A Cesarean section (C-section) is surgery to deliver a baby. The baby is taken out through your abdomen (belly). In the United States, almost one in three babies are born this way. Some C-sections are planned. Others are emergency C-sections, which are done when unexpected problems happen during delivery.

When is a Cesarean section (C-section) needed?

You may need a C-section because:

• You have health problems, including infection
• You are carrying more than one baby
• Your baby is too big
• Your baby is in the wrong position
• Your baby's health is in danger
• Labor is not moving along as it should
• There are problems with your placenta (the organ that brings oxygen and nutrients to your baby)

Not everyone who has had a C-section before will need another one next time. You may be able to have a vaginal birth after Cesarean (VBAC). Talk to your health care provider about what is right for you.

A cesarean delivery, also called a C-section or cesarean birth, is the surgical delivery of a baby through a surgical cut or incision in a woman's abdomen and uterus. After the baby is removed from the womb, the uterus and abdomen are closed with stitches that later dissolve.

According to the U.S. Centers for Disease Control and Prevention, in 2015, 32% of births were by cesarean delivery—the lowest rate since 2007. Between 1996 and 2008, the number of cesarean deliveries increased by 72%.

Cesarean delivery, also called c-section, is surgery to deliver a baby. The baby is taken out through the mother's abdomen. Most cesarean births result in healthy babies and mothers. But c-section is major surgery and carries risks. Healing also takes longer than with vaginal birth.

Most healthy pregnant women with no risk factors for problems during labor or delivery have their babies vaginally. Still, the cesarean birth rate in the United States has risen greatly in recent decades. Today, nearly 1 in 3 women have babies by c-section in this country. The rate was 1 in 5 in 1995.

Public heath experts think that many c-sections are unnecessary. So it is important for pregnant women to get the facts about c-sections before they deliver. Women should find out what c-sections are, why they are performed, and the pros and cons of this surgery.

Reasons for c-sections

Your doctor might recommend a c-section if she or he thinks it is safer for you or your baby than vaginal birth. Some c-sections are planned. But most c-sections are done when unexpected problems happen during delivery. Even so, there are risks of delivering by c-section. Limited studies show that the benefits of having a c-section may outweigh the risks when:

• The mother is carrying more than one baby (twins, triplets, etc.)
• The mother has health problems including HIV infection, herpes infection, and heart disease
• The mother has dangerously high blood pressure
• The mother has problems with the shape of her pelvis
• There are problems with the placenta
• There are problems with the umbilical cord
• There are problems with the position of the baby, such as breech
• The baby shows signs of distress, such as a slowed heart rate
• The mother has had a previous c-section

Patient-requested c-section: Can a woman choose?

A growing number of women are asking their doctors for c-sections when there is no medical reason. Some women want a c-section because they fear the pain of childbirth. Others like the convenience of being able to decide when and how to deliver their baby. Still others fear the risks of vaginal delivery including tearing and sexual problems.

But is it safe and ethical for doctors to allow women to choose c-section? The answer is unclear. Only more research on both types of deliveries will provide the answer. In the meantime, many obstetricians feel it is their ethical obligation to talk women out of elective c-sections. Others believe that women should be able to choose a c-section if they understand the risks and benefits.

Experts who believe c-sections should only be performed for medical reasons point to the risks. These include infection, dangerous bleeding, blood transfusions, and blood clots. Babies born by c-section have more breathing problems right after birth. Women who have c-sections stay at the hospital for longer than women who have vaginal births. Plus, recovery from this surgery takes longer and is often more painful than that after a vaginal birth. C-sections also increase the risk of problems in future pregnancies. Women who have had c-sections have a higher risk of uterine rupture. If the uterus ruptures, the life of the baby and mother is in danger.

Supporters of elective c-sections say that this surgery may protect a woman's pelvic organs, reduces the risk of bowel and bladder problems, and is as safe for the baby as vaginal delivery.

The National Institutes of Health (NIH) and American College of Obstetricians (ACOG) agree that a doctor's decision to perform a c-section at the request of a patient should be made on a case-by-case basis and be consistent with ethical principles. ACOG states that "if the physician believes that (cesarean) delivery promotes the overall health and welfare of the woman and her fetus more than vaginal birth, he or she is ethically justified in performing" a c-section. Both organizations also say that c-section should never be scheduled before a pregnancy is 39 weeks, or the lungs are mature, unless there is medical need.

