A cesarean section takes about 45 minutes from start to finish, but your baby is typically delivered within the first 10 minutes. The rest of the time is spent closing the incision. Here’s what happens at each stage, from the moment you arrive in the operating room to when you’re wheeled into recovery.
Preparation Before the First Cut
Once you’re in the operating room, the team moves through several steps quickly. A nurse starts an IV line in your arm and begins fluids, which help maintain your blood pressure during anesthesia. The surgical site on your abdomen is shaved if needed, then cleaned with antiseptic. A urinary catheter is inserted to keep your bladder empty during surgery, which gives the surgeon more room to work and reduces the risk of bladder injury. You’ll be positioned on the operating table, often tilted slightly to one side to keep your uterus from pressing on major blood vessels.
A drape is raised at your chest level so you can’t see the surgical field. Your support person is usually seated near your head on the same side of the drape. The whole prep process generally takes 15 to 20 minutes before the surgeon begins.
How the Anesthesia Works
Most C-sections use regional anesthesia, meaning you’re awake but numb from roughly the chest down. The two main types are spinal and epidural. A spinal involves a fine needle placed into the fluid-filled space around your spinal nerves in your lower back. It works fast, and surgery can begin about 8 minutes sooner than with an epidural. An epidural uses a slightly larger needle that stops just outside that space, and a thin catheter is threaded through so medication can be delivered continuously. It requires about ten times the volume of anesthetic to achieve the same level of numbness.
If you already have an epidural from labor, your anesthesiologist can increase the dose through that same catheter. General anesthesia, where you’re fully asleep, is reserved for true emergencies when there isn’t time for a spinal or when regional anesthesia isn’t possible.
Before surgery starts, the anesthesiologist tests your numbness, often with a cold sensation or a light pinch, working up from your legs toward your chest. Surgery won’t begin until the team confirms you can’t feel sharp pain in the surgical area.
What You Feel Without Feeling Pain
Regional anesthesia blocks pain, but it doesn’t block all sensation. A qualitative study on surgical sensation during cesarean sections found that patients commonly experienced pressure and movement at varying intensities, though most did not experience pain. You may feel tugging, pulling, or a sense of rummaging around in your abdomen. Some people describe it as someone doing dishes inside them. Environmental factors like sounds in the room and the distraction of hearing your baby cry also shape how you perceive these sensations.
Many patients say that knowing what to expect ahead of time made the sensations less alarming. If at any point the pressure becomes uncomfortable or shifts toward pain, your anesthesiologist is right beside you and can adjust your medication in real time.
The Skin Incision
The surgeon typically makes a horizontal incision low on your abdomen, just above the pubic hairline. This is called a Pfannenstiel incision, and it’s used in the vast majority of C-sections because it heals well and leaves a scar that’s easy to conceal. A vertical incision running from the navel downward is less common and usually reserved for specific situations, such as very preterm deliveries or certain emergencies where the surgeon needs more room quickly.
After the skin, the surgeon works through several layers: the fat beneath the skin, the tough connective tissue (fascia) that holds the abdominal muscles together, and the muscles themselves, which are usually separated rather than cut. The lining of the abdominal cavity is then opened, and the bladder is gently moved down and out of the way to expose the lower part of the uterus.
Opening the Uterus and Delivering the Baby
The surgeon makes an incision in the uterus, most often a low horizontal cut across the thinner lower segment. This part of the uterus heals more reliably than the thicker upper portion and is one reason many people can attempt vaginal birth in a future pregnancy. The incision is often started with a scalpel, then widened by stretching it with the surgeon’s fingers rather than cutting further, which causes less bleeding.
For a baby in the typical head-down position, the surgeon slides a hand into the uterus to cradle the baby’s head and lift it up into the opening. An assistant then applies gentle pressure on the top of the uterus from outside the abdomen to help guide the baby out. The average time from the first skin incision to delivery is about 9.5 minutes. For a baby in breech position (feet or bottom first), the surgeon reaches in to locate and gently grasp the feet or hips and guide the baby through the incision.
This is the moment when most people feel the most intense pressure and pulling. It passes quickly, and within seconds you typically hear your baby cry.
What Happens With Your Baby Right Away
The umbilical cord is clamped and cut. In many hospitals, delayed cord clamping (waiting 30 to 60 seconds) is now standard even during cesarean births, as it allows more blood to transfer to the baby. Your baby is handed to a neonatal team standing by in the operating room. They dry the baby, assess breathing and muscle tone, and assign Apgar scores at one and five minutes after birth. These scores rate heart rate, breathing effort, muscle tone, reflexes, and skin color on a simple 0 to 10 scale.
If your baby is doing well, many hospitals now offer skin-to-skin contact right there on your chest while the surgical team finishes closing. Your support person can often hold the baby near your face if skin-to-skin isn’t immediately possible. The placenta is delivered shortly after the baby, either by gentle traction on the cord or by the surgeon reaching in to detach and remove it.
Closing the Incision
Closing takes longer than opening, typically about 30 to 35 minutes of the total 45-minute procedure. The surgeon works from the inside out, starting with the uterus. The uterine incision can be closed in one or two layers of dissolvable stitches. Single-layer closure is faster and associated with less blood loss, though some surgeons prefer double-layer closure for its potential benefits in future pregnancies.
Next comes the fascia, the strong connective tissue layer over the abdominal muscles. This layer gives the entire wound its strength and is sutured carefully. If there’s at least 2 centimeters of fat beneath the skin, closing that layer separately with a few stitches helps reduce the chance of wound complications. Finally, the skin itself is closed. The most common method is a subcuticular stitch, a running stitch placed just below the skin surface using absorbable thread, so there’s nothing to remove later. Some surgeons use staples instead, which are removed a few days after surgery. In the UK, about three-quarters of cesarean skin closures use the subcuticular stitch technique, and similar patterns hold in the US.
Recovery in the First Hours
After the drape comes down and your incision is bandaged, you’re moved to a recovery area. Nurses monitor your heart rate, blood pressure, oxygen levels, and breathing rate continuously. They check your incision site for bleeding and press on your abdomen periodically to make sure your uterus is firming up, which helps control bleeding. The catheter typically stays in for several hours until you’re able to get up.
Feeling gradually returns to your legs over one to three hours, starting as tingling and progressing to full sensation. You may feel shaky or nauseated as the anesthesia wears off, both of which are normal. Pain medication is given before the numbness fully fades so you’re not hit with sudden discomfort. Many people are able to breastfeed and hold their baby during this recovery period.
Most people spend two to four days in the hospital after a C-section. You’ll be encouraged to get up and walk within 12 to 24 hours, which helps prevent blood clots and gets your digestive system moving again. Full recovery from the surgery itself takes about six weeks, though many people feel significantly better well before that.