Sources and Guidelines Referenced

The clinical guidance, surgical protocols, and risk estimates presented in this guide are derived from published practice guidelines and scientific statements established by leading international obstetric and gynecological authorities:

• ACOG Practice Bulletin No. 205: Vaginal Birth After Previous Cesarean Delivery (American College of Obstetricians and Gynecologists, 2019, Reaffirmed 2021).
• ACOG Committee Opinion No. 761: Cesarean Delivery on Maternal Request (2019).
• NICE Guideline NG192: Cesarean Birth (National Institute for Health and Care Excellence, UK, 2021).
• WHO Statement on Cesarean Section Rates: World Health Organization recommendations on appropriate surgical thresholds (2015, updated 2018).
• RCOG Green-top Guideline No. 45: Placenta Praevia and Placenta Accreta Spectrum (Royal College of Obstetricians and Gynaecologists, 2018).
• ASA Guidelines for Obstetric Anesthesia: American Society of Anesthesiologists task force standards (2016).
• Enhanced Recovery After Surgery (ERAS) Society Guidelines: Perioperative care in cesarean delivery consensus statement (2019).

Cesarean Section (C-Section): A Comprehensive Patient Guide

1. Definition and Medical Identity

A cesarean section, also called a C-section or abdominal delivery, is a major surgical procedure in which an infant is delivered through surgical incisions made in the maternal abdominal wall and uterine muscle. It is classified as an inpatient surgical procedure within obstetrics and gynecology aimed at delivering a viable fetus safely when vaginal passage is unsafe.

The medical terminology for the abdominal incision is a laparotomy, while the surgical entry into the uterus is termed a hysterotomy. A cesarean section may be categorized as primary (a patient's first C-section) or repeat (performed on a patient with a prior C-section scar). Depending on clinical circumstances, the operation is performed either as a planned elective procedure or as an emergency intervention during active labor. Standardized guidelines from the National Institute for Health and Care Excellence (NICE NG192) and the American College of Obstetricians and Gynecologists (ACOG 2021) define exact parameters for timing, surgical technique, and clinical management.

2. The Underlying Condition or Need

A cesarean section is performed when physiological, anatomical, or pathophysiological conditions prevent safe delivery through the vaginal birth canal. Under normal circumstances, maternal uterine contractions dilate the cervix and propel the fetus through the bony maternal pelvis. However, mechanical mechanical obstruction, metabolic decompensation, or vascular failure can endanger maternal or fetal survival during labor.

Mechanical obstruction occurs when the physical dimensions of the fetus exceed the capacity of the pelvic outlet, a state known as cephalopelvic disproportion (CPD). Alternatively, abnormal fetal positioning, such as shoulder presentation or breech presentation (where the fetal buttocks or feet lead into the birth canal), prevents proper descent. Vascular and placental emergencies include placenta previa, where placental tissue overlays the internal cervical opening, and placental abruption, where the placenta detaches prematurely from the uterine wall. Without surgical intervention, severe maternal hemorrhage, permanent fetal neurological damage from lack of oxygen (hypoxia), or maternal and perinatal death can result (ACOG Practice Bulletin No. 205).

3. How the Treatment Works — Mechanism

A cesarean section achieves delivery by creating a direct, controlled surgical path through the anterior abdominal wall into the uterine cavity, bypassing the cervix and vagina entirely. The surgical team dissects through sequential anatomical layers to access the amniotic sac while maintaining hemodynamic control and sterile fields.

The procedure begins with an incision through the skin and subcutaneous adipose tissue. The underlying fascia covering the rectus abdominis muscles (the rectus sheath) is incised horizontally. The underlying rectus muscles are separated along their vertical midline (the linea alba) rather than cut. The surgeon then opens the parietal peritoneum (the thin membrane lining the abdominal cavity) to expose the pregnant uterus. The loose tissue fold between the bladder and uterus (the vesicouterine peritoneum) is mobilized to push the urinary bladder downward, protecting it from injury. A transverse incision is then made into the lowermost portion of the uterine wall, known as the lower uterine segment. The amniotic sac is punctured, fluid is suctioned, and the infant is gently maneuvered out through the abdominal opening before the umbilical cord is clamped and divided.

4. Types and Variations

Cesarean sections are differentiated by their level of surgical urgency and by the specific anatomical placement of the skin and uterine incisions. Categorizing urgency ensures that clinical resources and anesthesia preparations match the safety needs of the patient and fetus.

