Are you having a scheduled C section? Here’s what to expect!
I thought I’d share some valuable info regarding CESAREAN SECTIONS. Today, C-sections make up around 30% of all births here in the United States.
And, in some parts of the world, it’seven higher. In China, the rate is approaching 50%, and in some private Brazilian clinics back in 2013, the rate had topped out at around 80%-90%.
That’s a lot of women! Since that number is so high, I thought I’d share with you how everything goes from my perspective, so YOU might have a more informed, positive perception of how your surgery will go.
Follow @mommy.labornurse on Instagram to join our community of over 640k for education, tips, and solidarity on all things pregnancy, birth, and postpartum!
When are scheduled C sections used?
Today, I’m not here to discuss the pros and cons regarding C-sections vs vaginal birth, nor am I going to discuss WHY it’s more beneficial to have a vaginal birth over a cesarean section.
Because if you’re here, you’re probably already scheduled for a C section And IN YOUR CASE a C-section was determined to be the safest route for delivering YOUR BABY at THIS TIME.
OR you’re here because you know that in some cases C section can’t be avoided. Unplanned C sections are a thing, and it’s an AWESOME idea to learn about what goes down ahead of time so you’re no caught off guard (go, mama!)
Let me give a few examples of when C sections happen, so we can get on the same page
- Your baby is having a hard time adjusting to labor. His heart rate is dipping much too low, and interventions have already been taken to try and increase his heart rate back to normal, multiple times : C-SECTION. Your baby doesn’t want to come out of your vagina
- You are pushing for more than 3 hours, and have made very little, if any, progress and baby is starting to get stressed out. Your doctor tries to perform a vacuum delivery, but is unsuccessful : C-SECTION. Your baby doesn’t want to come out of your vagina
- You’ve had 2 or more C-sections before because you’ve tried to labor, and were unsuccessful (for whatever reason) : C-SECTION. Your baby doesn’t want to come out of your vagina
- Your baby’s shoulder, feet, booty, face, or any other part of his body is presenting at your your cervix instead of his head : (In most cases) C-SECTION. Your baby doesn’t want to come out of your vagina
I will say, there are some women who rock breech (booty first) deliveries, and in some cases this is totally safe and fine! Many times if you’ve never had a baby before, though, and your baby is booty first, it’s much safer to have a C-section for numerous reasons.
These aren’t the ONLY reasons C-sections are used
THERE ARE PLENTY OF OTHER REASONS AS WELL. These are just a few examples of why, sometimes, it’s much more beneficial to your babe to have a C-section.
YES, there are some C-sections that are unwarranted. There are some practitioners out there who perform C-sections for unnecessary reasons, or for convenience. I’m not sure of your specific case, but as a general rule….trust your provider!
How to avoid an unnecessary C-section?
- Choose a provider that you trust, and do some research
- If you are interested in AVOIDING A C-SECTION, look up hospitals in your state, and their C-section rates. Not many people actually do this, but this is one of the easiest ways of improving your vaginal delivery rate
- If you are in the US, you can use this website to look up your hospital
- In addition, Yelp just recently added C-section rates and other statistics to their website!
- And, at your first prenatal appointment, interview your doctor or midwife. Ask them THEIR specific C-section rate. If they have a good one, they will be happy to share that with you.
Scheduled C-section – What to expect
SO, if you are planning on a C-section, or end up having a C-section (for whatever reason)…I’m about to share with you how everything goes from my perspective as a labor and delivery nurse.
I’m also going to explain everything as if you were having a SCHEDULED C-Section. If you end up having an unscheduled C-Section, or an emergency C-Section, know that most of these procedural tasks still happen, they just happen much faster and with more people helping.
You need this list: Packing Your C-Section Hospital Bag
1. Getting prepped
You’ll need to arrive early
Your doctor will ask you to be at the hospital about 2-3 hours before your actual surgery. Starting an IV, drawing blood, waiting for the blood to result, and monitoring your baby, takes some time, and we want to make sure we have plenty of time to complete these tasks!
No eating 8 hours before
It’s important to also note that your doctor will tell you not to eat anything for at least 8 hours before your surgery. Trust me, there have been ladies who have stopped at McDonalds on their way into the hospital, and, unfortunately, that will get your surgery delayed!
Monitoring baby
Once you arrive, you’ll be asked to undress completely, take off all jewelry, and change into a gown. I’ll then put you on the monitor, and watch baby’s heart rate for awhile while we go over all of your health history.
