Calm down. Breathe. Usually you get this news during labor. Sometimes you have some hints because labor has been going on for a long time. Other times something happens suddenly and you are rushed to the operating room with a short explanation about what’s going on. Let me help explain some of this.
Would you know before labor?
The answer is: sometimes. Reasons for a planned cesarean would include placenta previa (where the afterbirth is over the cervical opening), abnormal position of the baby like breech or transverse lie, contracted pelvis, twins or more with babies in abnormal positions. There are many other reasons. Women who have had a previous cesarean delivery need to discuss this with their obstetrician. There is a risk with labor to mom and baby. Pregnant women who are in some kind of accident and have the placenta tear away from the wall of the uterus (placental abruption) may need emergency surgery without labor in order to save the baby.
What might happen during labor?
Mother Nature has designed babies to fit through the mom’s pelvis. She also has designed mom to push baby out. When things don’t go according to plan, we obstetricians earn our wrinkles, gray hair and high blood pressure.
One common problem we see is that the baby is too big to fit through the pelvis (passenger) or the pelvis (passage) is too small to fit the baby. This is called CPD for cephalo (head) pelvic disproportion. Other problems that can require surgery are heavy bleeding, fetal distress, or failure to progress. There are times when mom is too ill to undergo labor. These include various types of heart disease, blood pressure issues and maternal diseases. Remember the whole goal is to get as healthy a mom and baby (or babies) as possible.
What should I expect after the decision is made for surgery?
Things usually get pretty busy at this point. If you don’t have an IV, you will usually get one started now. If you don’t have an epidural, your anesthesiologist will discuss your options. There may be reasons why you should have a general anesthetic. You may have a catheter inserted in your bladder to keep it empty during the surgery.
You will most likely be moved to an operating room. Your abdomen will be washed and surgical drapes will be put over it. There will be lots of scary noises. Those of us that work in the operating room regularly are familiar with them and comforted by them. Instruments, sponges and such are counted, the “field” is set up, the pediatrician and pediatric nurses get their area ready, anesthesia works to get mom comfortable and make sure you are doing well. You will have a heart monitor (sticky pads), oxygen monitor, blood pressure monitor, and various other things. There will be lots of sticky things and soapy stuff to wash off later.
When do I get to see my baby?
Once the surgery starts, it doesn’t take very long until the baby is delivered. You will usually hear an announcement of “it’s a boy!” or “it’s a girl” before you get to see the baby. Some doctors will lift the baby over the drape so you can see you little one. Sometimes the baby has to go directly to the pediatrician. Even if the baby is having problems, you should get a chance to see your bundle of joy before it is whisked off to the nursery.
You may get medicine to relax you at this point. The rest of the surgery takes a while. Details omitted for the faint of heart or stomach. Skin closure depends on your doctor. Ask before your dressing comes off so you aren’t surprised.
Usually you go to a recovery area for a while after here. Then you get to visit the nursery on the way to your room. Baby will come to visit you later depending on how both of you are doing. My triplets were early. They had to stay in their little incubators in the intensive care nursery. I got to go visit them! I spent hours in the nursery with my new little guys. I did get a couple of good nights of sleep before we were home together and I started learning to be a mom!
This is a good resource from the American College of Obstetrics and Gynecology. There are good drawings of the types of incisions that you might have: