A cesarean section, commonly called a C-section, is a surgical delivery in which a baby is born through incisions in the mother’s abdomen and uterus rather than through the birth canal. It is the most common major surgery performed in the United States, accounting for 32.4% of all births in 2024. Some C-sections are planned weeks in advance, while others happen during labor when complications arise.
Why C-Sections Are Performed
C-sections fall into two broad categories: planned (scheduled before labor begins) and unplanned (decided during labor). The reasons differ for each.
Planned C-sections are typically scheduled when a known condition makes vaginal delivery risky. Common reasons include carrying multiples, a baby in breech position (feet-first), or a placenta that covers the cervix and blocks the birth canal. Women who have had previous C-sections may also schedule a repeat procedure.
Unplanned C-sections happen when something changes during labor. The most common trigger is an abnormal fetal heart rate, where a heart rate that’s too high or too low signals the baby is in distress and needs to be delivered quickly. Another frequent reason is labor stalling: the cervix stops dilating before reaching the full 10 centimeters needed for delivery. In other cases, the baby simply won’t descend through the birth canal despite active pushing.
What Happens During the Surgery
Most C-sections use regional anesthesia, either a spinal block or an epidural, which numbs you from the chest down while you stay awake. General anesthesia, where you’re fully asleep, is reserved for emergencies when there isn’t time for a regional block or when regional anesthesia isn’t medically safe.
Once anesthesia takes effect, the surgeon works through several layers of tissue. The incision is usually horizontal, just above the pubic hairline. After cutting through the skin and the fatty tissue beneath it, the surgeon opens the tough connective tissue covering the abdominal muscles, then separates the muscles themselves (they’re pulled apart rather than cut). Next comes the membrane lining the abdominal cavity, giving the surgeon access to the uterus.
The uterus has three layers of its own: an outer coating, a thick muscular wall, and an inner lining. All three are incised. If the amniotic sac hasn’t already ruptured, the surgeon breaks it at this point. The baby is then delivered through the opening, the umbilical cord is clamped and cut, and the placenta is removed. The entire incision is closed layer by layer with stitches or staples. From the first incision to the moment the baby is out, the process typically takes only a few minutes, though closing everything up afterward takes longer.
Recovery in the First Six Weeks
Most women leave the hospital one to two days after a C-section. The first few days involve the most discomfort around the incision site, and for some women, pain can linger for several weeks. If non-dissolvable stitches or staples were used, they’re usually removed five to seven days after surgery.
Recovery is gradual. In the early weeks, you’ll be advised not to lift anything heavier than your baby. Activities like driving, exercise, and sex are typically off the table until they no longer cause discomfort, which for many women takes around six weeks. A postnatal checkup at the six-week mark is standard to assess how you’re healing.
Walking soon after surgery, even short distances in the hospital hallway, helps with recovery by improving circulation and reducing the risk of blood clots. That said, a C-section is major abdominal surgery, and pushing yourself too hard too early can slow healing.
Risks for the Mother
Like any surgery, a C-section carries risks. The most common complication is blood loss. In a Spanish national survey of complicated cesarean cases, about half involved blood loss between 500 and 1,000 milliliters, while 35% involved heavier bleeding between 1,000 and 1,500 milliliters. Roughly 6% experienced extreme blood loss above 1,500 milliliters.
Infection is another concern. Surgical wound infections occur in fewer than 3% of cases according to the majority of surveyed clinicians, and uterine infections (endometritis) are reported at under 1% in most settings. Blood clots in the legs or lungs are a less common but serious risk, which is why hospitals encourage early movement after surgery.
How C-Sections Affect the Baby
Babies born by C-section skip the physical compression of passing through the birth canal, which plays a role in squeezing fluid out of the lungs. As a result, C-section babies have a higher rate of temporary breathing difficulties. The most common is a condition sometimes called “wet lung,” where fluid clears from the lungs more slowly than normal, causing rapid breathing in the first hours or days of life. Most cases resolve on their own, but some babies need supplemental oxygen or a stay in the neonatal intensive care unit.
One study found that 6.2% of babies delivered by planned repeat C-section developed respiratory distress, compared to 3.3% of babies born vaginally. NICU admissions followed a similar pattern: 11.1% versus 7.5%. On the other hand, C-sections reduce the risk of birth injuries, oxygen deprivation during a prolonged labor, and certain other delivery complications. The tradeoff depends entirely on the individual medical situation.
Future Pregnancies After a C-Section
A C-section doesn’t necessarily mean all future deliveries must be surgical. Vaginal birth after cesarean (VBAC) succeeds about 74% of the time among women who attempt it. Not everyone is a candidate, though. Factors like the type of uterine incision, the reason for the first C-section, and the number of previous cesareans all influence whether a VBAC is a safe option.
Each additional C-section increases the risk of specific complications in a dose-response pattern, meaning the more you have, the higher the risks climb. The rate of placenta previa, where the placenta attaches over the cervix, rises with each cesarean. A more serious condition called placenta accreta, where the placenta grows too deeply into the uterine wall, becomes statistically significant after two or more prior C-sections. The odds of needing a hysterectomy also increase with each repeat surgery, with women who’ve had three or more C-sections facing the steepest increase in risk.
For women considering future pregnancies, the number of C-sections they may ultimately need is worth discussing early. A single C-section carries relatively modest long-term implications, but the cumulative effect of multiple surgeries on the same uterine scar tissue is a meaningful factor in family planning decisions.