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When a Cesarean Is the Only Option

For some women, vaginal birth is just not possible due to the risks to the mother and baby. The most common conditions during pregnancy that require cesarean delivery include placenta previaplacenta accreta, previous major surgery of the uterus, and high-order multiples (three or more babies). While the need for a cesarean initially may be disappointing to an expectant mother, planning for the delivery can make the experience more positive.

In today’s blog post, obstetrician Dr. Daniela Carusi, Director of Surgical Obstetrics at Brigham and Women’s Hospital (BWH), offers valuable information and helpful advice for women who are preparing for the birth of a baby by cesarean section (C-section).

Timing is key.

In cases with high risk of bleeding or uterine rupture with contractions, the cesarean is typically scheduled several weeks before the due date. This is to minimize the risk that the mother will go into labor before the scheduled cesarean.

Childbirth classes are still important.

Childbirth classes that specialize in cesarean delivery are available. They outline care guidelines for mothers and baby care tips and techniques for use during the days and weeks following cesarean delivery.

Consider a family-centered cesarean.

Also called the gentle C-section, the family-centered cesarean includes the use of clear draping for the mom to view the delivery and assists the parents with skin-to-skin contact with the baby in the operating room. Midwives and doulas may be present to provide support for the mother and family and facilitate the family-centered cesarean.

Moms need support in the weeks following cesarean delivery.

After the cesarean, mothers typically stay in the hospital for four nights before going home. They should not drive for two weeks and should not lift more than 10-15 pounds for four weeks after delivery. This can be a challenge, especially for moms with toddlers at home. Extended paternal leave or having another family member on hand can be a great asset to moms in the month following cesarean delivery.

Plan ahead for high-risk pregnancies and complex deliveries.

Women with a history of extensive surgery or high-risk conditions (such as placenta accreta) should consider a tertiary care center for prenatal care and delivery and discuss this with their primary provider. These centers are staffed by specialists and subspecialists who collaborate to provide expert care during pregnancy and delivery and have access to advanced technology for complex surgical procedures. BWH, for example, is home to one of few hybrid operating rooms in the New England region, which can be needed in certain complicated deliveries, including accreta.