Surgical urgency is stratified into four recognized urgency categories defined by NICE Guideline NG192. Category 1 indicates an immediate threat to maternal or fetal life (such as severe fetal bradycardia or total placental abruption), requiring delivery within 30 minutes. Category 2 represents maternal or fetal compromise without immediate life threat. Category 3 indicates a need for early delivery without current compromise, while Category 4 is a planned elective procedure scheduled at a convenient time after 39 weeks of gestation.

Selection of hysterotomy type carries significant implications for future pregnancies. A low transverse hysterotomy leaves a strong scar in thin muscle tissue with a less than 1% risk of rupture in future labors. Conversely, a classical vertical incision cuts through thick, contractile uterine muscle, carrying a 4% to 9% risk of rupture during subsequent labor; thus, patients with a prior classical incision require planned repeat cesarean delivery in all subsequent pregnancies (ACOG 2019).

5. Who the Treatment Is For — Indications

A cesarean section is indicated whenever objective clinical data demonstrate that the safety risks of vaginal birth outweigh the inherent risks of abdominal surgery. Indications are grouped into maternal, fetal, and fetoplacental factors, evaluated through standardized diagnostic criteria during prenatal care or active labor.

• Maternal Indications: Cephalopelvic disproportion, structural pelvic deformities, prior classical uterine incision, prior myomectomy opening the uterine cavity, active genital herpes simplex virus (HSV) lesions at labor onset, human immunodeficiency virus (HIV) with viral load exceeding 1,000 copies/mL near delivery, and severe maternal cardiovascular instability.
• Fetal Indications: Malpresentation (breech, shoulder, or face presentation), non-reassuring fetal heart rate tracings unresponsive to intrauterine resuscitation (fetal distress), umbilical cord prolapse ahead of the presenting part, and certain congenital malformations (such as severe hydrocephalus).
• Fetoplacental Indications: Complete or partial placenta previa, placental abruption, and conditions within the placenta accreta spectrum (where placental villi attach directly to or invade through the myometrium).
• Elective Request: Cesarean delivery on maternal request (CDMR) refers to a planned C-section without medical indication. ACOG Committee Opinion No. 761 recommends that CDMR should not be performed before 39 completed weeks of gestation and requires comprehensive patient counseling regarding long-term surgical risks.

6. Who the Treatment Is NOT For — Contraindications

While a cesarean section can be a life-saving operation, it is a major surgical procedure carrying inherent risks of infection, hemorrhage, and tissue injury. Therefore, specific medical scenarios exist where performing an elective or non-essential C-section is clinically inappropriate or contraindicated.

Absolute contraindications to elective cesarean section include delivery prior to 39 completed weeks of gestation in the absence of medical indications, as premature delivery increases neonatal respiratory complications requiring intensive care (NICE NG192). Elective C-section is also contraindicated when maternal surgical risk is unacceptably high due to uncorrected severe maternal coagulopathy (bleeding disorders), severe medical instability where anesthesia poses immediate mortality, or when the patient lacks capacity and valid consent is absent.

In cases of intrauterine fetal demise (fetal death in utero) without placental abruption or maternal hemorrhage, vaginal delivery is strongly preferred over cesarean section. Performing major abdominal surgery in the presence of fetal demise exposes the patient to operative risks without conferring fetal benefit, unless severe maternal indications independently mandate immediate abdominal delivery (ACOG 2019).

7. Alternatives and Clinical Comparison

The primary alternative to a primary or repeat cesarean section is vaginal delivery, which may occur spontaneously or with instrument assistance. For patients with a history of a single previous low transverse C-section, a trial of labor after cesarean (TOLAC) leading to a successful vaginal birth after cesarean (VBAC) represents a clinically supported alternative to routine repeat C-section.

According to ACOG Practice Bulletin No. 205, approximately 60% to 80% of eligible candidates who attempt a TOLAC achieve a successful vaginal birth. A successful VBAC avoids major operative morbidity, shortens recovery, and reduces complications in future pregnancies. However, an unsuccessful TOLAC requiring an emergency intrapartum C-section carries higher rates of wound infection and uterine scar breakdown than a planned elective repeat C-section.

8. Pre-Treatment Phase

The pre-treatment phase for a scheduled cesarean section involves standardized clinical evaluations designed to confirm fetal maturity, optimize maternal medical stability, and minimize perioperative infection and thrombotic risks.

Diagnostic preparation includes a baseline Complete Blood Count (CBC) to quantify hemoglobin and hematocrit, alongside a formal blood type and antibody screen (Type and Screen) to prepare matched blood products if needed. For patients with high-risk conditions, such as suspected placenta accreta spectrum, targeted magnetic resonance imaging (MRI) or advanced color Doppler ultrasonography is performed to map vascular structures (RCOG Guideline No. 45).

