Cesarean Birth

A cesarean birth is a surgical procedure in which an incision is made a few centimeters above the pubic bone to access the abdominal cavity and open the uterus, allowing the baby to be delivered safely. With today’s advanced surgical techniques and modern anesthesia methods, cesarean delivery can be performed safely whenever medically necessary for both mother and baby.

Some mothers may prefer cesarean delivery because it allows for a more predictable and sometimes quicker birth experience. However, cesarean section is generally a planned surgical procedure performed for medical indications.

Modern Cesarean Practices

Thanks to advancements in surgical techniques, sterilization standards, antibiotics, and high-quality suturing materials, modern cesarean operations are now extremely safe.

In rare cases during vaginal delivery, there may be risks of the baby becoming compressed or experiencing birth trauma. To monitor such risks, fetal monitoring systems are used throughout labor.

Fetal Monitoring Methods

• External Monitoring: Tracks the baby’s heartbeat and uterine contractions indirectly using sensors placed on the mother’s abdomen.
• Internal Monitoring: As labor progresses, an electrode may be placed on the baby’s scalp to record heartbeats directly.
• Fetal Pulse Oximetry: This modern technique measures the baby’s oxygen levels, allowing physicians to make real-time assessments of fetal well-being during labor.

When Is a Cesarean Necessary?

Cesarean delivery is medically indicated in several circumstances, including:

• Narrow pelvis or cephalopelvic disproportion
• Breech or transverse fetal position
• Multiple pregnancies (twins, triplets)
• Breech presentation in premature or large babies
• Preeclampsia, eclampsia, or high blood pressure
• Large baby due to gestational diabetes
• Placenta previa or placental abruption
• Fetal distress (abnormal heart rate on NST, cord prolapse, etc.)

The Surgical Procedure

• Preparation: The surgery is performed by at least two physicians (a lead surgeon and an assistant). Either epidural anesthesia or general anesthesia is administered.
• Incision: A horizontal incision of about 10 cm is made above the pubic bone, cutting through the skin, subcutaneous tissue, abdominal wall layers (fascia, rectus muscle), and peritoneum to reach the uterus. Once the uterine wall is opened and the amniotic sac is ruptured, the baby’s head and then body are gently delivered.
• Baby and Placenta: After delivery, the umbilical cord is clamped and cut, and the baby is handed to the neonatal team. The placenta is removed, the uterine cavity is inspected, and all layers are closed one by one using synthetic absorbable sutures (vicryl) for safety and minimal tissue reaction.

Postoperative Care and Recovery

• First Hours: After surgery, you’ll stay in a recovery area for about 30 minutes before being moved to your room. A urinary catheter remains in place.
• Mobilization & Nutrition: Within 6–8 hours, light fluids are offered, and gentle mobilization begins — crucial for stimulating bowel function.
• Pain Management: Epidural anesthesia may be continued, or PCA (patient-controlled analgesia) may be used after general anesthesia.
• Breastfeeding & Bonding: Early skin contact and breastfeeding are encouraged. Nursing helps the uterus contract, reducing bleeding naturally.

Following Days

• Postoperative Day 1: The catheter and epidural line are removed, and a soft diet is introduced. Once gas passage occurs, a regular diet begins. Gentle walking is encouraged.
• Days 2–3: If your condition is stable, you may be discharged. Showering and light daily activities are allowed.
• At Home: Avoid strenuous activity, but maintain gentle movement. Postpartum bleeding may continue for 2–3 weeks and can intermittently start and stop; this is normal as long as the color lightens over time. Continue taking your iron and vitamin supplements, drink plenty of water, and limit gas-forming foods. Mild uterine cramps during breastfeeding are normal and help the uterus return to its pre-pregnancy size.
• Avoid baths, pools, and jacuzzis until bleeding has completely stopped — shower only during this period.

The Cesarean Decision

Cesarean delivery is a safe and effective alternative when vaginal birth poses risks or is not possible for the safety of mother or baby. However, when conditions allow, vaginal delivery remains the preferred option.

During the decision-making process, the medical necessity of the procedure is explained clearly, and the mother’s comfort, preferences, and understanding are treated as the most important factors in determining the best and safest approach.

Frequently Asked Questions

In Which Cases Is a Cesarean Delivery Necessary?

There are many situations in which a cesarean birth may be medically required. In general, cesarean delivery is recommended when vaginal birth is impossible or highly risky — in order to protect the life and well-being of the mother and/or baby. Some indications are related solely to the mother, others to the baby, and some to both.