The c-section experience

Most c-sections are unplanned. So, learning about c-sections is important for all women who are pregnant. Whether a c-section is planned or comes up during labor, it can be a positive birth experience for many women. The overview that follows will help you to know what to expect during a nonemergency c-section and what questions to ask.

Before surgery

Cesarean delivery takes about 45 to 60 minutes. It takes place in an operating room. So if you were in a labor and delivery room, you will be moved to an operating room. Often, the mood of the operating room is unhurried and relaxed. A doctor will give you medicine through an epidural or spinal block, which will block the feeling of pain in part of your body but allow you to stay awake and alert. The spinal block works right away and completely numbs your body from the chest down. The epidural takes away pain, but you might be aware of some tugging or pushing. Medicine that makes you fall asleep and lose all awareness is usually only used in emergency situations. Your abdomen will be cleaned and prepped. You will have an IV for fluids and medicines. A nurse will insert a catheter to drain urine from your bladder. This is to protect the bladder from harm during surgery. Your heart rate, blood pressure, and breathing also will be monitored. Questions to ask:

• Can I have a support person with me during the operation?
• What are my options for blocking pain?
• Can I have music played during the surgery?
• Will I be able to watch the surgery if I want?

During surgery

The doctor will make two incisions. The first is about 6 inches long and goes through the skin, fat, and muscle. Most incisions are made side to side and low on the abdomen, called a bikini incision. Next, the doctor will make an incision to open the uterus. The opening is made just wide enough for the baby to fit through. One doctor will use a hand to support the baby while another doctor pushes the uterus to help push that baby out. Fluid will be suctioned out of your baby's mouth and nose. The doctor will hold up your baby for you to see. Once your baby is delivered, the umbilical cord is cut, and the placenta is removed. Then, the doctor cleans and stitches up the uterus and abdomen. The repair takes up most of the surgery time. Questions to ask:

• Can my partner cut the umbilical cord?
• What happens to my baby right after delivery?
• Can I hold and touch my baby during the surgery repair?
• When is it okay for me to try to breastfeed?
• When can my partner take pictures or video?

After surgery

You will be moved to a recovery room and monitored for a few hours. You might feel shaky, nauseated, and very sleepy. Later, you will be brought to a hospital room. When you and your baby are ready, you can hold, snuggle, and nurse your baby. Many people will be excited to see you. But don't accept too many visitors. Use your time in the hospital, usually about four days, to rest and bond with your baby. C-section is major surgery, and recovery takes about six weeks (not counting the fatigue of new motherhood). In the weeks ahead, you will need to focus on healing, getting as much rest as possible, and bonding with your baby — nothing else. Be careful about taking on too much and accept help as needed. Questions to ask:

• Can my baby be brought to me in the recovery room?
• What are the best positions for me to breastfeed?

Vaginal birth after c-section (VBAC)?

Some women who have delivered previous babies by c-section would like to have their next baby vaginally. This is called vaginal delivery after c-section or VBAC. Women give many reasons for wanting a VBAC. Some want to avoid the risks and long recovery of surgery. Others want to experience vaginal delivery.

Today, VBAC is a reasonable and safe choice for most women with prior cesarean delivery, including some women who have had more than one cesarean delivery. Moreover, emerging evidence suggests that multiple c-sections can cause serious harm. If you are interested in trying VBAC, ask your doctor if you are a good candidate. A key factor in this decision is the type of incision made to your uterus with previous c-sections.

Your doctor can explain the risks of both repeat cesarean delivery and VBAC. With VBAC, the most serious danger is the chance that the c-section scar on the uterus will open up during labor and delivery. This is called uterine rupture. Although very rare, uterine rupture is very dangerous for the mother and baby. Less than 1 percent of VBACs lead to uterine rupture. But doctors cannot predict if uterine rupture is likely to occur in a woman. This risk, albeit very small, is unacceptable to some women.

The percent of VBACs is dropping in the United States for many reasons. Some doctors, hospitals, and patients have concerns about the safety of VBAC. Some hospitals and doctors are unwilling to do VBACs because of fear of lawsuits and insurance or staffing expenses. Many doctors, however, question if this trend is in the best interest of women's health.