Patients are instructed to fast from solid food for at least 6 to 8 hours prior to surgery, while clear liquids are allowed up to 2 hours before anesthesia, following guidelines from the American Society of Anesthesiologists (ASA 2016). Immediately prior to transfer to the operating room, patients receive an oral non-particulate antacid (such as 30 mL of 0.3 M sodium citrate) or intravenous H2-receptor antagonists to neutralize gastric contents and reduce pulmonary damage should aspiration occur. Broad-spectrum intravenous antibiotics, typically 2 grams of cefazolin, are administered within 60 minutes prior to skin incision to prevent surgical site infection (NICE NG192).

9. The Procedure — Step-by-Step Clinical Detail

A standard cesarean section requires a coordinated, multi-disciplinary team comprising an obstetric surgeon, assistant surgeon, scrub nurse, circulating nurse, anesthesiologist, and neonatal resuscitation personnel. The operation typically takes between 45 and 60 minutes from skin incision to final skin closure.

Step 1: Anesthetic Induction and Patient Positioning

The patient is placed in a sitting or lateral decubitus position for administration of a spinal block or combined spinal-epidural (CSE) anesthesia. Neuraxial anesthesia numbs the body from the mid-chest down to the feet while keeping the patient conscious and breathing independently. The patient is positioned supine with a 15-degree left lateral tilt, accomplished by placing a wedge under the right hip, to prevent the pregnant uterus from compressing the inferior vena cava and causing maternal hypotension.

Step 2: Surgical Field Preparation and Draping

An indwelling Foley catheter is inserted into the bladder to monitor urine output and keep the bladder empty during surgery. The lower abdomen is cleansed with an alcohol-based chlorhexidine skin prep solution and allowed to dry completely. Sterile surgical drapes are placed around the abdomen, and an anesthesia drape screen is raised at chest level.

Step 3: Abdominal Incision (Laparotomy)

The surgeon makes a transverse skin incision using a Pfannenstiel or Joel-Cohen technique approximately 2 to 3 centimeters above the pubic bone. Surgical scalpels and electrocautery dissect through subcutaneous fat to reach the anterior rectus sheath fascia. The fascia is incised horizontally, freed from the rectus muscles, and the muscles are retracted laterally along the midline. The parietal peritoneum is identified, picked up with forceps to avoid underlying bowel, and opened vertically to enter the peritoneal cavity.

Step 4: Uterine Incision (Hysterotomy) and Fetal Delivery

The bladder flap is created by incising the vesicouterine peritoneum and retracting the bladder inferiorly. A small transverse incision is made into the lower uterine segment using a scalpel and extended laterally with blunt finger traction or surgical scissors. The amniotic sac is ruptured, suctioning clear or meconium-stained fluid. The surgeon manually elevates the fetal head or presenting part through the hysterotomy while the assistant applies firm pressure to the top of the uterus (fundal pressure). Once the head emerges, the mouth and nasal passages are suctioned, the shoulders are delivered, and the infant is fully lifted out.

Step 5: Umbilical Cord Clamping and Placental Delivery

In accordance with WHO and NICE guidelines, delayed umbilical cord clamping for 30 to 60 seconds is performed for vigorous term and preterm infants to increase neonatal iron reserves. The cord is double-clamped and cut. Intravenous oxytocin (10 to 20 units) is administered to stimulate uterine muscle contraction and control bleeding. Controlled cord traction or manual extraction removes the placenta, followed by manual swabbing of the uterine cavity with gauze to remove remaining membranes.

Step 6: Uterine Reconstruction and Abdominal Closure

The low transverse uterine hysterotomy is closed using a continuous two-layer technique with absorbable delayed-absorbability sutures (such as polyglactin 910), ensuring full muscle approximation and bleeding control. Hemostasis is verified across the uterine scar and pelvis. The abdominal cavity is cleared of blood clots. The rectus fascia is closed with continuous heavy absorbable suture. Subcutaneous tissue layer thickness exceeding 2 cm is reapproximated with interrupted sutures to prevent seroma or hematoma formation. Finally, the skin is closed using subcuticular absorbable sutures or surgical staples, and a sterile dressing is applied.

10. Immediate Post-Procedure Period

The immediate post-procedure period encompasses the first 24 to 48 hours following surgery. Care takes place initially in a Post-Anesthesia Care Unit (PACU) before transfer to a specialized postpartum ward, focusing on physiological stability and early recovery milestones.