IV and Blood Work
The most important task that I need to complete is starting your IV, and getting a few blood tubes down to our lab. Some of these blood tests can take an hour or more to result, and if I have a difficult time starting your IV, this can delay the process by quite a bit.
Checking in with the Provider
Once we get your health history completed, your IV started, and your paperwork completed, your provider will come to see you and explain how your procedure will go. This will be the time when he/she will answer any questions that you have, and have you sign a consent form for your surgery.
Your provider also may perform an ultrasound at this time, to assess the way baby is lying. As I referenced before, a popular reason why many women have C-sections is because baby is breech, or side lying.
Sometimes babies like to magically flip around and become head down on the day of your surgery! In that case, your doctor will talk to you about possibly being able to have a vaginal delivery instead.
And the Anesthesiologist
Another team member who will talk to you before your surgery is either an anesthesiologist or a nurse anesthetist. A member of the anesthesia team is always in the operating room (OR) during your surgery, so they have a checklist of tasks and assessments they must complete before we roll back to the OR as well.
They usually perform an assessment on you, have you sign a consent form, and answer any questions you have about the form of anesthesia you will receive during surgery.
You’ll be given a dose of sodium bicarbonate
Once everyone that needs to see you has been in the room, I’ll grab a set of OR clothes for your partner (or whoever you choose to be back with you during surgery), and I’ll also grab you a dose of sodium bicarbonate.
Sodium bicarbonate is routinely given before surgery, because it helps to neutralize the acid in your stomach. In the event that you vomit while laying flat on the OR table (which sometimes happens), and breathe in a little bit of vomit to your lungs, the acidity of your stomach contents can be harmful to your lung tissue.
So, sodium bicarbonate helps to neutralize that acid, just in case that happens. Don’t worry, though, this is a pretty rare event.
Heads up, though, sodium bicarbonate is given orally, and it’s pretty yucky. It’s about the size of a tequila shot, and tastes like grape Gatorade mixed with ocean water. It’s not pleasant, but it IS necessary, so bottoms up!
Related Reading: Could a VBAC Be Right For You?
2. Scheduled C-section go time!
Your partner will hang back until the surgery starts
Alright, time to head back to the OR! Your partner will stay back in your room for about 15-20 minutes while we prep you in the operating room.
Numbing you up
Once we get back there, the first order of business is numbing you up. Generally, if you have no major heath history, the anesthesiologist will be placing a spinal block, and giving you a medication that numbs you from about the waist down.
If you are having an unscheduled, or emergency C-section, and you ALREADY have an epidural placed, we skip this step! The anesthesia team will dose your epidural accordingly, AS LONG AS your epidural was working properly before your surgery.
How the anesthesia is placed
Once we arrive to the room, you’ll sit on the edge of the OR table, and the anesthesiologist will prep your back for placement. It’s important to remember to sit very still during the procedure, and also to curl your back in a C shape.
You want to sit very slouched, and with very bad posture. Head and neck rolled down, looking at your feet. Once your back has been prepped, a small needle will be inserted to numb your back, followed by a larger needle that’s used for placement.
This is very similar to receiving an epidural, and I’ve actually written an entire article on epidural placement here, if you’d like to check it out!
Once anesthesia has found a placement, he/she will deliver the medication and your feet will begin to go numb very quickly. Contrarily to epidural placement, no type of line will stay in your back, unless your doctor feels your surgery will be much, much longer than usual.
Getting you into position and checking on baby
Once anesthesia is finished, we will all help to lay you down flat on the OR table. Once flat, I’ll listen to baby’s heart rate for just a few seconds, and also put a big bump (a pillow or rolled up blanket) underneath your right hip. This bump helps to maximize your blood flow output to baby.
By this point, your legs will have almost completely gone numb. I’ll then insert a Foley catheter into your bladder. Some hospitals also routinely perform what’s called a “vaginal prep” before all C-sections.
This is done to reduce infections of the surgical skin site or any infection of the uterus (endometritis) post-op. I basically take a big sloppy wet sponge and paint your groin and perineum area.
Placing compression devices on your legs
At this time I’ll also place sequential compression devices (SCD’s) on your calves. SCD’s are worn by almost all surgical patients in the United States, during surgery and post-operatively as well. They are big velcro calf sleeves connected to a pump that inflates and deflates every few seconds.