Choosing to try a VBAC is complex. If you are interested in a VBAC, talk to your doctor and read up on the subject. Only you and your doctor can decide what is best for you. VBACs and planned c-sections both have their benefits and risks. Learn the pros and cons and be aware of possible problems before you make your choice.

Cesarean delivery may be necessary in the following circumstances:

• Labor is not progressing. Contractions may not open the cervix enough for the baby to move into the vagina for delivery.
• The infant's health is in danger. The umbilical cord, which connects the fetus to the uterus, may become pinched, or the fetus may have an abnormal heart rate. In these cases, a cesarean delivery allows the baby to be delivered quickly to address and resolve the baby's health problems.
• The baby is in the wrong position. Most often when this occurs, the baby is breech, or in a breech presentation, meaning that the baby is coming out feet first instead of head first. The baby may also be in a transverse (sideways) or oblique (diagonal) position.
• The pregnant woman is delivering two or more fetuses (multiple pregnancy). A cesarean delivery may be needed if labor has started too early (preterm labor), if the fetuses are not in good positions within the uterus for natural delivery, or if there are other problems.
• The baby is too large. Larger infants are at risk for complications during delivery. These include shoulder dystocia (pronounced dis-TO-she-ah), when the infant's head is delivered through the vagina but the shoulders are stuck. Women with gestational diabetes, especially if their blood sugar levels are not well controlled, are at increased risk for having large babies.
• The placenta has problems. Sometimes the placenta is not formed or working correctly, is in the wrong place in the uterus, or is implanted too deeply or firmly in the uterine wall. These issues can cause problems, such as preventing needed oxygen and nutrients from reaching the fetus or causing vaginal bleeding.
• The mother has an infection, such as HIV or herpes, that could be passed to the baby during vaginal birth. Cesarean delivery could help prevent transmission of the virus to the infant.
• The mother has a specific medical condition. A cesarean delivery enables the health care provider to better manage the mother's health issues.

Women who have a cesarean delivery may be given pain medication with an epidural block, a spinal block, or general anesthesia. An epidural block numbs the lower part of the body through an injection in the spine. A spinal block also numbs the lower part of the body, but through an injection directly into the spinal fluid. Women who receive general anesthesia, often used for emergency cesarean deliveries, will not be awake during the surgery.

Cesarean delivery is a type of surgery, so it has risks and possible complications for both mother and baby.

Possible risks from a cesarean delivery include:

• Infection
• Blood loss
• Blood clots in the legs, pelvic organs, or lungs
• Injury to surrounding structures, such as the bowel or bladder
• Reaction to medication or anesthesia used

It is important to note that these risks also apply, to some degree, to vaginal birth.

A woman who has a cesarean delivery may also have to stay in the hospital longer than a woman who has had a vaginal delivery.

The more cesarean deliveries a woman has, the greater her risk of certain medical problems and problems with future pregnancies, such as uterine rupture and problems with the placenta.

There are several different types of anesthesia:

• Local anesthesia numbs a small part of the body. It might be used on a tooth that needs to be pulled or on a small area around a wound that needs stitches. You are awake and alert during local anesthesia.
• Regional anesthesia is used for larger areas of the body such as an arm, a leg, or everything below the waist. You may be awake during the procedure, or you may be given sedation. Regional anesthesia may be used during childbirth, a Cesarean section(C-section), or minor surgeries.
• General anesthesia affects the whole body. It makes you unconscious and unable to move. It is used during major surgeries, such as heart surgery, brain surgery, back surgery, and organ transplants.

Some women may want to have a cesarean birth even if vaginal delivery is an option. Women should discuss their options in detail with their health care provider before making a decision about a type of delivery. The decision should consider the impact of the delivery not only on the current pregnancy but also on future pregnancies. The safest method of delivery for both the mother and the fetus is an uncomplicated vaginal delivery.

Regardless of the type of delivery, unless there is a medical necessity, delivery should not occur before 39 weeks of pregnancy (called "full term"). Watch this video to learn why it is important for the mother's and infant's health to wait until at least 39 weeks to deliver unless there is a medical reason to do so earlier.

VBAC refers to vaginal delivery of a baby after a previous pregnancy was delivered by cesarean delivery.

In the past, pregnant women who had one cesarean delivery would automatically have another. But research shows that, for many women who had prior cesarean deliveries, attempting to give birth vaginally—called a trial of labor after cesarean delivery (TOLAC)—and VBAC might be safe options in certain situations.

