Many patients wonder whether they'll need a cesarean. Sometimes your doctor knows the answer before labor even begins – if you have a placenta previa, for example, or if the baby is in a transverse lie (that is the baby is lying sideways within the uterus rather than head-down). But most of the time, neither you nor your doctor can know whether you'll need a cesarean until you see how your labor progresses and how your baby tolerates labor. 

A cesarean delivery is performed in an operating room under sterile conditions. The exact place on the women's abdomen where the incision is made depends on the reason she's having the cesarean. Most often, it is low, just above the pubic bone, in a transverse direction (perpendicular to the torso). This cut is known as a Pfannensteil incision or, more commonly, a bikini cut. Less often, the incision is vertical, along the midline of the abdomen. A cesarean delivery takes 30 – 90 minutes to perform. 

Anesthesia for a Cesarean Delivery
The most common forms of anesthesia used for cesarean deliveries are epidural and spinal. Both kinds of anesthesia numb you from mid-chest to toes but also allow you to remain awake so that you can experience the birth of your child. You may feel some tugging and pulling during the operation, but you do not feel pain. Sometimes the anesthesiologist injects a slow-release pain medication into the epidural or spinal catheter before removing it in order to prevent or greatly minimize pain after the operation. 

If the baby has to be delivered in an emergency and there's no time to place an epidural or spinal, general anesthesia may be needed. In that case, you are asleep during the cesarean and totally unaware of the procedure. Also, general anesthesia may be needed in some cases because of complications in pregnancy that make it unwise to place epidurals or spinals. 

Reasons for Elective Cesarean Delivery

• The baby is in an abnormal position (breech or transverse)
• Placenta previa
• You've had extensive prior surgery on the uterus, including previous cesarean deliveries or removal of uterine fibroids
• Delivery of twins, triplets, or more 

Reasons for Unplanned but Non-emergency Cesarean Delivery

• The baby is too large in relation to the women's pelvis to be delivered safely through the vagina – a condition known as cephalopelvic disproportion (CPD), or the position of the baby's head makes vaginal delivery unlikely
• Signs indicate that the baby is not tolerating labor
• Maternal conditions preclude safe vaginal delivery, such as severe cardiac disease Normal labor comes to a standstill

Reasons for Emergency Cesarean Delivery

• Bleeding is excessive
• The baby's umbilical cord pushes through the cervix when the membranes rupture (known as prolapsed cord)
• Prolonged slowing of the baby's heart rate

Recovery from a Cesarean Delivery
After the surgery is finished, you are taken to a recovery area, where you stay for a few hours, until the hospital staff can make sure your condition is stable. Often, you can see and hold your baby during this time. 

During the first day you have a cesarean, you will spend most of the time in bed.  After that, you will gradually increase your activity so you can build the strength you need to take care of yourself and the baby at home. The recovery time from a cesarean delivery is usually longer than from a vaginal delivery, because the procedure is a surgical one. Typically you stay in the hospital for 3-4 days, sometimes longer if complications arise.