They squeeze your legs sporadically like this because they are thought to help increase blood flow to the lower half of your body. This, in turn, reduces the likelihood of you developing any blood clots. Sometimes if you are on bed rest for an extended period of time, your doctor will order these to remain on your legs as well.
Prepping your belly and positioning the drape
Once I’ve completed these tasks, we will strap your legs down with a safety belt to the table, and begin prepping your belly with a solution for surgery. This only takes a few minutes, and then the doctor will suit up and hang a sterile drape over you and prepare for incision.
***Some hospitals also have clear drapes that can be requested, so you can see baby come out live in action! Check accordingly with the place you deliver.
Your L&D nurse may be bopping around
As all of this is going on, I’m usually running back and forth completing tasks as required, and doing my necessary charting in our computer system.
However, a NURSE ANESTHETIST will be with you the entire time at your head, talking to you throughout prep and surgery. His/Her responsibility is monitoring your vital signs, and giving you any necessary medications during surgery.
Your partner comes in to be with you and we are READY!
Once we’ve got your draped, the medical team will do a quick “time out” to verify the procedure, your name, birth date, allergies, and other identifying information. Now we will get started! The doctor will test the incision site, to make sure you are completely numb, and then we will go get your partner to come sit with you during surgery.
Depending on which hospital you deliver at, a pediatric team may also be present at your delivery. This is standard at the hospital I work at. Right around the time of incision is when we call them to attend.
They are in charge of catching baby from the doctor, stabilizing baby if needed, and assigning Apgars.
Related Reading: C-Section Recovery in the OR
Related Podcast: All of Your C-Section Questions Answered
3. Let’s have a baby
Making the initial incision
Cut! We make a note of all key events that happen in the OR, and this is a big one! If you’ve never had any sort of abdominal surgery before, the time from when the doctor makes the incision to the time baby is born is actually pretty quick!
If you HAVE had another C-section, or any sort of abdominal surgery, you have scar tissue near your incision, and it can take a bit of time for the doctor to cut through this scar tissue.
Getting into the uterus
Once the doctor has cut through your skin, fat and muscle layers, and any scar tissue, next up is your uterus! Once this incision is made, baby is born in just a few seconds!
You won’t have felt much of anything up until this point, BUT as the doctor is manipulating baby from your uterus, you will feel a TON of abdominal pressure and discomfort. Breathe through it though, because it is short-lived.
You have a baby!!
Baby is out! Baby will be stabilized, umbilical cord will be clamped and cut, and Apgars will be assigned. This is the time when your partner may come over to the warmer and get a few first looks and pictures of baby.
If you are feeling up to it, as well, most facilities will let you do skin-to-skin at this time. Many mamas opt to do this after we exit the OR, however, and that is totally fine, too! In that case, we will wrap baby up and let your partner hold baby for the remainder of the procedure.
4. Sewing you back up
After baby is out, your placenta will be detached, and then comes the longest part of all…stitching everything back together!
Pitocin is used to decrease postpartum bleeding
The doctor will start by sewing your uterus back up, followed by each layer he/she has cut through. While this is going on, we will be giving you PITOCIN through your IV, and monitoring your bleeding. Pitocin is given to help DECREASE the amount of postpartum bleeding you will experience.
Dressing your wound
Once everything is sewn back up, we put a BIG dressing over your incision site, and begin cleaning you up. We put an initial dressing on you, but I’ve actually heard of women using these nifty things when they return home. Check with your provider, but they are generally safe to use after the first dressing is removed.
Time to head to the PACU
We will move you off of the OR table, to a postpartum bed as we prepare to transfer you to the Post Anesthesia Care Unit (PACU). I’ll stay with you for approximately 2 hours in the PACU, and from there we will head to postpartum!
Now you know! Scheduled C-section and what to expect
That’s pretty much a C-Section in a nutshell! As you can see, there are a TON of team members doing a TON of different tasks, so it can get confusing at times, if you don’t know what’s going on!
I’ve just highlighted prep and procedure. Continue learning by heading over to this article about C-section RECOVERY. There is a lot that goes on in the first 2 hours after your C-section!
Be sure to pick up some super sexy postpartum panties, too, while you’re at it! These are specifically designed for C-Section mamas 🙂
Do you have a C-section scheduled? Be sure to checkout my C-section birth course!
Happy Delivery Day! 🙂