In fact, NICHD research shows that among appropriate candidates, about 75% of VBAC attempts are successful. A 2010 NIH Consensus Development Conference on VBAC evaluated available data and determined that VBAC was a reasonable option for many women.

Women should discuss VBAC and TOLAC with their health care providers early in pregnancy to learn whether these options are appropriate for them. Providers are encouraged to discuss plans for VBAC or refer women to a facility that can support VBAC when it is medically safe to consider.

When is VBAC appropriate?

VBAC may be safe and appropriate for some women, including those:

• Whose prior cesarean incision was across the uterus toward its base (called a low-transverse incision)—the most common type of incision. Note that the incision on the uterus is different than the incision on the skin.
• With two previous low-transverse cesarean incisions
• Who are carrying twins
• With an unknown type of uterine incision

Benefits of VBAC include:

• No abdominal surgery
• A lower risk of hemorrhage and infection compared with a C-section
• Faster recovery
• Potential to avoid the risks of many cesarean deliveries, such as hysterectomy, bowel and bladder injury, blood transfusion, infection, and abnormal placenta conditions
• Greater likelihood of being able to have more children in the future

If labor fails to progress or if there is another problem, a woman may need a C-section after trying TOLAC. Most risks associated with C-section after TOLAC are similar to those associated with choosing a repeat cesarean. They include:

• Uterine rupture
• Maternal hemorrhage and infection
• Blood clots
• Need for a hysterectomy

We tend to think of pregnancy as lasting for 9 months. But ideally it should last for nearly 10 months. Research shows that babies are born healthier if they have at least 39 weeks to grow in the womb.

In recent years, there’s been a trend toward earlier deliveries, as more women are choosing the date they’ll give birth. This is known as an elective delivery. Studies suggest that the number of elective deliveries rose dramatically from 1990 to the mid-2000s.

If there’s a particular medical reason to deliver early, then it’s best not to wait, says Dr. Catherine Spong, a pregnancy expert at NIH. “But if the mother and baby are healthy, there’s no benefit to delivering the baby early,” she says. In fact, delivering early can create lasting health problems. Even women of advanced maternal age, older than 35, should wait until at least 39 weeks unless there are medical reasons to deliver early.

“We’ve gotten to the point where people feel they can choose the timing of their delivery,” says Spong. “But in reality, that baby, in the last 4 weeks of pregnancy, is doing a huge amount of developing.”

Those last few weeks can make a big difference. At 39 to 40 weeks of pregnancy, a baby’s brain weighs one-third more than it does at 35 weeks. The lungs and liver also continue to develop up to 39 weeks. And those last few weeks allow time for layers of fat to grow under the baby’s skin, which helps keep the infant warm after birth.

Studies have found a greater risk of serious medical complications—such as dangerous bloodstream infections and breathing and feeding problems—in babies born before 39 weeks of gestation. “While there are risks to every pregnancy, the risks to the baby are higher if all organs are not completely developed,” Spong says.

One NIH-funded study looked at more than 13,000 women who gave birth by elective cesarean delivery (C-section) at 37 weeks or later. The babies delivered at 37 weeks were twice as likely as those born at 39 weeks to have complications—such as difficulty breathing, heart problems and seizures—that usually require time in a neonatal intensive care unit.

Moms who choose to give birth early may also face their own health challenges. They have a greater chance of postpartum (after childbirth) depression; stronger, more frequent contractions during labor; and an increased chance of needing a C-section. Women who have a C-section have a greater risk of infection and a longer recovery time than women who’ve had a vaginal birth.

“Know the true due date of pregnancy and get prenatal care early,” Spong advises.

A woman’s body will go into labor when the baby is ready to enter the world, she says. “By letting that baby get born at term, you’re improving the lifelong health of that baby.”

For a Healthy Pregnancy

• See your health care provider for regular prenatal care.
• Talk to your doctor about the medicines you take. Some may not be safe during pregnancy.
• Follow a healthy diet.
• Take folic acid—at least 400 micrograms each day.
• Stay active. Ask your health care provider about physical activity that’s safe for you.
• Avoid drinking alcohol and smoking.
• Control any existing conditions such as diabetes.
• If there are no medical reasons to deliver early, wait until at least 39 weeks for delivery.