Cesarean  -- delivering a baby surgically  -- has become the dirty word of childbirth, but it's important to remember that cesareans are done to protect you and your baby. Some even save lives. No woman wants to envision her baby's birth on an operating table, but you needn't feel like a failure if that happens. With one in five births today being a cesarean, it's important that you understand what to expect.

When
The usual guidelines for performing an emergency cesarean include signs of fetal distress; a baby who won't fit through the birth canal; an umbilical cord wrapped around the baby's neck or dropping through the cervix (either of which may cut off the baby's oxygen supply); or labor that's failing to progress, even with Pitocin. In other circumstances, your doctor may feel the need to schedule a cesarean before you go into labor. These include cases of maternal illness, such as preeclampsia, diabetes, or an active herpes infection; when the baby is in a breech (feet or buttocks first) or transverse (sideways) position; and when the placenta is blocking the cervix (placenta previa) or beginning to tear away from the uterine wall (placental abruption).

In the past, once a woman had one cesarean, she'd be expected to deliver all of her children that way. That thinking is changing. Vaginal birth after cesarean (VBAC) is now an option for some women. While it poses less risk and offers a faster recovery than a surgical birth does, concerns have been raised about the safety of a VBAC when labor is induced. Talk to your doctor about whether you should try for a vaginal delivery if you previously delivered by c-section.

How
Cesareans are usually performed with epidural anesthesia. In such a case, you'll be awake and your partner will probably be able to stay with you. In an emergency, however, you may require general anesthesia, leaving you unconscious and your partner in the waiting room. In preparation, you may need to have your abdomen shaved, a catheter inserted in your urethra to drain your bladder and an IV line put into your arm to administer fluids. Your doctor will make two incisions, the first in your skin, the second in the wall of your uterus. The baby will then be pulled out, followed by the placenta. The procedure often takes less than 15 minutes.

What's next
Recovery is more difficult when you've had a cesarean. After all, it's a major surgery. In addition to bleeding and discharge, constipation, fatigue, and hormonal shifts, you can expect incision pain, severe gas pain (walking around often helps), and possible anemia due to the additional blood loss, which can exacerbate your exhaustion. Prescription pain medication for the first week and ibuprofen after that can help. Talk to your doctor about which medications are safe while nursing.

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