Cesarean Section Procedure

Here is a video that shows an animation of a cesarean section procedure.

A normal c-section takes about 45 minutes to an hour. The baby is usually delivered within the first 5-15 minutes, and the rest of the time in the procedure is spent cleaning out the uterus and sewing you back up.

Prepwork for the c-section

To prepare you for a cesarean section procedure, especially if this is an "elective" surgery (meaning it was scheduled before you went into labor), they may ask you to not eat for a certain number of hours. How many hours seems to depend entirely on your doctor or hospital's practices. In some places, they tell you to stop eating 12 hours before surgery, while other women report they were allowed to eat breakfast before a lunch-time surgery. And of course if you have an "emergency" c-section (meaning the decision to have the surgery was made after you went into labor), then it's too late to ask you not to eat anything.

As preparation for the cesarean section procedure, you will receive an IV line in your hand, and you will be given about a liter of liquid through the IV before they administer the pain medication, especially if you are having an epidural or a spinal. The reason for this is to counteract the drop in blood pressure that regional anesthesia can cause.

Pain relief options

Regional anesthesia

Most c-sections are performed under regional anesthesia, that means either an epidural or a spinal. In both cases, they need to introduce the pain medication into your spine, so they will ask you to curl your back like a cat to be able to pinpoint exactly where to put the needle. You will first get a local anesthetic, usually lidocaine or a similar drug that is just like what you would get at the dentist. After you get the local anesthetic, you will not feel the rest of the procedure, which involves introducing the pain medication into your spine through a needle or thin tube. Regional anesthesia usually needs 20 minutes to start working. Under regional anesthesia, you will be awake and aware through the cesarean section procedure, though you will be unable to feel or move anything below the level where the pain medication was introduced.

General anesthesia

If regional anesthesia is not possible because of a medical condition or because there isn't enough time, you will be given general anesthesia. General anesthesia takes effect almost immediately, so it is often used in true emergencies, where every minute counts. General anesthesia is faster, and gives medical staff better control over your breathing and blood pressure (since these are maintained artificially). However, under general anesthesia, you will be unconscious during the surgery and for some time afterward.

Other preparation

You will get a catheter inserted into your urethra to relieve your bladder of urine while you are under anesthesia. If they are nice, they will do this procedure after you are already under the effects of the anesthetic.

Your pubic area will be shaved to expose the area right over your pubic bone, which is where they will cut.

In the operating room

Don't be surprised if you are cold in the operating room. They keep temperatures low in order to slow down the spread of bacteria and other pathogens.

They will ask you to lie down on the operating table, and fix your arms in a spread position. You will receive a heart rate monitor clip on one of your fingertips, and EKG pads on your chest. These serve to monitor your vital signs during surgery.

Your belly will be swabbed with an antiseptic solution, then covered with surgical drapes. These drapes have a hole made of a sterile plastic, kind of like cling wrap. This film is smoothed over your belly. They actually cut through it when they do the surgery, and the point is that this way, your surrounding skin is covered, which reduces the chances of germs entering your incisions from your skin.

At some point, they will put up the screen between you and your belly.

During the cesarean section procedure

The anesthesiologist will probably start talking to you at this point. He or she will be making conversation, in part to keep you calm, and in part to assess how the anesthetic is working. He or she may test whether you're satisfactorily anesthesized by squirting cold water on your skin along your hips and your side. This reveals whether the anesthetic has started working. If you pass this test, the anesthesiologist will give the go-ahead to the surgeons to start cutting. The first cut they make is just a scratch, and they watch for signs from you that you felt it.

If you feel the first incision, the anesthesiologist can either tilt the table down toward your head and let the anesthetic "flow" a bit higher up, or they can wait or increase your dose before they continue the cesarean section procedure.

Once the anesthetic has kicked in, they complete the cut. First the skin, then the underlying fat and connective tissue, then the abdominal muscles, and finally, the wall of the uterus. The cut on the uterus can be different than the cut on the abdominal wall, so ask your surgeon about your incisions. Their direction and the manner of closing them up can affect your future deliveries.

Once the cut on the uterus is made, the surgen reaches in to free the baby's head. You will feel some pressure and some tussling around your abdomen. As they move your intestines around, you may also feel nauseous or need to burp.

Once the baby is out, they start working on removing the placenta. Once the placenta is removed, they inspect the inside of your uterus to make sure no little bits of placenta or amniotic sac remain, since these can cause problems down the line. If they are satisfied, they start suturing up your incisions.

For more info about what happens after the cesarean section procedure, please read the article about c-section recovery.

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