In certain cases, vaginal birth is not physically possible, and a cesarean is planned before labor begins, usually after the 38th week of pregnancy. In other instances, a cesarean decision may be made during labor if complications arise. Cesarean indications can be grouped as follows:

Conditions Where Vaginal Birth Is Impossible or Unsafe (Pre-Planned Cesarean)

• Transverse Lie: The baby lies sideways in the uterus. Vaginal delivery is impossible in this position and can endanger both mother and baby. Normally, the baby turns head-down near the end of pregnancy; if this does not occur, cesarean delivery is essential.
• Breech Presentation: When the baby’s buttocks present first. If the baby’s feet present first, cesarean is mandatory. In “complete” or “frank” breech cases, a vaginal birth may be considered depending on the situation, though most doctors today prefer cesarean due to the higher risks involved.
• Placenta Previa Totalis: The placenta completely covers the cervix, blocking the birth canal. Vaginal birth is impossible, and a pre-planned cesarean is required. Even partial obstruction increases the risk of heavy bleeding during dilation, so cesarean delivery is recommended.
• Very Large or Very Small Babies: Babies weighing more than 4500 g or less than 1500 g are at increased risk of birth trauma during vaginal delivery. In large babies, the most feared complication is shoulder dystocia — when the head is born but the shoulders get stuck. In small babies, intracranial bleeding and malpresentation are more common. Cesarean helps minimize these risks.
• Cephalopelvic Disproportion (CPD): A mismatch between the baby’s head size and the mother’s pelvic dimensions. This may occur even if the pelvis is normal-sized but the baby is large. Vaginal birth is impossible in some cases, especially when pelvic deformities exist (e.g., due to rickets).
• Multiple Pregnancies: Although not always necessary, cesarean is preferred for triplets or more. In twin pregnancies, if one baby is breech and the other head-down, the risk of head entrapment requires cesarean delivery.
• Congenital Anomalies: Structural defects that prevent the baby from passing through the birth canal (e.g., gastroschisis, omphalocele, severe skeletal or neural tube defects, conjoined twins) require cesarean delivery.
• Masses Blocking the Birth Canal: Large fibroids or genital warts can obstruct vaginal delivery, making cesarean necessary.
• Maternal Systemic Diseases: Conditions like advanced heart disease or brain aneurysms may make pushing unsafe, so cesarean is chosen.
• Maternal Herpes Infection: Active genital herpes poses a serious risk of transmitting infection to the baby during vaginal delivery; cesarean is mandatory.
• Previous Cesarean Section: A prior cesarean does not always mean the next must be surgical — except in classical (vertical) uterine incisions, where rupture risk is high. Low-transverse incisions may allow for VBAC, though many doctors still prefer cesarean.
• Previous Myomectomy: If a prior fibroid removal entered the uterine cavity, cesarean is generally recommended.
• Prior Vaginal Surgery: Some vaginal surgeries make vaginal birth inadvisable.
• Vaginismus or Fear of Childbirth: In cases of extreme fear or intolerance to examination, cesarean may be chosen even without medical necessity.
• Fetal Distress: Abnormal fetal heart patterns on NST may require emergency cesarean.
• Elective Cesarean: In private hospitals, elective cesareans are common. Reasons include fear of labor pain, desire to avoid prolonged labor, minimizing perceived risks to the baby, scheduling convenience, or choosing a symbolic date (e.g., wedding anniversary, memorable numbers).

Some physicians may also recommend cesarean for precious pregnancies (e.g., IVF or advanced maternal age), aiming to reduce risk. However, all babies are “precious,” and the term is now considered outdated.

Conditions Requiring Cesarean During Labor

Even when labor begins normally, some issues may necessitate an emergency cesarean:

• Failure to Progress: Despite strong contractions, if the cervix does not dilate or the baby’s head does not descend, cesarean is required.
• Fetal Heart Rate Abnormalities: During contractions, temporary oxygen reduction is normal; if the baby cannot tolerate it and heart rate drops persist, cesarean becomes necessary (acute fetal distress).
• Placental Abruption: Premature separation of the placenta from the uterus before birth deprives the baby of oxygen — an emergency requiring immediate cesarean.
• Umbilical Cord Prolapse: When the cord slips out ahead of the baby, it can be compressed, cutting off oxygen. This is a life-threatening emergency — cesarean must be performed immediately.
• Meconium-Stained Fluid: Indicates fetal distress; cesarean may be chosen to prevent aspiration-related lung complications.
• Head Entrapment: Rarely, the baby’s head may become stuck mid-delivery, requiring surgical intervention.

When Should I Be Concerned After Cesarean?

