Labor is a natural process during which the fetus, membranes, umbilical cord, and placenta are expelled from the uterus. Natural childbirth involves labor without medical pain relief, leading to a vaginal birth, and possibly a third stage, without any interventions (such as artificial rupture of membranes, induction of labor, epidural, etc.), lasting more than 24 hours. Cesarean delivery (C-section) involves delivering a baby through incisions in the abdomen and uterus.

Indications for Cesarean Section:

There are no strict guidelines for choosing a cesarean section over normal childbirth because each pregnancy is unique. However, some indications (relative or absolute) determine whether a normal birth is possible or if a cesarean section should be performed. Elective cesarean section, performed solely at the mother’s request without medical indication, is considered a separate category. Indications for cesarean section include:

• Health problems developed during pregnancy or pre-existing conditions that worsen during pregnancy, or anatomical abnormalities that prevent vaginal birth (e.g., previous cesarean section, previous fibroid removal, increased maternal age, failure to progress in labor).

• Abnormal conditions in the fetus that may hinder normal delivery (e.g., irregular fetal heart rates, placenta accreta, low birth weight, fetal macrosomia). If the fetus is in an abnormal position or presentation, labor may be more difficult, and vaginal delivery may not be possible (e.g., transverse lie position, breech presentation).

• Situations where the baby cannot be delivered vaginally due to size, the shape of the mother’s pelvis, or weak uterine contractions (e.g., cephalopelvic disproportion, failed induction of labor, hypertensive pregnancy, active genital herpes, untreated diabetes mellitus).

Due to potential complications for both the mother and newborn, the possibility of a normal delivery should be considered. However, the rate of cesarean sections has increased significantly compared to previous decades. Sometimes, the decision for a cesarean section is made long before delivery, while in other cases, it is decided after extensive efforts to achieve vaginal delivery.

Once a Cesarean Section, always a Cesarean Section?

For years, women who had a C-section were advised to schedule C-sections for all future births due to concerns about uterine weakness. Now, it is believed that patients who had a cesarean delivery with a low transverse uterine incision may attempt vaginal delivery in subsequent pregnancies (vaginal birth after cesarean section – “VBAC”). About 60% to 80% of women who attempt VBAC succeed. However, predicting which women will have successful vaginal deliveries and which will need another cesarean section is not possible. The main benefits of VBAC include shorter hospital stays, less need for blood transfusions, and a lower chance of infection. The most serious risk is the possibility of uterine rupture at the previous incision site, which is less than 1%. This risk is higher for women with multiple previous cesarean deliveries or difficult births. Close monitoring of the mother and fetus is required, and proper preparation by the nursing staff and hospital is essential in case an emergency cesarean section is needed.

Cesarean Section Technique:

When a cesarean section is planned and scheduled, it is called “selective.” In cases where complications arise that endanger the fetus, an emergency cesarean section is performed. Depending on the hospital’s policy, you may or may not be allowed to have someone with you in the operating room. If allowed, this person will sit at the edge of the operating table, near your head. The procedure is performed under sterile conditions by the surgical team. If you receive epidural anesthesia, you will hear the team talking and feel tissue pulling without pain. The baby is handed to the nursing staff immediately after birth. “Closing” the procedure takes several minutes. After the procedure, the intravenous line remains to provide necessary medication. The catheter will not be removed until you can walk. When the anesthesia wears off, you will feel abdominal pain. Your vital signs (blood pressure, temperature, pulse) should be monitored regularly, and the incision should be checked daily by your healthcare provider. Move while lying down and avoid staying in the same position for long periods. Walking as soon as possible helps prevent blood clots. It may be difficult initially due to incision pain, but with help from hospital staff and encouragement from loved ones, you will manage. Contact your healthcare provider or nursing staff if you experience any symptoms (pain, nausea, dizziness, etc.) for appropriate medication.

Diet:

Immediately after the procedure, you are allowed to drink liquids. Your healthcare provider will inform the nursing staff about the diet you should follow for the next few days until you leave the hospital. It is normal to feel abdominal discomfort due to gas pain as your digestive system adjusts after the procedure and anesthesia.

Returning Home:

In the first few days at home, you may feel discomfort and find breastfeeding challenging. Starting breastfeeding after a cesarean section can be more difficult than usual. Bonding with the newborn and recovering from the cesarean delivery simultaneously is more challenging than after a vaginal birth. Mood swings may occur, similar to those after vaginal delivery, and should be discussed with your physician to address any significant issues.