A cesarean section, commonly called a C-section, is a surgical procedure used to deliver a baby through incisions in the abdomen and uterus rather than through the birth canal. In the United States, about 32.3% of all deliveries are cesareans, making it one of the most frequently performed surgeries in the country. Some are planned weeks in advance for known medical reasons, while others happen during labor when complications arise.
Why a Cesarean Is Performed
Cesareans fall into two broad categories: planned and unplanned. A planned cesarean is typically scheduled when a known condition makes vaginal delivery risky. Common reasons include the baby being in a breech (feet-first) position, the placenta covering the cervix, carrying multiple babies, or having had a previous cesarean. Being over 35 or having gestational diabetes also increases the likelihood of a planned cesarean.
Unplanned cesareans happen during labor itself. The most common trigger is an abnormal fetal heart rate, where a heart rate that is too high or too low signals the baby is in distress. Another frequent reason is labor that stalls: the cervix may stop dilating before reaching the full 10 centimeters, or the baby simply won’t move down the birth canal despite sustained pushing. In these situations, the surgical team may need to act quickly.
What Happens During the Surgery
Most cesareans are performed under 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 to place a regional block.
The surgery involves two separate incisions: one through the skin and abdominal wall, and a second through the uterus. The skin incision is most commonly a horizontal cut low on the abdomen, near the pubic hairline. A vertical cut running from below the belly button to above the pubic bone is less common and typically reserved for specific situations. The uterine incision is also usually horizontal across the lower, thinner part of the uterus. This type of uterine cut, called a low transverse incision, heals more reliably and carries the lowest risk of complications in future pregnancies.
Once the uterus is opened, the baby is delivered, the umbilical cord is clamped and cut, and the placenta is removed. The surgical team then closes the uterus with dissolvable stitches and works back through each tissue layer, checking for bleeding at every step before closing the skin. The entire procedure typically takes under an hour, though the baby usually arrives within the first several minutes.
Types of Uterine Incisions and Why They Matter
The type of cut made on your uterus, not the one on your skin, is what matters most for future pregnancies. A low transverse (side-to-side) incision on the lower uterus is the standard and carries the least chance of the uterus rupturing in a later pregnancy. A low vertical incision, made up and down on the lower uterus, carries a somewhat higher rupture risk. A high vertical incision, sometimes called a “classical” incision, cuts into the thicker upper portion of the uterus and has the highest rupture risk. This type is occasionally necessary for very early preterm deliveries.
Your surgical record will note which uterine incision was used, and this information becomes critical if you consider vaginal delivery in a future pregnancy.
Risks and Complications
A cesarean is major abdominal surgery, and it carries higher short-term and long-term risks for both parent and baby compared to vaginal birth. Immediate risks include infection at the incision site, excessive bleeding, blood clots, and reactions to anesthesia. Injury to surrounding organs like the bladder can occur, though it’s uncommon.
For the baby, cesarean delivery can occasionally cause breathing difficulties in the first hours after birth, since the squeezing action of moving through the birth canal helps clear fluid from a newborn’s lungs. Long-term, each cesarean creates scar tissue on the uterus, which can complicate future pregnancies by increasing the risk of abnormal placenta placement and uterine rupture. A previous cesarean is itself one of the strongest predictors of needing another one.
Recovery Timeline
Full recovery from a cesarean takes about six weeks, though individual timelines vary. Most people spend two to four days in the hospital, where staff help manage pain, monitor the incision, and encourage early movement.
The first week at home is the hardest. You’ll need to avoid lifting anything heavier than your baby, twisting, or any motion that strains the incision. Over-the-counter pain relievers on a regular schedule help manage discomfort, and a wide compression belt worn around the abdomen can take pressure off the stitches. Vaginal bleeding is normal after a cesarean and can last four to six weeks. The first few days are the heaviest, with blood clots potentially as large as a golf ball. Walking around regularly, even short distances, is important for preventing blood clots in the legs.
During weeks two through five, you’ll typically have a checkup where your doctor inspects the incision and confirms healing is on track. By week six, most people have a final postpartum appointment. If pain has decreased and the incision looks good, you’ll generally be cleared to gradually resume exercise, sex, and normal daily activities.
Vaginal Birth After a Cesarean
Having one cesarean doesn’t automatically mean every future delivery must be surgical. Vaginal birth after cesarean, known as VBAC, is an option for many people, particularly those whose previous cesarean used a low transverse uterine incision. If your prior incision was a high vertical cut, VBAC is generally not recommended because the rupture risk is too high.
VBAC needs to take place in a hospital equipped to handle emergencies, including the ability to perform an urgent cesarean within minutes if the uterus begins to tear. Not all hospitals offer VBAC for this reason. Certain factors can reduce the chances of a successful vaginal delivery, such as needing labor to be induced with medication. Your obstetric team can help you weigh the risks and benefits based on your specific surgical history and current pregnancy.
Reducing Unnecessary Cesareans
Medical organizations are actively working to lower cesarean rates for first-time parents carrying a single baby in a head-down position at full term. The current U.S. cesarean rate for this specific group is about 25.6%, and the national goal is to bring it down to 23.6% by 2030. The focus is on better labor support, evidence-based management of slow labor progress, and ensuring patients are fully involved in decisions about interventions like labor induction. The aim isn’t to eliminate cesareans, which remain lifesaving when genuinely needed, but to ensure that each one is performed for a clear medical reason.