What is a scheduled cesarean section or delivery?

A scheduled cesarean delivery (as compared to an unscheduled cesarean section) is a cesarean section that has been scheduled, usually, because there are cesarean delivery indications that are known ahead of time or without specific indications, on maternal request. Reasons to schedule a cesarean include:

• Prior and now repeat cesarean delivery
• Maternal request
• Breech
• Placenta previa
• Multiple gestation eg twins
• Abnormal lie of the fetus
• Prior surgery on the uterus
• Placenta accreta
• Malposition of the umbilical cord
• Fetal malformation
• Abnormal fetal heartbeat
• Maternal issues
• A Shirodkar cerclage in place
• A big baby (usually over 4,500 grams)
• Small maternal pelvis
• Prior uterine rupture

Though every pregnancy book lays out the process of labor and vaginal delivery in great detail, most only dedicate a few pages on what happens during a c-section. Whether your baby is breech, you’re having a scheduled repeat, or if you elect to have a c-section for other reasons after consultation with your doctor, it’s still good to know exactly what to expect. Having attended dozens of cesarean sections in several different hospitals, I’ve noticed that the process is very similar no matter where you deliver and I hope that this post provides a bit of insight into it!

When to arrive for a scheduled cesarean

A scheduled cesarean is not unlike any other scheduled surgery. Most hospitals will have you arrive two hours before your surgery time. You’ll be asked to refrain from eating and drinking 8 hours prior to the procedure to decrease your risk of inhaling stomach contents into the lungs in case you end up needing general anesthesia in an emergent situation. You’ll be admitted to the labor & delivery floor and will most likely be weighed and asked to give a urine sample. Over the two hours prior to the procedure, you’ll be a very popular person! Your nurse will put your baby on the external monitors and you’ll have an IV placed for some fluids to start running. You’ll have a chance to speak with your OB and sign the surgical consent forms, as well as an anesthesiologist, who will go over the plan for pain management during the surgery and recovery and answer any questions you may have.

Moving from recovery or pre-op to the OR

Once you are ready to go back to the Operating Room, you’ll likely walk back. Though there are several options for pain management during a scheduled c-section, the most common is a spinal block. The spinal will be placed in the OR while you are sitting upright with your back arched to resemble the letter “C” on the operating table. This should take between 10 and 15 minutes. After the spinal is placed, you’ll lie back on the operating table and a Foley catheter will be inserted to drain your bladder during the surgery to ensure it stays empty and out of the way during the operation. A nurse will apply SCD booties, which will stay on during surgery and the immediate postpartum period while you are unable to get out of bed to prevent deep vein thrombosis (DVT). Soon after, the anesthesiologist will ensure that the spinal is working properly by poking your belly with a sharp object. Once it is confirmed that you can feel only pressure, not pain, near the surgical site, the nurses will clean your belly with an antiseptic and put up sterile drapes. Most hospitals only allow one person in the OR with you, and they will be brought back to sit on a stool right next to your head once all of these steps have been completed. Now it’s time to meet your baby!

The cesarean surgery

The surgery itself takes between 30 and 60 minutes, though the baby should be born within about 5 minutes of incision time. Some C-sections take longer, especially if you’ve had one or more before since scar tissue takes extra time to get through. After your baby has been born, your partner will be allowed to go over to the warmer and take pictures. The baby will be dried off and examined while the doctors are delivering your placenta and stitching you up. Depending on the hospital you deliver at, the baby will either go to the nursery for monitoring soon after birth or stay with you and your partner in the OR. Be sure to ask your care provider what your hospital’s policies are!

Post-cesarean recovery

Once the surgery is completed, the nursing staff will clean you up on the operating table and give you a new gown. You’ll be wheeled to the recovery room, where you can expect to remain for 2 to 3 hours after the procedure is completed. During those hours, both you and your baby will be closely monitored by the nursing and medical staff. A nurse will perform fundal checks to make sure that your uterus is clamping down appropriately and you aren’t having excessive bleeding. She will also monitor the baby’s vital signs. You will have the opportunity to initiate breastfeeding in the recovery room and may want to ask your nurse for advice on getting a good latch right away. Though you’ll likely have family and friends that are eager to meet the baby, it is usually best that they wait until you are recovered from surgery and moved up to a postpartum room to visit.

