What to Expect When You’re Getting a Cesarean Section

What to expect when you are having a c-section. Written by an experienced L&D nurse

So you are having a c-section! In this blog, you are going to find out all the (gory) details of what typically happens during this surgery. This way, you will feel more comfortable going into it! Even if you’re not planning on having a c-section, about 1 in 3 births end up being c-sections anyways (in North-America at least). So it’s good to know what’s going to happen. Always be prepared!

There are a lot of different reasons you might need to have a c-section.

For example, if your baby is breech (bum first). Or if your first was born by c-section, you might need to have a repeat delivery by c-section

Often times, if your baby is in some type of distress during birth, for example, if the heart rate drops suddenly, or is not able to be born vaginally for various reasons, you might need to have a c-section. 

Sometimes, women specifically request a c-section because they don’t want to go into labour. It will be up to the health care provider whether or not this is a possibility.

What actually happens during your c-section? Written by a labour and delivery nurse

 

Who is in The Operating Room?

First things first. Who will be in the operating room? There will be multiple health care providers there and I think its really useful for you to know each person’s role.

Most often each health care provider will introduce themselves to you and your family, but sometimes things can get hectic and that is not possible.

Circulating Nurse

This nurse takes care of you during the procedure.

He or she will ask you questions about your pregnancy and health history. They will start your IV and give you any medication you might need before the surgery.

They are your advocate and helper throughout, so don’t hesitate to ask them anything!

The circulating nurse is your resource person in the operating room. There may be times where the nurse is busy helping the doctors and other members of the team, but they are never far off.

Once in the recovery room, they do all the regular nursing tasks such as vital signs and assessments to make sure you are stable after the surgery. Some hospitals have a different nurse before, after and during the c-section, this all depends on each facility and their policies.

Ever wonder about L&D nurses job? Read more about it right here on Babytalk! Question & Answer Session with a Labour and Delivery Nurse

Lots of people will be in the room for your surgery.

Scrub Nurse

This nurse is scrubbed in and sterile during the surgery and is behind the drapes with the doctors.

She or he will hand instruments and whatever else needed to the doctors and help them during this sterile procedure.

Anesthetist – Anesthesiologist

The anesthesiologist is the doctor that will be closest to you during the procedure, he or she takes care of giving you all the medication you’ll need, in addition to being responsible for pain management. The pain management is usually in the form of spinal anesthesia, that will be explained more thoroughly later.

They are technically “in charge” of the surgery, nothing starts until they give the OK.

Doctors

If it’s a booked c-section, most likely your own obstetrician (or OB, that’s the fancy name for pregnancy and birth doctor) will be there for the surgery.

In addition, there will be an assistant, which can be a resident who is a doctor training to be an OB or any other surgeon.

They help each other out during the surgery and make sure your baby is delivered safely and you are put back together properly.

Respiratory Therapist or Baby Nurse

Depending on the hospital, another professional will take care of the baby after delivery, just to make sure everything is alright and your baby is transitioning normally from the womb.

If not, they will take care of resuscitating your baby after the delivery.

Some babies have a harder time breathing on their own right after a c-section. This is because the mucus in their lungs isn’t squeezed out in the same way as it can be during vaginal delivery. That is why it is important to have a dedicated health care professional taking care of the baby. 

The baby nurse will do all the measuring and weigh your baby as well once the baby is breathing normally on their own.

Support Person

You will be allowed to have a support person by your side during the c-section. It is up to you who you choose.

Some facilities allow more than one person.

Most often your husband or partner will be the one supporting you, but again that is your choice! Find out ahead of time what your hospital’s policies are. If you have a doula, you can ask whether she is allowed to be present along with your partner.

Read about how to interview for your doula right here on Babytalk. Top Ten Questions to Ask Your Doula

Other People in The Operating Room

If you’re delivering at a teaching hospital, you might be asked to accept students into the operating room.

There could be nursing or medical students, or other professionals that need to be present for their learning. It will be up to you whether or not you allow this.