During the initial 2 to 4 hours in the PACU, nursing staff monitor maternal vital signs, oxygen saturation, and urine output every 15 minutes. Abdominal palpation checks uterine firmness (uterine tone) to ensure the uterus remains contracted, preventing postpartum hemorrhage. The vaginal bleeding rate, termed lochia, is monitored closely. Skin-to-skin contact between the mother and infant is initiated in the recovery area as soon as the patient is stable, supporting early infant thermal regulation and successful breastfeeding initiation.

Enhanced Recovery After Surgery (ERAS 2019) protocols recommend early oral intake of clear fluids within 2 to 4 hours after surgery, progressing to normal diet as tolerated. Multi-modal pain control relies on regular scheduled non-opioid analgesics, such as intravenous or oral acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs like ibuprofen), supplemented by short-acting opioids only for breakthrough pain. The urinary catheter is typically removed 6 to 12 hours post-surgery once regional anesthesia has worn off, encouraging early ambulation to reduce the risk of venous thromboembolism (VTE).

11. Recovery — Short and Long Term

Recovery following a cesarean section requires progressive physical healing spanning 6 to 8 weeks for soft tissue repair, while internal uterine tissue remodeling continues for several months.

During Days 1 to 4 (hospital stay), care focuses on transitioning from intravenous to oral pain medications, managing intestinal gas discomfort, verifying normal voiding, and maintaining wound cleanliness. Patients are encouraged to perform short, frequent walks in the ward corridors. Hospital discharge criteria require stable vital signs, adequate pain control on oral medications, ability to ambulate independently, passage of intestinal gas or bowel movement, and absence of active wound drainage.

Driving should be avoided until the patient can comfortably perform an emergency stop without abdominal pain and is off all opioid pain medications—typically 3 to 4 weeks post-surgery. Abdominal core exercises, high-impact running, and heavy weightlifting must be deferred until formal clearance is provided at the 6-week postpartum clinical examination (ACOG 2021).

12. Risks, Side Effects, and Complications

As a major surgical operation, a cesarean section involves inherent surgical, anesthetic, and infectious risks. While modern aseptic techniques and anesthesia standards have made C-sections safe, understanding potential complications is critical for informed clinical decision-making.

A primary long-term concern following a C-section is the impact on future reproductive outcomes. The risk of placenta accreta spectrum—where the placenta embeds abnormally into the previous uterine scar—increases exponentially with each subsequent C-section, rising from 0.2% after one C-section to over 2.1% after three (SMFM Consult Series #52, 2020). Placenta accreta carries significant risks of severe intraoperative hemorrhage and may necessitate an emergency hysterectomy at delivery.

13. Lifestyle and Behavioural Considerations

Optimizing maternal recovery and protecting long-term abdominal wall function after a cesarean section requires deliberate lifestyle adjustments during the early postpartum period.

Proper incisional care is essential to prevent surgical site infection. Patients should keep the incision clean and dry, washing gentle over the area with plain water during daily showers and patting the skin dry with a clean towel. Direct scrubbing, soaking in bathtubs, swimming in pools, or using hot tubs must be avoided until the incision has fully healed and the 6-week examination confirms complete skin closure.

Nutritional choices directly impact tissue repair and lactation performance. Protein intake should be prioritized at 1.2 to 1.5 grams per kilogram of body weight daily to support fascial collagen synthesis, alongside adequate dietary fiber and fluid consumption (2.5 to 3 liters daily) to prevent constipation and straining during bowel movements. Patients performing infant care should utilize ergonomic body mechanics—such as bringing the infant to the chest rather than bending deeply over a crib—to minimize strain on healing abdominal musculature.

14. How Outcomes Are Measured

Clinical success for a cesarean section is evaluated through a dual focus on maternal safety parameters and neonatal physiological adaptation.

Immediate neonatal outcome is measured using standard 1-minute and 5-minute Apgar scores, which rate heart rate, respiratory effort, muscle tone, reflex irritability, and skin color on a 10-point scale. A 5-minute Apgar score of 7 or higher indicates normal physiological transition. Umbilical artery blood gas analysis (pH and base excess) is performed in high-risk deliveries to assess metabolic status and rule out severe intrapartum asphyxia.

