Whether you’ve decided to have a traditional childbirth experience or have opted for a more natural childbirth, surgical intervention may be necessary if there are complications or if your health care provider thinks it’s safest for your baby.
The two most common surgical interventions are C-sections (caesarian sections) and episiotomies.
A C-section, also known as a caesarian section, is a surgical procedure to remove a fetus from its mother’s uterus. Some C-sections are planned and scheduled in advance, and some are considered emergency C-sections. When a woman cannot safely deliver her baby through the vaginal canal, doctors will perform a C-section.
Some reasons for C-sections include:
- the mother has delivered a child by C-section in the past
- the baby is in distress
- the baby is too large to fit through the vaginal canal
- the baby is not in the proper position to allow for vaginal delivery (he or she is positioned feet, shoulders or bottom down rather than top of the head down)
- labor is not progressing normally
- there are complications with the placenta
- the mother has a medical condition that could be passed to the baby through the vaginal canal (such as HIV infection or other sexually transmitted diseases)
- the mother is carrying twins or multiples
During a C-section, an anesthesiologist will provide medication to block pain from the waist down with an epidural or a spinal block. Usually moms get to stay awake for the procedure so they can see their babies as soon as they are delivered, but in some cases, doctors may need to give general anesthesia so the mother is asleep for the surgery. Once the anesthesia has taken effect, the doctor will make an incision in the abdomen and separate the muscles to expose the uterus, and then will make another incision in the uterus. After the uterine incision is made, the doctor will pull the baby out. The baby’s mouth and nose will be suctioned, and then the umbilical cord will be clamped and cut. The doctor will then remove the placenta from the uterus, close the uterus with dissolvable stitches and close the abdominal incision with additional stitches or surgical tape. The skin is closed with a stitch under the skin, or staples. Staples are removed within a few days.
If you have a C-section, you may have to stay in the hospital a bit longer than if you deliver your baby vaginally. Your recovery may take a little bit longer as well. However, most C-sections don’t involve complications, so you should be back to feeling good within a short time.
An episiotomy is an intentional cut to the area of the skin and muscle between the vagina and the rectum. This area is called the perineum. Although episiotomies used to be common as a preventive measure (to try to avoid natural tearing that can happen during childbirth), they are not typically done anymore unless there is a complication during a vaginal birth or the baby needs to be removed quickly.* A health care provider may choose an episiotomy if the baby is too big or there isn’t enough room, or the baby is in distress and needs to be removed quickly.
If you do need an episiotomy, your health care provider will likely give you a local anesthetic to numb the area and will then use surgical scissors to make a small cut in the perineum. The cut is made just before you’re about to give birth. After your baby is born, the health care provider will give you additional local anesthetic before giving you stitches to close up the incision. The level and duration of discomfort after an episiotomy (or a natural tear) varies from woman to woman. We recommend that you use a cold pack immediately after your baby is born and then on and off for the following 24 hours to help reduce the pain and keep the swelling down.
Whether you have an episiotomy or you tear naturally during childbirth, you will likely heal within four to six weeks after you deliver your baby. You shouldn’t have sex before your health care provider examines you and gives you the okay to resume sexual activity.
*Although recent research shows that episiotomies heal more slowly than natural tears and have higher risk of infection and complications, some doctors still perform them to prevent tearing. If you are concerned about whether or not your doctor will perform an episiotomy, ask him or her before you go into labor. Talk about the risks and benefits, and find out what circumstances might cause your doctor to perform one. If you are uncomfortable with having one, let your doctor know.