Guide | Understanding Cesarean Delivery: From Preparation to Recovery
Ellen Spencer, 40, is recovering from a cesarean delivery. Caring for a 1-month-old baby and a young child has made her recovery from surgery more difficult.
"I knew I was going to have a cesarean," Spencer told the author. "Several years ago, I had abdominal surgery to remove uterine fibroids, so my doctor believed a cesarean would be better than vaginal delivery. However, recovery has been much slower and more difficult than I expected."
Despite the slow recovery, knowing the exact delivery date in advance made planning easier, especially with a busy job and family traveling from out of town. Spencer's experience is increasingly common: cesarean deliveries now account for 31.8% of all births in the United States each year—more than 1.3 million—and the number continues to rise. Over the past decade, the U.S. cesarean delivery rate has increased by more than 50%.
As cesarean delivery rates rise, expectant mothers need to understand the effects on the body and health. This article summarizes expert perspectives on the benefits and risks of cesarean delivery, reasons for rising rates, and recovery after surgery.
1. Benefits and risks of cesarean delivery
Simply put, a cesarean delivery is surgery to deliver a baby through the mother's abdomen. In the United States, nearly one in three women delivers by cesarean, either by choice or because of risks to the mother or baby.
Like any surgery, cesarean delivery has benefits and risks that require careful consideration.
"Cesarean delivery has practical benefits," says Iffath Hoskins, MD, Chair of Obstetrics and Gynecology at Lutheran Medical Center in Brooklyn. "With a planned cesarean, the mother knows the delivery time in advance."
Another benefit is ensuring that important resources are available, such as neonatologists who can provide immediate care if the baby has a problem.
However, cesarean delivery also carries risks.
"Women need to understand that a cesarean is major abdominal surgery," says Jan Kriebs, a certified nurse-midwife at the University of Maryland Medical Center. "Although a team that includes an obstetrician, midwife, and nurses works together to ensure a successful procedure, a cesarean remains a serious operation."
The procedure involves incisions through the skin, abdomen, and muscle before reaching the uterus. From start to finish, including preoperative and postoperative care, a typical cesarean takes 3-4 hours.
"Because cesareans are performed so often, many people have a false sense of security," Hoskins says. "Although the procedure usually goes very smoothly, there are still risks when opening the abdomen, moving organs, and making incisions near the bladder and bowel."
Possible complications include injury to surrounding organs, excessive bleeding, or infection.
Risks are higher for women who have had three or more cesarean deliveries.
"Because of scarring from previous cesareans, the placenta may attach deeply to the uterus. This can cause severe bleeding that requires a blood transfusion or even removal of the uterus to save the mother's life," Hoskins says.
It is therefore important to limit cesarean delivery to situations in which it is medically necessary.
2. Why cesarean delivery rates are rising
Despite the risks, the number of cesarean deliveries in the United States continues to rise for several reasons.
"Training in and willingness to use instruments such as forceps and vacuum extractors have declined," says Katherine Economy, MD, MPH, a maternal-fetal medicine specialist at Brigham and Women's Hospital and Harvard Medical School. "Without training in the proper use of these tools, doctors are more likely to choose cesarean delivery."
In addition, as the number of first cesarean deliveries rises, so does the number of subsequent cesareans.
"Women are not adequately informed about vaginal birth after cesarean (VBAC)," Kriebs says. "In fact, many facilities do not allow vaginal delivery after a woman has had a cesarean."
Risk also plays a role, both medically and legally. More health care providers turn to cesarean delivery when even minor complications arise during labor, seeking to minimize risk to the baby.
More women are also choosing cesarean delivery as a birth "option."
"Women worry that something unexpected will happen during labor, so they may choose a cesarean in advance," Economy says. "Or they may want to avoid labor pain, which is genuinely painful, and believe they can manage surgical pain better in a controlled setting."
3. Recovery after cesarean delivery
"Recovery after a cesarean is not easy," Economy says.
The typical hospital stay after a cesarean is four days, compared with two days after vaginal delivery.
After surgery, a urinary catheter remains in place, regional anesthesia continues to work for several hours, leaving you numb below the waist, and pain medication is needed.
The good news is that the catheter is removed the next day and feeling returns to your feet and legs. Pain medication is still needed, especially because nurses will encourage you to get out of bed and move to reduce the risk of blood clots.
Recovery does not end when you leave the hospital. "For the first few weeks after discharge, you cannot lift anything heavier than the baby," Economy says.
You also should not drive for about two weeks, exercise for 4-6 weeks, or have sex for six weeks.
"You will feel very tired while also caring for a newborn, so the physical demands are considerable," Hoskins says. "Do not expect dramatic improvement within 3-4 weeks. Many women need up to three months to recover fully."
Although cesarean delivery may sound daunting, thousands are performed successfully every day in the United States, resulting in healthy mothers and babies.
"It is important to communicate that both vaginal and cesarean delivery are safe," Economy says. "But it is also important to remember that when comparing an uncomplicated vaginal delivery with an uncomplicated cesarean, vaginal delivery is still safer."
