My birth plan for baby No. 2 didn’t go as planned. At 9 a.m. I was breathing through manageable contractions and telling our nurse about how I wanted my son to come into the world: A drug-free vaginal delivery with minimal interventions, similar to the fairly textbook birth of my daughter two years earlier. By 5:30 p.m., I was wheeled into the operating room, destined to become one of the 27.5 percent of Canadian women who deliver by Cesarean section.
Most first-time C-sections are done for three reasons, explains Jonathan Tankel, an Edmonton-based obstetrician and instructor at the University of Alberta: Labour isn’t progressing; there are signs of fetal distress; or baby is in a position other than head down. Some other less common culprits include: Placenta covering or close to the cervix, umbilical cord prolapse, multiples, or an abnormally shaped pelvis. In my case, my baby was Frank breech, or bum first, which we didn’t actually discover until I had been in labour for four hours. I tried to deliver vaginally, but he didn’t move when I pushed and his heart rate climbed too high for too long.
For me, and so many other women, Cesareans are necessary to provide the best possible outcome for baby and mom. “We still believe vaginal births to be the preferable way to deliver. I don’t think there is any obstetrician who would disagree with that,” says Tankel. “In every Cesarean section, we think it through. There is always a reason for it. It is always discussed with the parents.”
Nevertheless, the International Cesarean Awareness Network, a non-profit advocacy group, feels the current C-section rate is too high (the World Health Organization says the ideal should fall between 10 to 15 percent of births) and has declared April Cesarean Awareness Month in an effort to help drop it.
Now that I’ve given birth both ways, I’d advocate for a vaginal birth whenever possible. A Cesarean section is major surgery. It was a scary experience for me, even under the care of a doctor I trusted, and recovery is tough. It took me a full month to be able to get in and out of bed without wincing. In the first weeks, I couldn’t even cuddle my toddler, lest she accidentally hit my stomach. I still can’t carry her.
While every woman’s labour and path to C-section varies, here’s how it typically works. You’ll probably get regional anesthetic—either an epidural, or a spinal—to numb the lower half of your body. In emergency cases, general anesthetic can be used, but this is very rare. You’ll also get antibiotics through an IV. “That cuts down on both the risk of infection on the skin, as well as the infection in the uterus,” says Tankel. Next, a nurse will clean your stomach with iodine (it may stain your skin brown temporarily) and may use an electric razor to give your pubic hair a quick trim so the doctor has a clear view. A catheter will be inserted to empty your bladder so it’s less likely to get in the way during surgery.
Next, something that completely surprised me: Some hospitals may strap your arms to the operating table (others leave them free)—done to prevent you from inadvertently knocking a member of the medical team while they are wielding a scalpel. Sterile drapes are placed around the surgical site and a curtain may also be put up at your chest. Your partner (who is now wearing a clean hospital gown, mask and cap) will be invited in to sit near your head and support you during the surgery.
The first cut through the top layer of skin is called a “bikini cut,” which is made across the abdomen (very rarely it could be up and down, which is known as a midline incision), lower than you may think, far below where most waistbands sit, so the scar won’t be visible (even if you ever find yourself ready to rock a bikini). The doctor cuts through the fat and the fascia (connective tissue) and will move the two muscles of the abdominal wall aside before cutting into the uterus. Then, it’s time to deliver the baby, usually by pushing on the top of the uterus. (Some women feel pressure at this point. I can’t remember feeling anything.) When baby is delivered, doctors cut the cord and pass the baby over—to a parent, nurse or other care provider.
The trend toward gentle C-sections has meant tweaking traditional procedures. “We’re moving towards what I call family-centered care, trying to involve the parents,” says Tankel. “One of the things would be lowing the curtain so that both the partner and the patient can see the baby being delivered.” My doctor didn’t use a dividing curtain at all, so my husband could watch the procedure and I could see my son once doctors lifted him up. Other hospitals may use clear drapes, or invite partners to watch from the other side. There may also be an opportunity to immediately lay baby on top of mom for skin-to-skin contact in the operating room, depending on how mom and baby are doing.
Next, doctors remove the placenta with the help of an oxytocin injection, which makes the uterus contract (it’s sometimes used in vaginal births too). Then it’s time to stitch the uterus, suck out any extra blood or fluid from around it and close the other layers back up with stitches or staples (depending on the hospital). Meanwhile, nurses count the instruments to ensure nothing got left inside—something I was happy to hear as my doctor stitched me back together.
I didn’t get immediate skin-to-skin contact with my baby boy like I did after my vaginal birth. It turns out his cord was wrapped around his neck, so he needed a little extra attention. I was also shaking so much (a common side effect of anesthetics; some women may also feel nauseous and vomit) that it wouldn’t have been safe to immediately hold him. I did get plenty of skin-to-skin cuddles and the chance to breastfeed as soon as I was wheeled into the recovery room. The entire procedure took less than an hour, from start to finish.
After the anesthetic wears off, pain can be controlled with an over-the-counter or prescription anti-inflammatory, and sometimes narcotics. Some mothers receive an anti-blood-clotting drug shot into the stomach or hip. The catheter is usually removed within eight to 12 hours (but can be in as long as 24 hours), so you’ll have to get out of bed, if only to pee. I was standing and walking (more of a slow shuffle, really) the morning after my C-section.
Once you’re discharged from the hospital, typically 48 hours after your birth, you’ll need help at home. The six stairs in our split-level house felt like Everest, and I spent a lot of time in bed during that first week. Nursing went well and I was able to change diapers. However, my mom and husband had to do the cooking, care for our toddler and run errands. Lifting anything much heavier than baby isn’t allowed for two to six weeks, depending on what your doctor advises. “If you suddenly do very heavy lifting (like a bigger kid or a basket of laundry) within 48 hours, that can increase the risk of the incision coming apart,” says Tankel. You may be told not to drive—reaction times are slower after surgery. And there will still be postpartum bleeding and spotting to deal with, which can last up to six weeks—just like after a vaginal birth.
At nearly six weeks postpartum, I’m impatient with what feels like the world’s slowest recovery. I’m just now starting to have pain-free days. I regularly walked a brisk three-kilometer loop during my third trimester, right up until the day before my son was born, but there’s no way I could do that today. Walking half that distance is exhausting. My husband reminds me regularly that I had major surgery, plus I brought a new life into the world. He’s right, of course, and I try to keep this in mind.
Today, the bruising around my incision has disappeared, it’s only a little swollen, and my scar has faded to a reddish-purple line that remains tender to touch and strangely numb in some parts. As that scar continues to fade, it will be a reminder of the scary, but ultimately happy, day my son was born. A day when, like much of parenting, any challenge is totally worth it.