Remember, it’s your birth, so advocate for yourself or get a loved one to speak on your behalf!

Timing and Possible Delays

Usually, your c-section will be booked for a certain time, for example, 8 am. Some hospitals will have some sort of pre-registering appointment to prepare you for what lies ahead. At other hospitals, you just show up at a certain time and go from there.

Typically you are asked not to eat or drink 6-12 hours before the surgery, this will vary depending on the hospital you are delivering at so be sure to find out what the regulations are. If you happen to eat when you are not supposed to, your c-section will be delayed.

The reason for this is that the anesthetist might have to put you to sleep (don’t worry, it’s not really that common) and if you’ve eaten, there can be complications to that procedure.

That being said, even if you c-section is scheduled for a certain time, you might be delayed anyway. If the hospital labour and delivery floor is very busy, there will be a delay because of the lack of nursing staff or lack of space in the OR. This can be very frustrating since you probably haven’t eaten for a while and might be feeling anxious.

Just know that it is out of your hands and the reason you’re waiting cannot be controlled!

It might be a good idea to pack some distractions like cards, books or movies, just to take your mind off the situation. Or if you have a cozy spot to wait, have a nap! You know you’re not going to sleep for a while after the baby is born.

You Are Going To the Operating Room! Now What?

Once it’s your time to go to the OR, you and your support person will be taken to a private area, which is sometimes the same place you’ll come back to after the baby is born.

The circulating nurse will talk to you about your medical history and pregnancy. He or she will ask about previous surgeries and reactions to any medications. They will also ask about your general medical and psychiatric history.

You will change into your hospital robe, and most often are asked to take everything off underneath the robe. This is because the doctors will need access to various parts of your body during the surgery. At this time you will get an IV and most hospitals will administer antibiotics to prevent infection from the c-section.

Some hospitals require you to do a wash the night before your scheduled c-sections and some tell you to shave down below. This differs from each hospital, so find out from your healthcare provider what kind of preparation you need before your surgery.

Special Wishes & Birth Plans

Now is a good time to mention any special things you want to be done during or after the delivery. For example, some hospitals allow “natural c-sections” or “skin-to-skin” c-sections.  This might require extra staffing and means that the baby crawls right onto your chest after delivery, instead of going to a support person first. Some hospitals even have clear drapes so you can see what is going on during your baby’s birth.

Babytalk’s got you covered if you need to plan for your c-section! Planning For Your C-Section. A Detailed Birth Plan.

Let the nurse know if you’d like your partner or support person to cut the umbilical cord.

Another request that is becoming more popular is “vaginal smearing”. That is when you insert sterile gauze into your vagina before the c-section and then apply it to various places on your baby’s body after delivery. The purpose is to colonize your baby’s gut flora, this happens naturally during a vaginal delivery but doesn’t happen during a c-section. Vaginal smearing is material for a whole other post, so stay tuned!

What Happens Once You’re in The Operating Room?

When all the doctors are ready, you will be taken into the operating room. There are a few things that have to happen before they help you birth your baby.

A Spinal, Epidural, or General Anaesthetic

First of all, you will want some good pain control on board. That’s the anesthesiologist’s job. You will have to get something called a spinal, or an epidural, and sometimes a combination of both those things. Basically, it is freezing in the lower part of your body. It’s probably not the most comfortable part of the procedure, but you really need it! This will make it so you don’t feel pain during the procedure.

The doctor first needs to put freezing in your skin, because the needle they use to give you the spinal is pretty big and the freezing will make it so you can’t really feel that part.

It feels like a little pinch on your skin, some describe it as a bee sting. After that, the doctor finds the spot for the medication in your back.

You will be asked to lean forward, usually the nurse or another support person will support you at the front, and also to round your back and push out the lower part of your back. That makes it easier for them to find the right spot in your back to put the spinal in.

Once the freezing is working all you feel is pressure from the needle that will give you pain relief.

