Caesarean Section

A caesarean section or c-section is an operation in which doctors remove the baby from the womb through an abdominal incision. The baby is therefore not born through the cervix and vagina as in a spontaneous vaginal delivery, but is delivered through the abdominal wall. Most people who deliver their babies by c-section have a planned caesarean section. Often there are medical reasons for this already apparent during pregnancy. Sometimes it is not until you are in the hospital that it is determined that it is better to have an unplanned, cesarean section, which is then performed similarly to a planned procedure. In some cases, however, doctors have to perform a caesarean section very spontaneously and quickly because complications suddenly arise during the birth process. This is called an emergency caesarean section. However, this rarely occurs.

A caesarean section is always medically necessary if it is clear that a spontaneous birth is not possible for you, the baby or both of you. This is the case, for example, if a spontaneous birth would be too risky and there might even be a danger to life. One reason may be that the baby is transverse or the placenta is blocking the cervix. Sometimes the baby is so big that there is a risk that it will not turn properly into the birth canal. It is estimated that a caesarean section is medically necessary in only 10 to 15 out of every 100 deliveries. Nevertheless, in many countries almost every third child is born this way. The most common reasons for a caesarean section in Germany are if the baby is in a breech presentation or in the case of a multiple pregnancy. Basically, the decision for or against a delivery by caesarean section always depends on the individual case. So it depends very much on how your doctor assesses your pregnancy.

Many cesarean sections are scheduled to take place starting in the 39th week of pregnancy. Maternity hospitals want to prepare for the operation in peace and wait until the baby is as developed as possible. A planned caesarean section usually takes place under partial anaesthesia. You stay awake and only the lower half of your body is numbed. It also puts less stress on you and the baby than general anaesthesia. You'll get an injection in your back. After about twenty minutes you will feel no pain from the abdomen down. The doctor then makes an incision about eight to twelve centimetres long across the lower abdomen and just above the pubic hairline. This way the baby can be delivered quickly. The procedure usually takes half an hour to an hour. The placenta is also removed during this procedure. Afterwards, you usually have to stay in the clinic for a few days. As with a spontaneous delivery, the person accompanying you at birth may be present for a planned caesarean section. If it is only determined during the birth that a caesarean section is advisable but there is not yet any pressing danger, this is known as an unplanned caesarean section. It proceeds like a planned caesarean section and can also take place under partial anaesthesia.

If a life-threatening situation develops for you or your baby during a spontaneous vaginal delivery, an emergency c-section may be necessary. This is often due to changes in the baby’s heartbeat or a failure to progress in labour. An emergency c-section is similar to a planned c-section. However, there are three important differences. An emergency caesarean section usually takes place under general anaesthesia. The effect of the anaesthetic is much faster than with a partial anaesthetic. The doctor can therefore start the operation more quickly. However, the drugs can enter the baby's circulation during general anaesthesia. This isn’t ideal for the baby. The doctor will therefore try to use the anaesthetic for as short a time as possible. Second, injuries and bleeding are more likely to occur during an emergency c-section than during a planned c-section. The third difference is that the person who accompanies you during the birth may not be present during an emergency caesarean section. They must leave the room and wait outside the door.

Some people who have given birth via emergency caesarean section suffer afterwards from the fact that they did not bring their child into the world via a spontaneous birth. For example, you may personally have a feeling that you did not do it ‘normally’ or that you did not experience a ‘proper’ birth. But every birth is a good birth. A c-section is certainly not a defeat. The most important thing is that you and your baby are healthy. For some people, the fear they experienced before the emergency c-section was also a bad experience. Others feel they cannot form a proper bond with their baby because they were not conscious when the baby was born. If such thoughts and feelings are bothering you, you can get support. A good option is to ask your midwife what might help you and who you can turn to for psychological counselling, for example. Your gynaecologist can also help you find the right places to go. You are not alone in this experience and your feelings.

Some people may want a c-section even if it is not medically necessary. One of the main reasons for this is fear. This includes, for example, the concern that the birth is dangerous for the baby and can cause permanent damage. However, the baby’s condition is closely monitored during delivery. If problems become apparent that could be threatening to the child, the doctor can usually still perform a caesarean section. Fear of pain or injury also plays a big role. These fears are understandable, because birth is a physically and emotionally exceptional situation. However, spontaneous birth is a process for which the pregnant body and the baby are naturally prepared. Many pregnant people underestimate their own strength and do not trust themselves to give birth. If you also have such fears, be sure to discuss them with your midwife or gynaecologist. A consultation at the hospital can also help you to understand the birth process better and to discuss your concerns in concrete terms. If there are no medical reasons for a c-section, then it is generally believed that a spontaneous birth is the healthiest option for you and your baby. It is important to know that you can still decide to have a caesarean section during the birth.

Those who hope that a caesarean section will result in a painless and safe birth are unfortunately mistaken. After all, the procedure is a major surgery with risks. Bleeding, blood clots, infection or injury to the bladder or bowel may occur. The body is permanently injured in the process. Among other things, this can lead to adhesions and problems during the next pregnancy. Of course you save yourself the pain of childbirth. But instead, after a cesarean section, you have pain from the abdominal incision for a long time. People who have given birth spontaneously are usually back on their feet again more quickly and can therefore concentrate better on their newborn than those who have had a caesarean section. In addition, after a caesarean section you usually have to stay longer in hospital, on average about a week.

If you have already given birth by caesarean section, this does not necessarily mean that a caesarean section will be necessary for every subsequent birth. If you become pregnant again, it is best to ask your doctor or midwife for advice on what speaks for and against a vaginal delivery or another caesarean section in your case.