Cesarean Section

An obstetrician can extract a baby by C-section in a matter of seconds. It’s an unexpectedly rapid and brutal surgery even when medically indicated and scheduled, like for this mother. She had the time to have an epidural line placed into her spinal canal so she could remain awake during the procedure. They checked by ultrasound the baby was head-down, laid the mom down gingerly, doused her abdomen in brown betadine cleaning solution, and draped her in blue. They invited in the husband, dressed in an absurd blue-scrub jumpsuit, and he stood on the other side of the drapes with the anesthesiologist to hold his wife’s hand during the surgery. He seemed anxious, but the mom seemed quite at ease lying on the table considering what was about to transpire.


“Ready?” The resident stood on the patient’s left, dressed in complete surgical garb, with cautery ready in his hand.

The attending stood on the patient’s right, dressed the same, with her hand hovering above the abdomen, holding the scalpel like a paintbrush. “Ready.”

She drew a curved ten centimeter incision across the lower abdomen. The skin split easily under its natural tension, and a few scalpel swipes carved through the gummy yellow fat underneath. The cautery followed the blade to burn shut any trickles of blood. From behind, a voice announced the time: “skin incision, 10:42.”

In synchrony, the two doctors yanked the skin and subcutaneous tissue to the side with astonishing force. If not counterbalanced, each could have easily pulled the mom off the table. “You may feel a bit of pressure down below,” the anesthesiologist reassured the mom. The mom nodded in response, unaware to the degree of violence below.

The attending and resident called for clamps and drew up the fascia, the tense sheet of fibrous tissue holding the abdominal contents inside, and split it swiftly with the blade. They yanked the fascia aside to stretch it out and then added the flaps to their handfuls of skin.

In plain sight were the mom’s pair of rectus abdominal muscles. The resident drew them up with his hands and used his fingers to separate them down the middle, and the pair of doctors tugged them aside.

With clamps, they drew up one more layer of tissue, the peritoneum, and cut and dissected that too.

Underneath, the gleaming muscular uterus, with the baby’s round skull bulging from within it. The resident introduced a broad instrument with a flat surface to hold the bladder down underneath bottom edge. With a metal retractor, he hooked the top edge and pried the two apart with all his might. Inside, with one delicate swipe of the scalpel, the attending split open the uterus. A tiny head and a tuft of hair appeared, then suddenly a of blood-tinged amniotic fluid gushed out, flooding into the draped bags around the incision. They shoved a suction tube in, but it couldn’t keep pace with the fluid. “Uterine incision, 10:43,” spoke a voice from behind.

Out came all the instruments, and in slid her hands. The attending took the baby’s skull with a strong grip and pulled and pulled. The resident shoved his hands firmly onto the mom’s upper abdomen and leaned in with his body weight, adding extra pressure to force the baby through the tight incision, Pop! Out came the face, and with guidance came the shoulders and then arms and chest and pelvis and legs and everything all at once.


Vaginally delivered babies often cry the instant they emerge, but C-section babies are taken out so abruptly that they don’t realize that they’ve been delivered already. These first silent seconds are filled with more gushes of fluid, many moving hands, and lots of equipment being passed around. The attending wraps it in a towel and the resident bulb-suctions the nose and mouth with amazing rapidity. With a few rubs of warm friction, the baby eventually registers that it’s time to cry. The first squeals emerge from the tiny little chest through its tiny little mouth. It’s a desperate and painful call, but it’s also one of the most wonderful sounds in the world.

“Congratulations, mom and dad! Time of birth, 10:44.” From the other side of the curtain, a muffled sigh of relief.

The dad’s bouffant-capped head peeks over the curtain with excitement. “It’s a girl! She’s all right!” he exclaims.

“Oh my goodness!” sobs the mom. She can’t move much, but the relief rings clear in her voice.

Quietly, the surgeons continue their work, clamping the umbilical cord twice and snipping it. The pediatrician and baby nurse whisk away the baby for antibiotic eye ointment and a vitamin injection and to be cleaned and weighed. The dad joins the baby team, the nurse infuses oxytocin, and suddenly all that’s left is the mom on the table and the surgeons looking down at a deflated abdomen and weirdly small incision.

Without hesitation, the resident thrusts her arm into the uterus and fishes out the placenta and tosses it into a bucket. Next, they pull out the uterus entirely out of the mom, wrap it in gauze, and place it on top of the mom’s belly button. They squeeze it and wait patiently for the uterus to contract down, expel leftover tissue, and stop bleeding. While waiting, they leisurely suction up the liter of blood that has collected all around the site and inside the abdomen.

Deliberately, the attending and resident pass around the sutures between each other to sew the patient shut. The silver hooked needle flashes in and out of the raw and frayed uterus, and the assistant tugs the trailing edge so tight that the uterine capsule folds in upon itself. The muscle will heal, but the uterus will forever remain fragile there. The abdominal muscles spring back into place, and above them the surgeons work on the fascia. They sew a generous margin away from the edge to ensure that the closure is strong enough to support the entire abdomen. The resident then takes a nearly invisible barbed suture attached to a straight tailor’s needle. He delicately runs it from side to side less than a millimeter underneath the skin, and as he pulls it tight, the skin pulls together and seals beautifully like a zipper. Finally, they tape a generous layer of bandages over the incision.

The closure takes twenty minutes, but meanwhile on the other side of the curtain, uninterrupted by the concluding surgery, the mom meets her newborn daughter for the first time. Their skins touch, and the squealing baby quiets.



PS. a decent video link. Start at 2:50.