If you get an epidural, the process is basically the same, except the anesthetist leaves a thin catheter in so he or she can top up the pain meds if the c-section takes longer than normal.

Very rarely will you be put to sleep (also called general anesthetic.) I usually only see women put to sleep if they are very very nervous and ask for it, or if for whatever reason, the spinal doesn’t work.

The doctor prefers not to put you to sleep because general anesthetic can cause more stress on your baby and they need to perform the operation faster than with a spinal.

Preparation Before The Surgery

When the medication is in, your nurse and doctor will help you lie down pretty quick because the medication takes effect almost immediately. Sometimes this medication can make your blood pressure drop. What that means is you’ll feel light-headed and weak, sometimes nauseated.  But don’t worry, the anesthesiologist has good medications that will make you feel better almost instantly.

At this point, things start to happen. Because the medication only lasts a certain time in your system, the doctors want to get the operation going sooner rather than later.

Your belly will be “painted” with an antiseptic solution to reduce infections. They will put drapes up so that you can’t see the operation itself.

The team will also insert a catheter into your bladder to help you pee since you can’t while you have the spinal. They also do this to keep your bladder empty and out of the way.

Once everything is prepped and set up the whole team will be in the room and it might seem quite hectic. When the doctors know they can go ahead with the operation they will call your support person in. They know this by pinching your skin and checking to see if you feel the pinch.

Usually, the doctors don’t like to have a lot of support people in the OR, two is the absolute maximum, although mostly they’ll only allow one support person. This is due to the sterility of the room and procedure. If you have a doula and a partner, ask your nurse if both of them can come into the room for support, but don’t be surprised if you have to choose one.

Information written by an L&D nurse

That Magical Time: The Birth of Your Baby!

Once the operation starts, things happen very quickly.

You won’t feel very much, just a pulling or tugging sensation. Right before the baby is born, you might feel more pressure on your abdomen, that’s the doctors getting your baby out!

They usually have to push pretty hard, but this part doesn’t typically take to long. The baby usually comes out within the first 5-10 minutes of the operation. You might hear the baby cry right away, or your baby might need a bit of stimulation and drying off before you hear him or her cry.

Don’t worry, there is a whole team of people taking care of your baby at this point.

Once the baby has been dried off and checked, you will most likely be able to hold or see your baby! Find out from your team if you can do skin-to-skin. It is so beneficial for you and your baby!

What are the benefits of skin-to-skin? Skin-to-Skin: The One Place Your Baby Wants to be After Birth

Some hospitals are doing skin-to-skin natural c-sections which would allow for the baby to come right on your chest after delivery.

The longest part of the procedure is the stitching and suturing. It usually takes about an hour to complete, give or take, depending on the team. You shouldn’t feel very much during this, maybe some pushing, pulling and tugging, but not pain.

Postpartum Recovery After a C-section

A c-section is not just birth, it’s major abdominal surgery. So after the surgery, you will go back to the recovery room for an hour or two. The nurse will monitor your blood pressure and other vital signs, as well as help you feed your baby and hold him or her skin-to-skin.

Once you’re stable enough for postpartum care, the nurse will transfer you and your support person to the postpartum unit.

Most women stay at least 48 hours after a c-section, it all depends on how quickly you recover.

You’ll want to start walking and moving around as soon as the nurse says it’s ok. Even though it’s painful, the more you move, the faster you heal.

Also, don’t hesitate to take extra pain medication if you need it. Most often women only need it for the first couple of days. The urinary catheter comes out within the first 24 hours after the c-section, but this will differ between hospitals.

Read all about what happens after your birth, right here on Babytalk! Postpartum Care: Everything You Need To Know!

In addition to all this, you will be taking care of a newborn. So be kind to yourself and take it one step at a time. 

I hope this post helped ease your fears and questions about c-sections, please don’t hesitate to comment or ask questions if there is more you’d like to know!

Also, please send along your own experiences of c-sections. I’d love to post other people’s experiences for us all to learn and grow.

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