Questions and Answers about Cesarean Section

In Germany, about one-third of children are born via cesarean section. The reasons for this can vary greatly. Even though a birth is always a very special event, a cesarean section differs in many aspects from a natural birth. What exactly happens during the procedure, what risks are involved, and what you should pay attention to after a cesarean section, you will learn in this article.

What is a cesarean section?

In a cesarean section (also called Sectio Caesarea or just Sectio), the baby is delivered through a surgical procedure instead of a vaginal birth. There is a distinction between the planned cesarean section (primary Sectio), the unplanned cesarean section (secondary Sectio), and the cesarean section upon request. A planned cesarean section is characterized by the fact that it is necessary for medical reasons. It is planned in advance jointly by parents and doctors and carried out at a set date before the onset of labor. In contrast, one speaks of a unscheduled cesarean section , if during a natural birth a switch to cesarean section becomes necessary spontaneously. A Elective Cesarean Section however, there is no medical necessity. It is carried out at a scheduled time for personal reasons

How does a cesarean section proceed?

If you have a planned cesarean section, the date for the procedure is scheduled about one to three weeks before the estimated due date. This minimizes the risk of your baby being born before the cesarean (due to premature contractions or premature water breaking). On the one hand, this allows the hospital to plan better; more importantly, however, the procedure is less complicated and risky if labor has not yet started. Shortly before the procedure, you will be prepared by the nursing staff as with any other operation: The surgical area, that is, your entire abdomen, will be disinfected and shaved, and the surroundings covered with sterile drapes. Additionally, a urinary catheter will be inserted into your bladder and it will be emptied before the cesarean to prevent injury during the procedure. The catheter is usually removed a few hours after the cesarean, but no later than the next day. Your arms will be loosely secured on both sides, one for the infusion, the other to prevent unconscious movements towards the abdomen. Surely you have seen in movies or photos that a drape is stretched between your head and the surgical area during a cesarean: this serves hygienic purposes and also ensures that you and your partner do not have to see the procedure if you prefer not to.

A cesarean section is always performed under anesthesia, with various anesthesia methods to choose from: In the local anesthesia , also local anesthesia , only the area to be operated on is numbed. With this method, you will experience the cesarean section while fully conscious. The advantage is that you can see and touch your baby immediately after birth. During the operation, you will feel no pain; it may only be that you perceive pulling and pressure sensations. Alternatively, there is the option of a General anesthesia . Some women prefer the idea of experiencing as little as possible of the operation. However, general anesthesia carries the risk that the anesthetic may pass through the placenta into the baby's bloodstream, causing the baby to be initially groggy after birth. Therefore, many doctors recommend local anesthesia.

No matter which type of anesthesia you choose, the following cesarean section always proceeds in a similar way. A cut eight to twelve centimeters long is made on the lower abdomen, just above the pubic bone. The various layers of skin, subcutaneous tissue, and fat are cut through, and the muscles are pushed apart to the right and left. Then, the uterus is opened with a cut and stretched until the baby can pass through. Afterwards, the doctor gently removes the baby from the uterus. The umbilical cord is tied and cut, and your newborn is immediately handed over to the attending midwife, who performs the initial examination.

In the meantime, the so-called gentle cesarean section (also as Misgav-Ladach Method known) Standard in hospitals. The layers of the abdominal wall are bluntly opened. This means that only the outermost layer of skin is cut, and the underlying tissue layers are stretched and torn open enough to allow the baby to be delivered. Although this may sound quite rough at first, this method offers several advantages: the tissue is less damaged, the mother experiences less blood loss and has less pain afterward, which can generally result in a shorter hospital stay.

After the baby has been delivered, the uterus contracts as it does after a natural birth. The doctor releases the placenta after the birth and removes any remaining amniotic membrane or placental tissue from the uterus to prevent infections. In some cases, you will be given a contraction-inducing medication after the cesarean section, which helps the uterus contract more effectively and prevents postpartum bleeding. Subsequently, the uterus and the individual tissue layers are sutured again. Overall, a cesarean section proceeds quite quickly: the preparations and anesthesia induction take about 30 minutes, and the operation itself only another 15 to 30 minutes.

While you receive medical care after the procedure, your newborn also has its first examination. As long as your baby is doing well, your companion can hold it for the first time. Of course, you can already touch and welcome your baby. After you've had the cesarean section, you and your little explorer will stay on the maternity ward for about four to seven days for postpartum care. Even after a cesarean section, as with a natural birth, there are afterpains. Afterpains are a natural, self-regulating form of uterine involution. They contract at regular intervals to reduce themselves, but especially to decrease the inner wound surface. After the birth, the begins. Compared to lochia after a natural birth, it is less intense after a cesarean section and, if a curettage has been performed, lasts about two to three weeks shorter.

What are the reasons for a cesarean section?

1. Planned Cesarean Section

There are various reasons that make a vaginal birth impossible or very risky and therefore favor a planned cesarean section. These can include, for example, a transverse lie of the baby in the uterus, its size in relation to the mother's pelvis, or the position of the placenta in front of the cervix. (Placenta previa) , a multiple pregnancy, a serious illness of the mother or previous surgeries on the uterus, a low birth weight, or a condition of the unborn child. In other cases, such as a breech presentation (where the baby is positioned with the buttocks or feet downward instead of the head), a cesarean section is not necessarily required. Then the Decision mostly at the discretion of the prospective parents in consultation with the doctors.

2. Unplanned cesarean section

If labor has already begun and it is only then determined that a cesarean section is necessary, it is called an unplanned cesarean. This is the case when the well-being of the mother or the child would be at risk if a vaginal birth were to continue. A spontaneous cesarean can, for example, become necessary in cases of birth arrest, complete exhaustion or fever of the mother, a rupture of the uterus, placental abruption, falling fetal heart tones, a trapped or other complications. Although the decision for an unplanned cesarean is usually made at short notice, it is also performed under local anesthesia whenever possible.

