearing, permanent sterilization can also be performed during a C-section. This is typically done by removing both fallopian tubes after your baby is delivered and does not require a separate surgery. Because sterilization is intended to be permanent, please discuss this with us during pregnancy if it is something you are considering.
→ Learn More About Permanent Birth Control
If your C-section is scheduled in advance, our office and the hospital will provide instructions before your delivery. Please follow the specific instructions you are given, as recommendations may vary depending on your medical history and medications.
In general, you can expect to:
Arrive at the hospital before your scheduled surgery time to allow time for registration and preparation.
Follow the eating and drinking instructions provided by the hospital. These are important for your safety with anesthesia.
Review your medications with us, including whether anything should be taken, adjusted, or held before surgery.
Have an IV placed and blood work obtained, and your baby's heart rate will be monitored before surgery.
Meet members of your nursing, obstetric, and anesthesia teams before going to the operating room.
Stay in the hospital for about 2–3 days after surgery. Your exact discharge timing will depend on how you and your baby are doing.
Enhanced Recovery After Surgery (ERAS)
We use an enhanced recovery approach for planned C-sections to help prepare you for surgery and support your recovery afterward. Please review the instructions provided before your scheduled delivery, including recommendations about eating, drinking, medications, and preparing for surgery.
Most patients stay in the hospital for about 2–3 days after a C-section. We encourage you to begin getting out of bed and walking later the day of surgery or the following day. Activity can gradually increase as you feel comfortable, but remember that recovery from a C-section takes time.
We may ask some patients to return for an incision check about one week after delivery. Even if you don't have an early postoperative visit scheduled, we are always happy to see you if you have concerns about your incision or recovery.
Caring for Your Incision
Unless you are given different instructions, you can generally shower and remove the outer bandage about 24 hours after surgery.
Allow soap and water to gently run over the incision. Avoid vigorous scrubbing, and keep the area clean and dry.
If moisture collects around the incision, gently pat it dry. Some patients find it helpful to use a hair dryer on a cool setting or place a clean, dry pad over the area to help absorb moisture.
If you have Steri-Strips, they often begin to loosen and fall off on their own. Any that remain can generally be removed after about 2 weeks.
If you have a PICO dressing, leave it in place for 1 week unless you are given different instructions.
→ PICO Wound Vaccuum Information
Activity & Restrictions
Walking is encouraged and can begin while you are still in the hospital. Gradually increase your activity as you feel able.
Avoid lifting anything heavier than about 10 pounds for 6 weeks.
Avoid intercourse, tampons, or placing anything in the vagina for 6 weeks.
Avoid baths, swimming pools, hot tubs, or other activities that submerge your incision in water for 6 weeks.
Most patients can begin driving within about 1–2 weeks, but you should be off narcotic pain medication and able to move comfortably enough to turn, react quickly, and brake suddenly if necessary.
Avoid strenuous exercise until you have recovered further. Walking is a great place to start, and we can help you determine when it is appropriate to return to more vigorous activity.
Pain & Other Common Recovery Concerns
You will receive medications to help manage pain after surgery. Taking your medications as directed can make it easier to stay mobile during the first several days of recovery.
Constipation is also common after delivery and surgery, particularly when taking narcotic pain medication. Staying hydrated, walking regularly, and using a stool softener or gentle laxative if needed can help.
When Should I Call? section is important enough to include here:
Please contact our office if you have concerns about your recovery, particularly:
Increasing redness, warmth, swelling, drainage, or separation of the incision
Fever
Pain that is worsening rather than gradually improving
Heavy vaginal bleeding
Persistent nausea or vomiting or difficulty keeping fluids down
New or worsening swelling or pain in one leg
Any other symptoms that concern you
Seek urgent medical attention for chest pain, difficulty breathing, fainting, severe bleeding, or other symptoms that may represent a medical emergency.
Many patients who have had a previous cesarean delivery may safely consider a vaginal birth in a future pregnancy. A trial of labor after cesarean (TOLAC) means planning to labor after a previous C-section. If that labor results in a vaginal delivery, it is called a vaginal birth after cesarean (VBAC).
