Cesarean Section

WHAT YOU SHOULD KNOW:

A cesarean section, or C-section, is when your baby is delivered through an incision in your abdomen.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

You could bleed too much, have breathing problems, or develop clots in your blood vessels. You may get an infection. Your intestines may slow down after surgery, causing bloating and discomfort. A weak spot may develop in the uterine wall after the incision in your uterus heals. You may have problems having a vaginal delivery in the future. If you do not have a C-section, you or your baby may have problems and could even die. Pain medicine can cause constipation. You may develop rectal pain and hemorrhoids because of the pressure during labor. Hemorrhoids are swollen veins in the rectum or anus.

WHILE YOU ARE HERE:

Informed consent

is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

Tests:

You may need one or more of the following tests. Some of these tests help caregivers find out how your baby is doing. Other tests are used to help caregivers know how you are doing during surgery.

• External fetal heart monitoring: Caregivers may use this to monitor your baby's heartbeat, and the contractions of your uterus. A small metal disc (monitor) with gel on it is placed on your abdomen. A belt will be fastened around your waist to hold the monitor in place. The monitor may need to be moved as your baby moves inside you. It may also be put on and taken off, or left in place. The monitor is attached to a machine with a TV-type screen, or a printer. The screen or the paper print out shows a tracing of your uterus contracting, and the baby's heartbeat.
  
  
• Internal fetal heart monitoring: An internal fetal monitor allows caregivers to carefully watch your baby's heartbeat while you are in labor. It may also measure your contractions. To place the internal monitor, your caregiver will first make sure your bag of water has broken. The opening to your birth canal must also be dilated (open) a little. Your caregiver will use a small plastic tube to guide a special wire through your birth canal. This small wire is attached to your baby's scalp (the skin covering the head). Then, the plastic guide is removed. This wire is attached to a machine with a TV-type screen. The screen shows a tracing of the baby's heartbeat and may also show your uterus contracting. Ask your caregiver about the risks and benefits of an internal fetal monitor.
  
  
• Fetal ultrasound: This test uses sound waves to show pictures of your baby (fetus) inside your uterus. Jelly-like lotion is put on your abdomen, and a small handle is gently moved through the lotion. As this is done, pictures of your baby can be seen on a TV-like screen. Caregivers can learn the age of your baby, and see how fast he is growing. The movement, heart rate, and position of your baby can also be seen. Caregivers can see your placenta, and can tell if you have more than one baby.
  
  
• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
  
  
• Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.

Support person:

Depending on the kind of anesthesia used, you may be allowed to have someone with you during your C-section. He or she will change into hospital clothes before going into the operating room.

Anesthesia:

This medicine is given to make you comfortable. You may not feel discomfort, pressure, or pain. An adult will need to drive you home and should stay with you for 24 hours. Ask your caregiver if you can drive or use machinery within 24 hours. Also ask if and when you can drink alcohol or use over-the-counter medicine. You may not want to make important decisions until 24 hours have passed.

• General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
  
  
• Regional anesthesia: Medicine is injected to numb the body area where the surgery or procedure will be done. You will remain awake during the surgery or procedure.

During surgery:

• Caregivers clean your abdomen with soap and water. An incision is made across, or up and down your abdomen. Caregivers deliver your baby through this incision. The incision is closed with stitches or staples. If everything is okay with your baby, a caregiver will bring the baby to you so that you can look at him or her. Your baby may then go to the nursery or go with you to the recovery room. This will depend on how well you and your baby are doing.
  
  

After surgery:

You are taken to a room where you can rest after surgery. Caregivers will watch you closely for any problems. When caregivers feel comfortable with your condition, you will be able to go back to your room. Do not get out of bed until your caregiver says it is okay. If you feel weak or dizzy, sit or lie down right away and call your caregiver.

• Activity: You may need to stand up or walk on the same day as your surgery. Activity is important because it helps prevent blood clots and pneumonia.
  
  
• Bandages: A bandage may be used to cover your stitches or staples to keep the area clean and dry, and help prevent infection. A caregiver may remove the dressing soon after surgery to check the incision.
  
  
• Breast care: Your milk should come in 2 to 4 days after delivery. Before your milk comes in, your breasts may feel soft. When the milk comes in, your breasts may feel full and hard. Colostrum is the early milk or yellow liquid that you can squeeze from your breasts after delivery. Colostrum is what your baby will drink during the first couple of days after birth if you breastfeed. Colostrum has fat, carbohydrates, protein, and other special ingredients in it that help keep your baby healthy. If you plan to breastfeed, ask caregivers to show you the correct ways to hold and breastfeed your baby. Ask caregivers for more information about how to care for your breasts whether or not you are breastfeeding.
  
  
• Uterus massage: After the C-section, your uterus should start to become hard. A caregiver will push on your abdomen. If your uterus feels soft, she will massage your abdomen to make it firm. This may be uncomfortable. Your uterus will be checked often after delivery. You may have abdominal pains for up to 3 days after you give birth. These pains happen because your uterus is still contracting and relaxing. The contractions help release blood from inside your uterus so it shrinks back to its normal size. These contractions may be stronger and hurt more while you breastfeed your baby.
  
  
• Vaginal discharge: You will have a vaginal discharge after delivery. The discharge is bright red the first 1 or 2 days after delivery, and then turns pink. The discharge becomes white or yellow by about day 10 after delivery. It is normal to have discharge on and off for 6 weeks after delivery. Use a sanitary pad rather than a tampon. This helps prevent a vaginal infection. The discharge should not have a bad smell.
  
  
• Deep breathing and coughing: This will help decrease your risk for a lung infection after surgery.
  
  
  • Hold a pillow tightly against your incision when you cough to help decrease pain. Take a deep breath and hold it for as long as you can. Deep breaths help open your airways. Let the air out and follow with a strong cough. Spit out any mucus you cough up. Repeat the steps 10 times every hour.
    
    
  • You may be given an incentive spirometer to help you take deep breaths. Put the plastic piece into your mouth and take a slow, deep breath. Let out your breath and cough. Repeat the steps 10 times every hour.
  
  
• Food and drink after surgery: You will be able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.
  
  
• Foley catheter: This is a tube caregivers put into your bladder to drain your urine into a bag. Keep the bag below your waist. This will help prevent infection and other problems caused by urine flowing back into your bladder. Do not pull on the catheter, because this may cause pain and bleeding, and the catheter could come out. Keep the catheter tubing free of kinks so your urine will flow into the bag. Caregivers will remove the catheter as soon as possible, to help prevent infection.
  
  
• Heat: Heat also helps decrease swelling and pain. Use a warm compress or heating pad. Dampen a washcloth or small towel with warm water and place in a plastic bag. Wrap a dry towel around the plastic bag to prevent burns. Place the warm compress or heating pad on your incision for 15 to 20 minutes every hour as long as you need it.
  
  
• Ice: Ice helps decrease swelling and pain. Use an ice pack or put crushed ice in a plastic bag. Cover the ice pack with a towel and place it on your incision for 15 to 20 minutes every hour for 2 days.
  
  
• Intake and output: Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.
  
  
• Medicines:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    
    
    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
    
    
  • Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.
  
  
• Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.
  
  
• Pneumatic boots: Inflatable boots are put on your legs. The boots are connected to an air pump. The pump tightens and loosens different areas of the boots. This helps improve blood flow to prevent clots.

Learn more about Cesarean Section (Inpatient Care)