During the 6-week postpartum period, contact your doctor immediately if you experience:

• Heavy bleeding
• Fever above 38°C
• Persistent or unusual pain despite medication
• Foul-smelling vaginal discharge
• Redness, swelling, or pain at the incision site
• Drainage or pus from the incision
• Shortness of breath
• Redness, warmth, or pain in the legs
• Any unusual symptom you cannot explain

What Is Labor Pain?

Labor pain is unique — one of the most intense yet most quickly forgotten types of pain. Its intensity and quality vary with each stage of labor. It originates primarily from uterine contractions, cervical dilation, and pressure on pelvic and perineal nerves. Early labor pain is felt in the lower back, abdomen, and pubic area, while in the later stages, it radiates to the thighs and legs as a burning or cramping sensation.

Possible Side Effects of Epidural Anesthesia

• Low blood pressure (10–20%) if fluid replacement or positioning is inadequate
• Back pain (up to 50%), often related more to posture changes in pregnancy than the procedure itself
• Headache (0.5–1%)
  Epidural anesthesia is not suitable in cases of infection, bleeding disorders, anticoagulant use, severe dehydration, or patient refusal.

Possible Risks During Cesarean Delivery

While cesarean birth poses minimal risk to the baby aside from temporary breathing issues, it remains a major surgery with potential maternal complications such as:

• Infection
• Postpartum hemorrhage
• Amniotic fluid embolism
• Thromboembolism (blood clots traveling to the lungs)

Complication	Vaginal Birth	Cesarean Birth
Postpartum Hemorrhage	4%	8%
Uterine Infection (Endometritis)	1.5%	5.5%
Wound Infection	0.5%	6%
Thrombophlebitis	1/9000	1/800

What Is a Water Birth?

Water birth aims to reduce stress and pain during labor, allowing for a smoother and more comfortable experience. Warm water has relaxing and analgesic effects, easing tension and facilitating cervical dilation. Water temperature should ideally be 37°C. Prolonged or overly hot immersion can cause dehydration or reduced blood flow to the placenta, posing risks to both mother and baby.

Conditions for Water Birth:

• Informed consent and hospital readiness
• No active infections
• Normal vital signs and a reactive NST before immersion
• Continuous monitoring during labor
• Availability of trained obstetric staff experienced in water birth

Acupuncture for Labor Pain

Acupuncture stimulates specific points on the body to restore balance. Studies show it can reduce pain intensity and the need for epidural analgesia without adverse effects on mother or baby.

Aromatherapy for Labor Pain

Aromatherapy uses natural essential oils — such as lavender, rose, sage, peppermint, and rosemary — to relieve pain, calm the mind, and promote relaxation. These oils may be gently massaged onto the temples, chest, or back during labor to ease anxiety and enhance comfort.

Tips for an Easier Labor

Pain can be reduced with breathing techniques, hypnosis, aromatherapy, acupuncture, and water birth, or with medical pain relief such as epidural anesthesia. Emotional support, knowledge, and a calm environment significantly reduce perceived pain.

Vaginal Birth or Cesarean?

Labor contractions, though intense, are purposeful — each one brings the baby closer. With advances in anesthesia, methods like epidural analgesia now allow for nearly pain-free vaginal births.

Cesarean delivery, performed through an incision above the pubic bone, allows the baby to be born quickly but is associated with greater maternal recovery challenges.

Complication	Vaginal Birth	Cesarean Birth
Postpartum Hemorrhage	4%	8%
Uterine Infection	1.5%	5.5%
Wound Infection	0.5%	6%
Thrombophlebitis	1/9000	1/800

Postoperatively, cesarean recovery takes longer — breastfeeding may be delayed, mobility is limited for the first 8 hours, hospital stays last 2–3 days, and full recovery may take several weeks.

Preparing for Birth

Emotional readiness is as important as physical preparation. Along with regular medical follow-ups, attending prenatal education classes, maintaining a balanced diet, and engaging in safe exercises such as prenatal yoga, pilates, swimming, or walking can greatly ease delivery. Touring the birth facility and meeting your care team beforehand can also reduce anxiety and foster trust.

Choosing the Mode of Delivery

From the moment pregnancy begins, many women wonder whether their delivery will be vaginal or cesarean. Common fears surrounding vaginal birth include pain, long labor, episiotomy, or possible complications. However, it’s important to remember that vaginal birth is the most natural, physiological process — a method nature has perfected over millions of years.

Ultimately, the choice should be based on medical assessment, maternal safety, and personal comfort, made in collaboration with your healthcare provider and support team.