C-section: key facts, risks, and what to expect

A C-section, short for caesarean section, is a surgical birth method. Your baby is not delivered through your vagina but through an incision made in your lower belly, in your abdomen and uterus. Fun fact: the procedure is named after the Roman leader Julius Caesar, who is said to have been born this way ¹. But of course, the historical accuracy is debated!

C-sections are often performed when vaginal delivery could be a risk for you or your baby. You can have specific medical conditions that necessitate this approach. However, it can also be performed for other reasons in consultation with your healthcare professional.

The practice of C-sections dates back to ancient times, but of course, it has evolved significantly with advancements in medical technology and surgical techniques. Today, C-sections are relatively common, accounting for about 21% ² of births in the world. But South Africa, is highly exceeding this rate with up to 75%! ³

Both types of C-sections are performed with the same goal: your safety and the safety of your newborn. The main difference between them lies in the level of preparation and the circumstances leading to the surgery ⁴. 

A planned or elective C-section is scheduled in advance before labour begins. It can be planned because of health concerns for you or your baby: 

• Baby presents feet or bottom first (breech position)

• Vaginal delivery may be dangerous (risk of eclampsia, uterine rupture)

• Your placenta covers the cervix and prevents the baby from exiting (Placenta Previa)

• Multiple babies are in your womb (twins, triplets, etc.)

The thought of labour during a vaginal delivery is making you anxious? It’s perfectly normal to be nervous and to want to avoid an experience you perceive is going to be uncomfortable. Maybe you had a previous challenging birth experience, and you feel scared to go through this again. You can plan a C-section to deliver your baby in a planned way, if your healthcare provider advises so. But keep in mind that every delivery is different: even if a previous vaginal delivery was difficult, it doesn’t mean that you’ll go through this again! 

Planned C-sections are generally performed at around 39 weeks of pregnancy. Indeed, your baby has to be fully developed to minimize the risks associated with early delivery.

With a planned C-section, the environment around you is more controlled. You have time to prepare physically and emotionally. Your surgical team can ensure that all resources are available, and you are more likely to feel calm and ready. You can also feel safer if you are surrounded by your partner or even your family, who prepare ahead of time.

In contrast, an emergency C-section is performed with little time for preparation. The priority is to deliver your baby as quickly as possible. It is performed when complications arise during labour: 

• Your baby has an abnormal heart rate (fetal distress)

• Labour does not progress despite contractions

• Your umbilical cord slips into the birth canal ahead of your baby and cuts off the oxygen supply (prolapsed umbilical cord) 

Emergency C-sections are more stressful for you: the situation is urgent. The surgical team must work rapidly to deliver your baby, sometimes within minutes. This sounds scary, but don’t worry if this happens to you: the medical staff is highly trained and used to the procedure, and they will do everything to guarantee your and your baby’s safety.

Your doctor recommended a C-section, but you don’t know what it is? Do you want to learn more about this procedure? Here is a list of what to expect from a caesarean delivery ⁵.

For instance, if your placenta covers your cervix (placenta previa), you must have a C-section to prevent life-threatening bleeding. Or if you show signs of severe high blood pressure during pregnancy (preeclampsia), you would also benefit from a C-section to avoid the risks associated with prolonged labour.

Additionally, if you have a heart condition or you had previous uterus surgeries, you may be advised to get a C-section to avoid the physical strain that labour could cause.

Other conditions, such as HIV or genital herpes, also make a C-section a safer option. Indeed, it reduces the risk of transmitting infections to your baby during vaginal delivery. 

A C-section can also be planned or performed in an emergency if your baby presents signs of distress like an abnormal heart rate, if they present themselves in a breech position, or if the umbilical cord is stuck around their little neck.

In these cases, a C-section is not just an alternative to vaginal delivery but a necessary intervention to protect both you and your little one. This decision is made with your healthcare provider, with careful consideration of your medical condition. 

A planned C-section offers you a controlled environment for childbirth. This is reassuring for both you and your medical team. The date and time of the birth are predetermined. Everyone can prepare themselves, and your partner and family can be present. You also have time to prepare emotionally. The surgical team is ready, and the operating room is equipped. Everything is in place for a smooth procedure.

This level of control also makes it easier to manage specific medical conditions. For example, if you have a history of uterine surgery, a planned C-section prevents potential complications, such as uterine rupture. 

Moreover, C-sections can be scheduled around the availability of specialists (paediatricians or anesthesiologists). This can be important in high-risk pregnancies!

