In Italy, one in three births occurs via surgery. The reasons can vary widely, including the profit-driven practices of some private hospitals and clinics, as well as complex medical conditions that could put the mother or the fetus at risk during childbirth.

Although birth is always a very special event, a cesarean section differs in many ways from a vaginal birth. In this article, you will learn exactly what happens during the operation, what the risks are, and what you should pay attention to after a cesarean section.

What is a cesarean section?

A cesarean section (also simply called a cesarean) is a surgical procedure that allows a baby to be born without a vaginal delivery. There are different types: scheduled cesarean (primary cesarean), unscheduled or urgent cesarean (secondary cesarean), and cesarean upon request .

• The scheduled cesarean section is performed for medical reasons. It is planned in advance by the parents and doctors and carried out on a predetermined date before labor begins.

• Unscheduled or emergency cesarean section is when a cesarean becomes necessary during a vaginal birth.

• Elective cesarean section , on the other hand, has no medical indication. It is performed for personal reasons at a scheduled time.

But in which cases is a cesarean section recommended:

• when the mother has already had a previous cesarean section;

• when the fetus is in an abnormal position, such as breech;

• in the case of a twin pregnancy;

• when the estimated fetal weight is greater than 4000 grams or less than 2500 grams;

• in the case of placenta previa;

• prolonged exhaustion;

• fetal heartbeat irregularities that raise concern;

• placental abruption.

How does a cesarean section work?

If the cesarean section is scheduled, the date of the procedure is set one to three weeks before the expected due date. This minimizes the chance that the baby will be born before the cesarean (due to premature labor or premature rupture of membranes). On the one hand, the hospital can plan better, but more importantly, the procedure is less complicated and less risky if labor has not yet begun.

Preparation for the operation

Shortly before the procedure, the nursing staff will prepare you, just like for any other operation: the surgical area—meaning the entire abdomen—will be disinfected and shaved, and the surrounding area will be covered with sterile drapes. In addition, before the cesarean section, a bladder catheter will be inserted and the bladder emptied to prevent injury during the procedure. The catheter is usually removed a few hours after the cesarean section, or at the latest, the following day.

Anesthesia

The cesarean section always takes place under anesthesia , and you can choose between different methods: local (only the area being operated on is anesthetized) or general .

• With local anesthesia, you experience the cesarean section fully conscious. This has the advantage of allowing you to see and touch your baby immediately after birth. You will not feel any pain during the operation—only sensations of pulling and pushing.

• Some women prefer to be as unaware as possible during the operation, which is why they choose general anesthesia. However, general anesthesia carries the risk that the anesthetic may pass through the placenta into the baby's blood, and the baby may be slightly drowsy after birth. For this reason, many doctors recommend local anesthesia.

How does a cesarean section happen?

1. A eight-to-twelve-centimeter incision is made in the lower abdomen , just above the pubic bone. The various layers of skin, subcutaneous tissue, and fat are cut, and the muscles are moved to the right and left.

2. Then the uterus is opened, also with an incision, and widened enough to allow the baby to pass through. The doctor then gently removes the baby from the uterus. The umbilical cord is clamped and cut, and the newborn is immediately handed to the midwife, who is waiting to perform the first examination.

Nowadays, for cesarean delivery, the following methods are used a particular method called Misgav Ladach . This method involves cutting only the top layer of skin and stretching and tearing the underlying tissue layers enough to allow the baby to be delivered. Although it may seem less gentle at first, this method offers some advantages: the tissue is less damaged, the mother experiences less blood loss and less pain afterward, and the hospital stay can usually be shorter.

After the baby is delivered, the uterus contracts, just like after a vaginal birth. The doctor will remove the placenta and any remaining tissue to help prevent infections. After a cesarean section, a medication may be administered to help the uterus contract more effectively and prevent bleeding.

Overall, a cesarean section is quite quick: preparation and anesthesia take about 30 minutes, and the operation itself lasts another 15–30 minutes.

While you receive medical care after the surgery, your newborn also undergoes their first check-up. If the baby is well, your accompanying person can hold them in their arms for the first time. Of course, you can also touch your baby and welcome them. After a cesarean section, you and your little one will stay in the maternity ward for about 2–3 days for postnatal care.

After a cesarean section, as with a vaginal birth, you may experience afterpains. These contractions are a natural, self-regulated part of uterine recovery. The uterus contracts at regular intervals to reduce the size of the wound area. After childbirth, lochia (blood-tinged vaginal discharge) will also begin. Compared to the flow after a vaginal birth, it is usually less intense after a cesarean section and, if you have undergone a surgical curettage, it lasts for a shorter period than two or three weeks.

What are the reasons for a cesarean section?

1. Scheduled cesarean section

There are several reasons that make a vaginal delivery impossible or very risky and therefore justify a scheduled cesarean section.

They can be, for example: a transverse position of the baby in the uterus, the baby's size relative to the maternal pelvis, the position of the placenta in front of the cervix (placenta previa), a multiple pregnancy, a serious maternal illness or previous uterine surgeries, a low birth weight, or a disease affecting the fetus.

In other cases, such as breech presentation (when the baby is bottom-down rather than head-down), a cesarean section is not always absolutely necessary; there are techniques that may help turn the baby. In these cases, the decision is usually left to the expectant parents, in consultation with the doctors.

2. Unscheduled cesarean section

If labor has already begun and it later becomes clear that a cesarean section is necessary, it is called an unplanned cesarean. This happens when the health of the mother or the baby would be at risk if a vaginal delivery continued.

An unplanned cesarean section may be necessary, for example: if labor stalls, the mother is completely exhausted or has a fever, there is a uterine tear, the placenta has detached, the baby's heart rate is dropping, the umbilical cord is compressed, or other complications arise. Although the decision to proceed with an unplanned cesarean section is often made on short notice, it is performed, whenever possible, under local anesthesia.

An emergency cesarean section occurs when the life of the mother or the baby is in serious danger during childbirth, and the delivery must take place within the next 20 minutes. To save valuable time, an emergency cesarean section is performed under general anesthesia , which works more quickly.

3. Elective cesarean section

Elective cesarean section, as the name suggests, is not medically justified. However, some women still choose this form of delivery.

The possible reasons are, for example: fear of pain during a vaginal delivery or birth injuries, or negative experiences in the past. Since cesarean delivery always carries risks for both the mother and the baby, many doctors discourage elective cesarean sections without a medical reason and encourage their patients to have a vaginal birth. .

What are the risks of a cesarean section?

For the mother

Cesarean section is a routine procedure in most hospitals and has become increasingly safe over the past decades. However, like any surgical procedure, it is associated with certain risks. Before the procedure, your doctor will explain that, in rare cases, there may be:

• bleeding,
• blood clots,
• infections,
• injuries to nearby organs,
• wound-healing problems,
• or complications related to anesthesia.

While many mothers associate cesarean birth with a positive birth experience, some women experience psychological difficulties after the surgery, which can lead to post-traumatic stress disorder. These problems can be triggered, for example, by the loss of control some mothers feel during a cesarean section. They may feel sadness or guilt about the perceived weakness of not having given birth naturally. If the thought of a cesarean section worries you, talk to your doctor or midwife, or speak with other mothers who have had the same experience. A cesarean section is not a sign of weakness; in many situations, it is the best choice for you and your baby. Under no circumstances should you feel guilty.

For the child

Unfortunately, some risks for the baby during and after a cesarean section can never be completely ruled out. Some babies born via cesarean section initially experience adaptation problems (difficulty adjusting to life after birth), usually in the form of respiratory issues. . This is because, after a cesarean section, unlike a vaginal birth, there may still be amniotic fluid in the lungs. In a vaginal birth, the fluid is expelled from the baby's lungs by the pressure of the birth canal. In rare cases, cuts or abrasions can occur during the procedure, but they usually heal completely on their own.

Some critics believe that children who have not experienced the natural birth process develop attachment disorders later on and are more susceptible to infections because they did not come into contact with the mother's natural bacterial flora as they would in a vaginal birth. Some parents try to address this after a cesarean section through so-called vaginal seminar . This technique involves swabbing the newborn with vaginal bacteria obtained from the mother's vaginal secretions after the procedure. However, neither the effect of cesarean delivery on a child's bonding ability nor the effect of vaginal seeding has been proven.

Can my partner be present during the procedure?

Whether it's a vaginal birth or a cesarean section, childbirth is physically and mentally demanding. Knowing that your partner or another trusted person is with you can make a real difference. The good news is that, if there is no medical reason against it, your partner or another close person can be with you during the procedure . During the procedure, your support person will likely sit beside you, above the drape, so they can stay completely by your side.

What should you keep in mind after a cesarean section?

Rest period

A cesarean section is a major procedure for your body, and it needs time to recover. Even though it is not always easy with a newborn, you should take it easy during the first few weeks after the cesarean.

• Pay special attention to avoiding bending over, lifting heavy objects, or getting up by twisting, so you do not strain the wound.

Despite the need for rest, it is not necessary to stay in bed, as this increases the risk of thrombosis or embolism. Although it is painful at first, new mothers are encouraged to sit up within a few hours after a cesarean section.

Breastfeeding of the baby

A cesarean section has no effect on your milk supply : if you wish, you can breastfeed your baby as soon as you feel well enough medically. To protect the scar, choose a breastfeeding position in which the baby is not resting directly on it.

The midwife will help you position the baby so you do not put pressure on the scar. To find out which breastfeeding positions are particularly suitable after a cesarean section, read our article " ".

Wound healing and scar care

The abdominal suture usually heals in eight to twelve days, while the internal tissue takes up to twelve weeks. As soon as the scab has fallen off, you can start caring for the scar and doing gentle abdominal massages to support recovery. To learn how to properly treat and care for the cesarean scar, see the article here. Naturally, the midwife will also be by your side after the cesarean section to support aftercare and wound healing.

Regression and pelvic floor

Even if you did not have a vaginal birth, your tissues and pelvic floor were still stressed during pregnancy and in preparation for childbirth. After about six weeks, you can start gentle postpartum exercises to strengthen the pelvic floor. . However, be careful not to strain the abdominal wall at this stage to avoid possible injuries. If you are unsure about resuming physical activity, consult your midwife.

If you are about to have a cesarean section, it is normal to feel a bit nervous. Sharing your experiences with other mothers and talking to your midwife can be helpful. Your midwife understands your concerns and fears and can help ease some of your worries. This way, you can approach the birth as calmly as possible.