The prospect of having surgery can be scary, but know that a scheduled C-section is significantly calmer than an unplanned or emergency one. You’ll notice that the staff is much more relaxed, no one is in a hurry and there will be time for all of your questions to be answered.  A cesarean birth can be just as empowering and special as a vaginal birth so long as you know what to expect and discuss your wishes with your care provider ahead of time.

How to prepare for a scheduled cesarean section and delivery

Our 12 step program helps you prepare for the cesarean delivery.

1. Inform the insurance company. Many insurance companies require approval for hospital stays if they are planned. If the C-section is planned, the insurance carrier will need to be called ahead of time for a preapproval.
2. Determine approved length of stay. When the insurance company approves the C-section, they will inform the mother of the approval length of stay. Most often this will range from three to five days depending on the coverage and the agreement between the hospital and the insurance company. If the hospital is out of the primary hospital list, the stay could be more expensive.
3. Write a birth plan. The birth plan is not reserved for vaginal delivery. Mom needs to plan out how she wants to handle the pain after surgery and the care of other children and pets. It is also important to plan out the days after returning home as mom will not be able to move around as much after a C-Section as she would if the baby were born vaginally.
4. Pack the hospital bag. The hospital bag will contain much of the same things for the C-section delivery as the vaginal delivery. The only difference is that the baby may be discharged before mom as mom's length of stay may be five days. The bag will need to carry additional changes of clothes and clothes that are incision friendly.
5. Spinal versus epidural. There are three forms of anesthesia used for a C-section. General anesthesia is often reserved for problem births and is not one of the two most common choices. The spinal and the epidural are the two most common. The spinal is a block anesthesia that works in minutes. The mother will not be able to feel from the waist down and will not be able to move those areas either. The spinal takes far longer to wear off than the epidural. Being a block anesthesia, it is given as one dose. The epidural is a catheter placed in the spinal cord that administers a constant flow of pain medication. After birth, the catheter is removed and the pain medication wears off. The epidural takes up to 1 1/2 hours to reach full effectiveness.
6. Discuss pain management. After the C-section, which is major abdominal surgery, there will often be pain medications prescribed. If mom has chosen to breastfeed, the obstetrician will prescribe a pain medication that is safe for the baby. Otherwise, the pain medication options will be determined by how much pain mom is feeling. Immediately after the surgery, the nurse will often offer the mother a shot of pain medication in the leg. This medication can cause numbness in the area of injection after administration.
7. Get help from friends and family. After birth, mom will not be able to cook, clean or move around as much as someone who gave birth via vaginal delivery. Friends and family members can help out by cooking and cleaning for the first week or so. It is important to notice mom during home visits and not just baby.
8. Set up care for other children and pets. Sometimes it is easier to care for the new baby in a home without other trials and struggles for the first few days. If there are pets in the home or other children, arranging care for a bit of time after birth can give mom some time to get used to being a new mom.
9. Will your partner be there? While a C-section is major surgery, the partner is often allowed to be in the room when the baby is born. This will need to be approved by the obstetrician and anesthesiologist and also the partner, of course. If there is any doubt that the partner will be able to handle the blood and surgical reality of the situation, they may need to stay in the waiting room.
10. Breastfeeding versus bottle feeding. The mother giving birth vaginally often has the opportunity to breastfeed or bottle-feed immediately after birth. This is becoming more common with C-section births as well. If mom wants to feed immediately after birth, the obstetrician will need to be in on that decision and the state of the baby at birth will need to be assessed before feeding.
11. Holding baby after birth. The C-section is a big deal to the doctors on hand. Sometimes, in a rush to care for the baby, the mother is not given the chance to hold the child. It is important to begin the bond as soon as possible between mom and baby. Some women report feeling less like a mother after a C-section due to the lack of labor. An immediate, close connection can help to ease this stress.
12. Take care of mom. After the C-section it is important for mom to take care of her body. The risk of infection is higher, the chance of wound dehiscence is higher and the pain and fatigue levels are higher after the C-section. The abdominal birth is not the same as the vaginal birth and no two C-sections are the same.