A vaginal birth can be strenuous on your pelvic floor. During delivery, the muscles, ligaments, and tissues supporting the pelvic organs can stretch or tear. Some women experience long-term problems like urinary incontinence, their pelvic organs can fall a bit (prolapse) or have chronic pelvic pain. Of course, most women recover well, but it can require a bit more pelvic floor care.

If you had a C-section, the pressure on your pelvic floor is minimised, which can help prevent these complications. This is especially beneficial for women who are at higher risk due to having a large baby, long labour, or previous pelvic floor issues. In any case, whether with a C-section or a vaginal delivery, preserving your pelvic floor integrity improves your overall postpartum health and quality of life.

Keep in mind that a caesarean delivery, though relatively more straightforward, is still an important surgery. As such, it has downsides you need to consider ⁵'⁶.

Even if the caesarean delivery was the right recommendation for you, it does take longer to recover. A vaginal birth requires a few weeks of recovery, but a C-section involves a healing period of 6 to 8 weeks. The nature of the wound explains this: this incision is surgical and not natural. Your body will need time to regrow the cut tissues.

Your wound can be painful, and you may feel discomfort when you move, cough, or laugh. While recovering, lifting heavy objects, even your newborn, can be challenging. Extended recovery also means a longer hospital stay, typically 3 to 5 days. This can cost more and mean more time away from home.

The prolonged recovery can also impact your bonding with your baby.  Physical limitations may delay activities like breastfeeding or skin-to-skin contact, especially in the first few days after birth.

As with any surgery, C-sections come with risks. Your incision wound can be infected and may require antibiotics or additional surgical intervention.

Blood clots, which mainly appear in the legs or lungs (deep vein thrombosis or pulmonary embolism), can be another concern. They must be promptly treated if they appear.

There is also the risk of reactions to anesthesia. These can range from mild side effects like nausea to more severe complications like allergic reactions or breathing difficulties.

Internal injuries, such as accidental cuts to the bladder or intestines, are rare but also possible.

Since a caesarean delivery involves cutting through your uterus, this organ carries a wound. A Vaginal Birth After a C-section (VBAC) has a higher risk of uterine rupture or placenta previa. These risks are increased if the C-section involved a vertical cut.

As a consequence, if you’ve had a C-section, you will likely deliver your other babies with this same method. Generally, women are limited to 3 or 4 C-sections. But this varies with each circumstance. Some women have had more than four without significant issues. You can always consult your doctor to make sure it is safe for you.

For some women, a C-section may come with mixed emotions, especially if you had initially hoped for a natural birth. It's completely normal to feel a range of emotions—whether it's a sense of disappointment or feeling out of control. But you’ve brought your baby safely into the world, and that is the most important thing. However your birth story unfolded, it’s still a beautiful journey of motherhood.

Postpartum depression and anxiety can also be more pronounced if you underwent a C-section. This can be due to the physical challenges of recovery and the emotional stress of surgery, and it's perfectly normal. The extended recovery period and physical limitations can exacerbate these feelings and make it harder to adjust to new motherhood.

Moreover, the surgical nature of a C-section can sometimes interfere with immediate bonding with your baby. You may feel a bit disconnected, especially if you were under general anaesthesia or if your baby was quickly taken for medical care. These factors can contribute to your feeling of isolation or dissatisfaction with your birth experience. In any case, you can ask for help when you need it and take care of yourself as best as you can. Don’t hesitate to rely on your support system: your partner, your family, your friends.

Babies born via C-section may face specific health challenges. These can be related to respiratory function and immune system development ⁷'⁸.

Indeed, during vaginal birth, your baby is exposed to beneficial bacteria from you. These bacteria colonise their gut and give a natural boost of immunity. C-section babies miss out on these good bacteria ​​called Bifidobacteria. It can thus affect your baby's microbiome and long-term immunity.

Passing through the birth canal naturally helps clear fluid from your baby's lungs. And well, this step is skipped during a C-section. This can lead to specific respiratory conditions: your baby could have trouble breathing because their lungs aren’t fully developed (Respiratory Distress Syndrome), or they can breathe too quickly because of the extra fluid (Transient Tachypnea in the Newborn).

But don’t worry: your baby can catch up right from the start with proper care! You can reach out to your healthcare provider to get advice on what’s best for your little one.

The decision between a C-section and vaginal birth is often based on safety and medical recommendations from your healthcare provider. In some cases, a C-section may be recommended for specific health reasons, while others may consider it for different reasons. What’s most important is ensuring the well-being of both mother and baby, with the support of your healthcare team guiding the way. No matter how your birth plan unfolds, the journey into motherhood— with its joys and challenges—awaits!