What does a C-section involve?

If the decision to have a C-section is made before contractions start, it's referred to as a scheduled (or “elective”) C-section. An appointment is then made for shortly after the 39^th week of pregnancy, which is about one week before the due date.

If the decision to have a C-section is made during vaginal birth, it's referred to as an unscheduled C-section. The C-section is then usually performed within a few hours. There is often enough time to mentally prepare for the procedure with your support person.

If you or the baby are in immediate danger, an emergency C-section is performed right away. The baby is then typically delivered within 20 minutes.

Talking to your midwife or women who have already had a C-section can help to prepare. It is also good to have a few practical things taken care of before the birth, such as:

• Arranging for a post-natal midwife to regularly come and check on mother and child in the first couple of weeks after birth
• Planning for someone to help look after the child and manage household chores after leaving the hospital, for example the other parent taking time off work or going on parental leave
• Talking to your physician or midwife about how to deal with pain after the C-section and how much rest you will need in the first days and weeks afterwards

Some couples try to get a family room in the hospital. Your partner can then also stay there overnight and take care of the baby if you can't yet get up and hold the baby. The extra costs for the family room are usually not covered by statutory health insurance in Germany.

You are more likely to have a more positive birth experience if you can have a say in what happens. That is why it’s so important for your needs to be considered when planning. You can talk about any wishes or questions you have during a preparatory appointment at the hospital of your choice. Your support person can also be at that appointment.

You might want to talk about things like

• who will be with you during the C-section procedure,
• what you would like to keep calm before or during the procedure, such as music,
• whether the procedure should be carried out with a local or general anesthetic,
• whether the screen between your head and your abdomen can or should be lowered as of a certain point during the procedure,
• how the baby’s umbilical cord should be cut,
• whether the baby should be placed on your chest as soon as possible after the C-section, and
• whether you want to breastfeed after the C-section.

As with any other procedure, your physician is required to provide detailed information to you beforehand. That includes information about what happens during the C-section and any possible complications, as well as discussing the type of anesthetic.

You are admitted to the maternity ward on the agreed date. Before the procedure, you have to take off all clothing and jewelry and put on a surgical gown and perhaps also compression stockings. Your pubic hair is shaved. An intravenous needle is placed into a vein. The unborn baby’s heart rate is checked before the C-section. There is enough time to talk to your support person and prepare for the procedure together.

C-sections are usually performed under local anesthetic. That means only the lower half of your body is numbed so that the you don’t feel any pain. But you remain fully conscious. The main advantage of this over general anesthetic is You experience the birth and can then hold your baby more quickly. The baby is also more alert right after birth, meaning intensive monitoring is not as likely to be needed. General anesthetic is only an option in emergencies or if you specifically request it.

A spinal block is then typically used as the local anesthetic. After numbing the surrounding area, a needle is inserted into the subarachnoid space in the lumbar region of the spine, which is filled with spinal fluid. An anesthetic is then injected. You no longer feel any pain, but still feel pulling and pressing sensations. This type of anesthesia is very safe, but there can sometimes be temporary side effects such as headache, circulatory problems and nausea.

With unscheduled C-section deliveries, an epidural anesthetic may be an option if it has already been prepared to relieve pain during vaginal birth. With an epidural, medication is fed into the epidural space of the lumbar vertebra via a small tube ( catheter) to prevent pain signals from traveling from the spinal cord to the brain. If a C-section is needed at short notice, the epidural can be used as an anesthetic.

The anesthetic is started in the operating ward. Blood pressure and oxygen monitors are connected. You are then taken to the operating room. Physicians, nurses and the midwife are there during the procedure to take care of you. Your support person can normally also be there as well. They sit at the head of the operating table.

To prevent any unwanted movements in the event of complications, your wrists and legs may be loosely strapped down. A bladder catheter is placed in the urethra, but you won't feel that at all because of the anesthetic. A screen is placed at chest height and the abdomen is covered with sterile towels. The procedure then gets underway.

The doctor makes an incision just above the pubic bone and opens the first abdominal layer. They then stretch open the further layers of tissue with their hands. In some hospitals, the screen can then be lowered so that the parents can see their child being born.

The baby is then taken out of the womb through an incision. You will feel a lot of tugging, pressing and pulling, but no pain. It usually only takes a few minutes after the first incision for the baby to be delivered.

After the umbilical cord is cut, the baby is wrapped in a warm towel. Babies that are doing well can go right to their parents. The placenta is removed and the surgical wound is closed. This takes about another ten minutes. During that time, your support person can hold the baby in their arms or you can have the baby placed on your chest.

If you or the baby are in immediate danger during vaginal birth, an emergency C-section is performed right away. The baby is then usually delivered within 20 minutes. A general anesthetic is usually needed for that. If an epidural anesthetic has already been placed, it can sometimes be used for the anesthetic. But that isn’t always possible because the epidural takes a little longer to have an effect than general anesthetic. The exact circumstances will determine whether there's enough time to start a spinal block.

There usually isn’t enough time to prepare mentally for an emergency C-section. That can be very distressing. Because as important as the emergency C-section is to safely deliver the baby, the situation can often feel overwhelming. An emergency C-section can be a traumatic experience for some women. Physicians and midwifes can help with empathetic support and by talking to the mother afterwards. And they can arrange for further support and advice, even if the distress only develops a long time after the birth.

Close cuddling and skin contact directly after birth help the baby to feel safe and secure and to get used to the new situation. That promotes special bonding between parents and baby. It is normally also possible to quickly take hold of your baby and place them on your chest after a C-section. If you want to, you can already breastfeed the baby for the first time in the delivery room.

If you were given a general anesthetic or if the baby needs medical attention, it can take a little while until you are able to hold the baby for the first time. But you can make up for the time that is lost.

You are taken to the postnatal ward after the procedure. There you can eat and drink again just a few hours after the C-section. It is also possible to stand up, but that can often still be painful. The bladder catheter is taken out as soon as you can get to the toilet on your own again. You will be able to shower as soon as your circulation is stable. It is a good idea to cover the wound with a waterproof dressing in the first two days.

It can sometimes be more difficult to start breastfeeding after a C-section, if you have had general anesthetic or if the wound is very painful, for example. Midwives and lactation consultants can help you.

The surgical wound might still be painful for a few days, especially when you cough, get out of bed or walk. It can also be difficult to carry the baby. If needed, the you can take painkillers, even if you are breastfeeding. Medications are then chosen which don’t harm the baby.

Afterpains can also occur in the first hours and days after birth via C-section. They make sure that the womb returns to its original position.

Mother and baby stay in hospital for about three to six days after a C-section. You will often still be in pain in the first few days after returning home and will have a limited range of movement. That’s why help with everyday things is especially important.

The C-section wound heals within two weeks, and the stitches dissolve on their own. The scar might still feel numb or itch for quite a while. It can also take a few weeks or even months until you no longer feel the effects of the procedure.

You have a right to support from a midwife during the first twelve weeks after giving birth. They help with things like checking that the wound is healing and breastfeeding.

It is important to avoid heavy lifting in the first six weeks after the procedure so that the wound can heal properly. Like vaginal birth, you can start postnatal exercise courses after about six to eight weeks. These exercises focus especially on strengthening the pelvic floor and the abdominal and back muscles.

Regardless of the type of birth, all babies have several check-ups during the postpartum period. Things like fine and gross motor skills and awareness are checked. Blood tests are also carried out and ultrasound scans of the pelvis are done to check for deformities.

But the postpartum period is mainly there for the baby and parents to get to know each other and for the mother to recover from the stress of the birth.