C-section awareness month: What does the surgical procedure look like?

In honor of Cesarean Section Awareness Month, medical professionals and healthcare advocates are emphasizing the importance of informed decisions for expectant mothers.

A C-section is a common surgical procedure in which a baby is delivered through an incision made in the mother's abdomen and uterus. Courtney Martin, DO, FACOG, board-certified OBGYN, and Medical Director of maternity services and quality improvement, explains that some C-sections are planned for repeat procedures or medical conditions, but others are recommended when problems develop during labor.

Some reasons for a C-section may include a breech or transverse position of the baby, concern for fetal distress during or prior to labor, significant health issues of the mother, or failure of labor and or failed induction.

During a C-section, a doctor makes an incision through seven different layers of tissue.

1. Skin
2. Subcutaneous fat
3. Fascia
4. Muscle
5. Peritoneum
6. Uterus
7. Amniotic Sac

Martin outlines the steps used to perform a C-section. The first is to ensure quality anesthesia. Then a scalpel is used to make the first incision, breaking through the skin through the dermis to expose subcutaneous fats. The doctor then dissects down to the fascia to expose the rectus muscle and extend fascia incisions laterally. Below is muscle that is then stretched to the side to reveal the uterus, which is stretched open to then break the amniotic sack and deliver the baby.

Although C-sections are generally safe, they also carry risks such as longer recovery time, pain, infection, damage to organs near the incision, numbness, bleeding, and complications with future pregnancies.

While the procedure can be lifesaving, it should be reserved for clear indications and only when necessary," said Martin. "We continue to strive to reduce primary C-sections, in first-time laboring patients, with national quality metric goals to keep this rate below 23.6%. LLUCH has met this mark year over year. There was a time when patients wanted them because it seemed easier, they were performed by physicians due to risk of litigation, and due to convenience, as the procedure could be planned, but they come with complications, mostly for the mother.” 

According to the Centers for Disease Control and Prevention, there were more than 2.4 million vaginal births in the United States in 2021 compared to 1.1 million births via cesarean section in the same year.

Martin says one of the biggest risks of having multiple C-sections is the potential of long-term complications, such as placenta accreta, which increases with each surgery. Typically, the placenta detaches from the uterine wall after delivering a baby, but this pregnancy condition causes the placenta to remain attached and can grow through the uterine wall into other organs, which can cause serious complications.

Women who have already had a cesarean birth may be able to have a VBAC, or vaginal birth after cesarean. Medical professionals and advocates say that in many patients, it can be a safe and less invasive option, compared to a repeat C-section. A successful VBAC can also lead to a faster recovery time for the mother and can lower the risk of complications.

While VBAC is considered safe for most women, it is important to discuss the potential risks and benefits with a healthcare provider and to carefully consider individual circumstances. It is important to discuss individual factors that may affect the chance of success for VBAC, as well as attempt a VBAC in a hospital setting where obstetricians and anesthesiologists are readily available.

"It is incredibly important to prevent and reduce C-Sections in first-time pregnant patients, given VBAC is not offered everywhere, and in general after one C-section, many patients opt for this method of delivery in future pregnancies," Martin said.

Visit our website to learn more about maternity services at Loma Linda University Children’s Hospital.