In Germany, about one-third of children are born via cesarean section. The reasons for this can vary greatly. Even though birth is always a very special event, a cesarean section differs in many ways from a vaginal birth. In this article, you’ll learn what happens during the procedure, what risks are involved, and what you should keep in mind after a cesarean section.

What is a cesarean section?

In a cesarean section (also called Sectio Caesarea or simply Sectio), the baby is delivered through a surgical procedure rather than through the vagina. A distinction is made between a planned cesarean section (primary Sectio), an unplanned cesarean section (secondary Sectio), and a cesarean section upon request. A planned cesarean section is necessary for medical reasons. It is planned in advance together by parents and doctors and carried out on a set date before labor begins. In contrast, an unplanned cesarean section is performed when a vaginal birth needs to be switched to a cesarean spontaneously. With 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 early rupture of membranes). On the one hand, this allows the hospital to plan better; more importantly, however, the procedure is less complicated and less risky if labor has not yet started. Shortly before the procedure, the nursing staff will prepare you as they would for any other operation: The surgical area—your entire abdomen—will be disinfected and shaved, and the surrounding area will be covered with sterile drapes. In addition, 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 toward your abdomen. You may have seen in movies or photos that a drape is stretched between your head and the surgical area during a cesarean section: This serves hygienic purposes and also ensures that you and your partner don’t have to see the procedure if you’d prefer not to.

A cesarean section is always performed under anesthesia, and there are different methods to choose from: With local anesthesia , also known as local anesthesia , only the area being operated on is numbed. With this method, you will experience the cesarean section fully conscious. The advantage is that you can see and touch your baby immediately after birth. During the operation, you won’t feel pain; you may only notice pulling and pressure sensations. Alternatively, there is the option of General anesthesia . Some women prefer the idea of experiencing as little of the operation as possible. 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. For this reason, many doctors recommend local anesthesia.

No matter which type of anesthesia you choose, a cesarean section generally follows a similar process. 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 gently pushed apart to the right and left. Then the uterus is opened with an incision and stretched until the baby can pass through. Afterwards, the doctor carefully removes the baby from the uterus. The umbilical cord is clamped and cut, and your newborn is immediately handed to the attending midwife, who performs the initial examination.

In the meantime, the so-called gentle cesarean section (also known as the Misgav-Ladach Method ) has become standard in many hospitals. The layers of the abdominal wall are opened bluntly. This means that only the outermost layer of skin is cut, while the underlying tissue layers are stretched and gently separated 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 less pain afterward, and this can generally result in a shorter hospital stay.

After the baby has been delivered, the uterus contracts as it does after a vaginal birth. The doctor releases the placenta after the birth and removes any remaining amniotic membrane or placental tissue from the uterus to help 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 is usually quite quick: The preparations and anesthesia induction take about 30 minutes, and the operation itself takes only another 15 to 30 minutes.

While you receive medical care after the procedure, your newborn will also have their first examination. As long as your baby is doing well, your companion can hold them for the first time. Of course, you can also touch and welcome your baby right away. After your 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 vaginal birth, you may experience afterpains. Afterpains are a natural, self-regulating part of uterine involution: The uterus contracts at regular intervals to shrink back, and especially to reduce the inner wound surface. After the birth, lochia begins. Compared to lochia after a vaginal birth, it is usually less intense after a cesarean section and, if a curettage has been performed, lasts about two to three weeks less.

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, the baby’s size in relation to the mother’s pelvis, or the placenta positioned in front of the cervix (Placenta previa) , a multiple pregnancy, a serious illness in the mother or previous surgeries on the uterus, a low birth weight, or a condition affecting 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 is 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 labor arrest, complete exhaustion or fever in the mother, uterine rupture, placental abruption, dropping fetal heart tones, a trapped baby, or other complications. Although the decision for an unplanned cesarean is usually made at short notice, it is performed under local anesthesia whenever possible.

An 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 takes effect more quickly.

3. Emergency cesarean section

An **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 safe 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 experience psychological distress after the procedure, which can include post-traumatic stress disorder. Such problems can be triggered, for example, by the loss of control some mothers feel during a cesarean section. They may feel grief or guilt over what they perceive as a weakness for not giving birth vaginally. 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; 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 experience adaptation problems (postnatal adjustment disorders), usually in the form of breathing difficulties. This is because, after a cesarean section, unlike a vaginal birth, there may still be amniotic fluid in the lungs. During a vaginal birth, the fluid 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 during a vaginal birth. Some parents choose to do this after a cesarean section through so-called Vaginal Seeding to make up for it. 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 a vaginal birth or a cesarean section, giving birth is physically and mentally demanding. Having your partner or another trusted person with you can therefore be very 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 their way into the world 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 drape at the head end, and be there fully for you. To help your companion support you as well as possible during the cesarean section, it’s helpful if they also learn about the procedure beforehand.

What should you pay attention to after a cesarean section?

• Closed season

A cesarean section is a major procedure for your body, and it needs time to recover. Even though caring for a newborn can sometimes be challenging, you should make sure to rest sufficiently in the first few weeks after the cesarean. Pay particular attention to not bending over or lifting heavy objects, and get up by rolling onto your side to avoid putting strain on the wound. Despite the need for rest, 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 help prevent blood clots and 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, 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 doesn’t 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 won’t affect your baby.

• Wundheilung und Narbenpflege

Your abdominal wound typically heals within eight to twelve days, while the internal tissue can take up to twelve weeks. Once the scab has fallen off, you can begin scar care and gentle abdominal massages as part of 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 support follow-up care and monitor wound healing.

• Postpartum recovery and pelvic floor

Even if you haven’t had a vaginal birth, your tissues and pelvic floor were still stressed during pregnancy and in preparation for 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 help prevent injury. 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. They understand your worries and fears and can help ease your concerns. This way, you can look forward to the birth as calmly as possible. After all, you’ll be holding your very own reward in your arms—the little explorer—after the procedure.