Whether TOLAC is an appropriate option depends on your previous delivery and uterine incision, your current pregnancy, and other individual factors. For many patients who are candidates, both TOLAC and a planned repeat C-section are reasonable options.
Many patients with one previous low-transverse C-section are candidates for TOLAC. Some patients with two previous C-sections may also be candidates, depending on their prior deliveries, uterine incisions, current pregnancy, and other individual circumstances.
We will review the records from your previous delivery when available. The scar on your uterus is what matters, not the scar on your skin. A low-transverse uterine incision is the most common type and generally carries the lowest risk of uterine rupture during a future labor. Certain other uterine incisions or previous uterine surgeries may make TOLAC unsafe.
We will also consider why your previous C-section was performed. Someone whose C-section was needed because their baby was breech or developed concerns with the fetal heart rate may have a different likelihood of successful VBAC than someone whose prior labor stopped progressing despite adequate time and contractions.
Other factors may include whether you have had a previous vaginal delivery or VBAC, the number of prior C-sections, and whether your current pregnancy has any complications that affect delivery planning. Whether you are likely to need an induction may also be part of the discussion, since induction after a previous C-section requires additional considerations and may carry greater risk than spontaneous labor.
We will review these factors with you individually to determine whether TOLAC is a reasonable option for your pregnancy.
For many patients who are candidates for TOLAC, either attempting a VBAC or planning a repeat C-section can be a reasonable choice. There isn't one answer that is right for everyone.
A successful VBAC avoids another abdominal surgery and is generally associated with a shorter recovery. Avoiding multiple C-sections can also reduce some of the risks associated with future pregnancies and surgeries, which may be particularly important if you are hoping to have several more children.
TOLAC also carries the possibility that labor will not result in a vaginal delivery and a C-section will still be needed. A rare but serious risk is uterine rupture, when the previous uterine scar opens during labor. Uterine rupture can cause significant bleeding and changes in the baby's heart rate and may require an emergency C-section. The risk of uterine rupture is generally higher when labor is induced than when labor begins on its own, which may also factor into your delivery planning.
A planned repeat C-section avoids the risks associated with labor and uterine rupture but carries the risks of another abdominal surgery and a longer recovery. Your plans for future pregnancies may also influence your decision. Each additional C-section can make future surgery more complex and increase the risk of certain placental complications in future pregnancies. On the other hand, if you feel your family is complete, some patients choose a planned repeat C-section because permanent sterilization can be performed during the same surgery.
We'll consider your previous delivery history, your current pregnancy, your future pregnancy plans, and what matters most to you when discussing these options.
Most patients who are appropriate candidates for TOLAC have a reasonable chance of having a successful vaginal delivery, although no one can predict exactly what will happen during labor.
Several factors can influence the likelihood of VBAC, including whether you have delivered vaginally before, the reason for your previous C-section, and characteristics of your current pregnancy. A previous vaginal delivery, particularly a previous VBAC, generally increases the likelihood of success.
Prediction calculators can provide an estimate, but they cannot determine whether you should attempt a VBAC or predict what will happen in an individual labor. We can use this information as one part of our discussion about your delivery options.
→ VBAC Success Calculator (MFM Units Network)
If you choose TOLAC, much of your labor experience will look similar to any other labor. Your baby's heart rate will be monitored continuously during labor, because changes in the fetal heart rate can sometimes be an early sign of a problem with the uterine scar.
Spontaneous labor is often preferred, but induction may still be an option in some circumstances. Some methods used for induction after a previous C-section differ from those used in patients without a uterine scar, so we will discuss the safest options with you if induction becomes necessary.
We will monitor your labor progress and your baby's wellbeing throughout labor. If concerns arise about you or your baby, or if labor is not progressing as expected, a repeat C-section may be recommended.
Choosing TOLAC means planning for a vaginal delivery while understanding that a C-section remains a possibility if circumstances change during labor.