Guide | Understanding Cesarean Delivery: From Preparation to Recovery
Guide | Understanding Cesarean Delivery: From Preparation to Recovery
Ellen Spencer, 40, is recovering from a cesarean delivery. Caring for a 1-month-old baby and a young child has made her recovery from surgery more difficult.
"I knew I was going to have a cesarean," Spencer told the author. "Several years ago, I had abdominal surgery to remove uterine fibroids, so my doctor believed a cesarean would be better than vaginal delivery. However, recovery has been much slower and more difficult than I expected."
Despite the slow recovery, knowing the exact delivery date in advance made planning easier, especially with a busy job and family traveling from out of town. Spencer's experience is increasingly common: cesarean deliveries now account for 31.8% of all births in the United States each year—more than 1.3 million—and the number continues to rise. Over the past decade, the U.S. cesarean delivery rate has increased by more than 50%.
As cesarean delivery rates rise, expectant mothers need to understand the effects on the body and health. This article summarizes expert perspectives on the benefits and risks of cesarean delivery, reasons for rising rates, and recovery after surgery.
1. Benefits and risks of cesarean delivery
Simply put, a cesarean delivery is surgery to deliver a baby through the mother's abdomen. In the United States, nearly one in three women delivers by cesarean, either by choice or because of risks to the mother or baby.
Like any surgery, cesarean delivery has benefits and risks that require careful consideration.
"Cesarean delivery has practical benefits," says Iffath Hoskins, MD, Chair of Obstetrics and Gynecology at Lutheran Medical Center in Brooklyn. "With a planned cesarean, the mother knows the delivery time in advance."
Another benefit is ensuring that important resources are available, such as neonatologists who can provide immediate care if the baby has a problem.
However, cesarean delivery also carries risks.
"Women need to understand that a cesarean is major abdominal surgery," says Jan Kriebs, a certified nurse-midwife at the University of Maryland Medical Center. "Although a team that includes an obstetrician, midwife, and nurses works together to ensure a successful procedure, a cesarean remains a serious operation."
The procedure involves incisions through the skin, abdomen, and muscle before reaching the uterus. From start to finish, including preoperative and postoperative care, a typical cesarean takes 3-4 hours.
"Because cesareans are performed so often, many people have a false sense of security," Hoskins says. "Although the procedure usually goes very smoothly, there are still risks when opening the abdomen, moving organs, and making incisions near the bladder and bowel."
Possible complications include injury to surrounding organs, excessive bleeding, or infection.
Risks are higher for women who have had three or more cesarean deliveries.
"Because of scarring from previous cesareans, the placenta may attach deeply to the uterus. This can cause severe bleeding that requires a blood transfusion or even removal of the uterus to save the mother's life," Hoskins says.
It is therefore important to limit cesarean delivery to situations in which it is medically necessary.
2. Why cesarean delivery rates are rising
Despite the risks, the number of cesarean deliveries in the United States continues to rise for several reasons.
"Training in and willingness to use instruments such as forceps and vacuum extractors have declined," says Katherine Economy, MD, MPH, a maternal-fetal medicine specialist at Brigham and Women's Hospital and Harvard Medical School. "Without training in the proper use of these tools, doctors are more likely to choose cesarean delivery."
In addition, as the number of first cesarean deliveries rises, so does the number of subsequent cesareans.
"Women are not adequately informed about vaginal birth after cesarean (VBAC)," Kriebs says. "In fact, many facilities do not allow vaginal delivery after a woman has had a cesarean."
Risk also plays a role, both medically and legally. More health care providers turn to cesarean delivery when even minor complications arise during labor, seeking to minimize risk to the baby.
More women are also choosing cesarean delivery as a birth "option."
"Women worry that something unexpected will happen during labor, so they may choose a cesarean in advance," Economy says. "Or they may want to avoid labor pain, which is genuinely painful, and believe they can manage surgical pain better in a controlled setting."
3. Recovery after cesarean delivery
"Recovery after a cesarean is not easy," Economy says.
The typical hospital stay after a cesarean is four days, compared with two days after vaginal delivery.
After surgery, a urinary catheter remains in place, regional anesthesia continues to work for several hours, leaving you numb below the waist, and pain medication is needed.
The good news is that the catheter is removed the next day and feeling returns to your feet and legs. Pain medication is still needed, especially because nurses will encourage you to get out of bed and move to reduce the risk of blood clots.
Recovery does not end when you leave the hospital. "For the first few weeks after discharge, you cannot lift anything heavier than the baby," Economy says.
You also should not drive for about two weeks, exercise for 4-6 weeks, or have sex for six weeks.
"You will feel very tired while also caring for a newborn, so the physical demands are considerable," Hoskins says. "Do not expect dramatic improvement within 3-4 weeks. Many women need up to three months to recover fully."
Although cesarean delivery may sound daunting, thousands are performed successfully every day in the United States, resulting in healthy mothers and babies.
"It is important to communicate that both vaginal and cesarean delivery are safe," Economy says. "But it is also important to remember that when comparing an uncomplicated vaginal delivery with an uncomplicated cesarean, vaginal delivery is still safer."
Source:
Collected online