As Emergency cesarean section is considered to have taken place if the life of the mother or child is in immediate danger during childbirth and the delivery must occur within the next 20 minutes. To save valuable time, an emergency cesarean section is performed under general anesthesia, as it acts more quickly.

3. Emergency cesarean section

A **elective cesarean section**, as the name suggests, is not medically indicated. However, some women choose this form of birth. Possible reasons include, for example, fear of the pain associated with a vaginal birth or birth injuries, negative experiences in the past, or the predictability that a cesarean offers. Since a cesarean section always carries risks for both mother and child, many doctors advise against an elective cesarean without medical reasons and instead encourage their patients to opt for a natural birth. If you are considering an **elective cesarean section**, it is best to discuss the options directly with your gynecologist.

What are the risks of a cesarean section?

• For the mother

Although cesarean sections are routine procedures in most hospitals and have become increasingly safer over the past decades, they are still associated with certain risks, like any surgical intervention. Before the operation, your doctor will inform you that in rare cases, there may be blood loss, blood clots, infections, injury to neighboring organs, wound healing problems, or anesthesia-related incidents. In the long term, complications such as paralysis, tingling sensations, or adhesions at the cesarean scar may occur.

While many mothers associate their cesarean section with a positive birth experience, some women suffer from psychological issues after the procedure, which can include post-traumatic stress disorder. Such problems can be triggered, for example, by the loss of control experienced by mothers during the cesarean section. They may feel grief or guilt over what they perceive as a weakness for not giving birth naturally. If the thought of a cesarean birth troubles you, be sure to talk to your doctor or midwife about it or share your experience with other mothers who have gone through the same. A cesarean section is not a sign of weakness, but in many situations, it is the best choice for you and your baby. Under no circumstances should you feel bad about it.

• For the child

Unfortunately, certain risks during and after a cesarean section can never be completely ruled out for the baby. Some children born by cesarean section initially suffer from adaptation problems (postnatal adjustment disorders), usually in the form of breathing difficulties. This is because, after a cesarean section, unlike a natural birth, there may still be amniotic fluid in the lungs. During a vaginal birth, the water is expelled from the baby's lungs by the pressure in the birth canal. In rare cases, cuts or abrasions may occur during the operation, but these usually heal on their own.
Some critics believe that babies who do not go through the natural birthing process later suffer from attachment disorders and are more susceptible to infections because they did not come into contact with the mother's natural bacterial flora as they do with a vaginal birth. Some parents choose to do this after a cesarean section through the so-called Vaginal Seeding to catch up. This technique involves dabbing the newborn with vaginal bacteria from the mother's vaginal secretions after the procedure. However, neither the effect of a cesarean section on the child's bonding ability nor the effectiveness of vaginal seeding has been proven. Most German hospitals do not offer the procedure. If you are interested in it, it is advisable to inform yourself early.

Can my partner be present during the operation?

Whether natural birth or cesarean section: Giving birth is physically and mentally demanding. Having your partner or another trusted person with you can therefore be comforting. The good news: As long as there are no medical objections, your partner or another close person can be present during the procedure. By the way, a cesarean section is the only operation where this is possible – after all, the other parent also wants to accompany their baby on its way into the world as best as possible and hold the little one in their arms as quickly as possible. Your companion will probably stay right beside you during the procedure, above the separated area at the head end, and be there entirely for you. To help your companion support you as best as possible during the cesarean section, it is helpful if they also inform themselves well about the procedure beforehand.

What should I pay attention to after a cesarean section?

• Closed season

A cesarean section is a major procedure for your body, which needs time to recover peacefully. Even though caring for a newborn can sometimes be challenging, you should definitely rest sufficiently in the first few weeks after the cesarean. Pay particular attention not to bend over or lift heavy objects, and to get up sideways to avoid stressing the wound. Despite resting, strict bed rest is not necessary, as it increases the risk of thrombosis or embolism. Although it may be painful at first, new mothers are encouraged to sit up just a few hours after the cesarean to prevent blood clots and to stimulate bowel activity.

• Breastfeeding your baby

A C-section has no impact on milk production: If you wish, you can breastfeed your baby as soon as both of you are medically ready. To protect your scar, you should choose a breastfeeding position where your baby is not lying directly on it. Your midwife will help you position your baby in a way that does not put strain on your scar. You can also read about which breastfeeding positions are particularly suitable after a C-section in our article "". If you experience severe pain after the procedure, your doctor can prescribe medications that are compatible with breastfeeding and do not affect your baby.

• Wundheilung und Narbenpflege

Your abdominal wound typically heals within eight to twelve days, while the internal tissue takes up to twelve weeks. Once the scab has fallen off, you can start scar care and gentle abdominal massages for the postpartum recovery. To learn how to properly treat and care for your cesarean scar, read the article "". Of course, your midwife will also be there for you after the cesarean to oversee follow-up care and wound healing.

• Postpartum recovery and pelvic floor

Even if you haven't had a natural birth, your tissues and pelvic floor were stressed during pregnancy and in preparation for the birth. After about six weeks, you can start gentle postpartum exercises to strengthen the pelvic floor. However, be careful not to strain your abdominal wall yet to prevent any injuries. If you're unsure whether and how you can become active again, it's best to ask your midwife for advice.

If you are scheduled for a cesarean section, it is completely normal to feel a bit nervous. Sharing experiences with other mothers and talking with your midwife can help here. They know your worries and fears and can certainly help alleviate some concerns. This way, you can look forward to the birth as relaxed as possible. After all, you will be holding your very own reward in your arms—the little explorer—after the procedure. :)