Maternal clinical outcomes are tracked through intraoperative blood loss estimation (normal C-section blood loss is under 1,000 mL), postoperative hemoglobin stabilization, rate of wound healing without infection, speed of bowel function recovery, and effective pain control enabling independent mobility. Long-term reproductive metrics evaluate scar thickness via mid-trimester ultrasound in subsequent pregnancies to guide decisions regarding TOLAC eligibility versus repeat elective C-section.

15. Recent Advances and Current Standard of Care

Over the past decade, obstetric practice guidelines have evolved significantly to streamline surgical protocols, enhance pain management, and reduce perioperative recovery timelines.

A major advance is the global implementation of Enhanced Recovery After Surgery (ERAS) protocols for cesarean birth. ERAS guidelines prioritize multi-modal non-opioid pain protocols (such as transverse abdominis plane [TAP] nerve blocks using long-acting local anesthetics like bupivacaine), early feeding within 2 hours, and rapid mobilization within 6 hours post-op. Clinical trials demonstrate that ERAS reduces hospital length of stay by 24 hours and lowers post-operative opioid requirements by over 50% without increasing readmission rates (ERAS Society 2019).

Surgical techniques have also been standardized based on high-quality comparative evidence. The routine practice of non-closure of both visceral and parietal peritoneum has become the standard recommendation in NICE NG192, as trials show it reduces operation time, post-operative pain, and surgical supplies without increasing adhesion formation. Furthermore, double-layer continuous hysterotomy closure has largely replaced single-layer closure in patients desiring future pregnancies, as prospective studies confirm double-layer repair produces thicker residual myometrial scar tissue and reduces the rate of uterine rupture during subsequent TOLAC (ACOG 2019).

16. Common Myths and Misconceptions

Misinformation regarding cesarean delivery can create unnecessary anxiety and misguide reproductive planning. Clinical guidelines clarify the evidence behind common delivery queries.

Myth: Having one C-section means all future babies must be delivered by C-section.
Reality: According to ACOG Practice Bulletin No. 205, approximately 60% to 80% of eligible candidates who attempt a Trial of Labor After Cesarean (TOLAC) achieve a successful Vaginal Birth After Cesarean (VBAC), provided the prior incision was a low transverse hysterotomy.

Myth: A C-section prevents immediate skin-to-skin contact and disrupts maternal-infant bonding.
Reality: Modern hospital protocols support intraoperative skin-to-skin contact in the operating room immediately after delivery for stable infants, which promotes early breastfeeding and bonding identically to vaginal delivery (NICE NG192).

Myth: Spinal anesthesia for a C-section leads to chronic long-term back pain.
Reality: Prospective cohort studies show that transient back soreness near the spinal injection site resolves within a few days. Long-term postpartum back pain is primarily related to pregnancy-induced ligamentous laxity and altered spinal posture rather than neuraxial anesthesia (ASA 2016).

Myth: You cannot breastfeed successfully after a C-section.
Reality: While milk production (lactogenesis II) may be delayed by 24 to 48 hours due to surgical stress or delayed feeding initiation, full lactation is completely achievable with early skin-to-skin contact, regular nurse-led support, and frequent infant feeding cues.

Myth: An elective C-section is an easier, pain-free alternative to natural labor.
Reality: While C-section avoids labor contractions, it is major abdominal surgery associated with significantly greater post-operative pain, longer recovery times, higher infection risks, and potential complications in future pregnancies compared to uncomplicated vaginal birth.

Myth: Surgical staples are always required to close a C-section skin incision.
Reality: Randomized controlled trials demonstrate that closure of the skin with subcuticular absorbable sutures reduces wound complication rates and surgical site infections compared to metallic staples (NICE NG192).

17. Frequently Asked Questions

How long does a typical cesarean section surgery take?

A standard, uncomplicated cesarean section takes approximately 45 to 60 minutes from start to finish. Delivery of the infant usually occurs within the first 10 to 15 minutes of surgery. The remaining 30 to 45 minutes are dedicated to placental extraction, multi-layer uterine repair, tissue reapproximation, and skin closure.

When is a planned C-section typically scheduled during pregnancy?

An elective or planned C-section is scheduled at or after 39 completed weeks of gestation (typically between 39 weeks 0 days and 39 weeks 6 days). Clinical guidelines from ACOG and NICE recommend avoiding delivery prior to 39 weeks unless medically indicated, to allow complete fetal lung development and reduce neonatal intensive care admissions.

Will I feel any pain during the C-section procedure?

You should not feel sharp pain during surgery under effective regional anesthesia (spinal block or epidural). You will remain awake and feel pressure, pushing, pulling, and tugging sensations as the surgical team maneuvers the infant through the abdominal incision. The anesthesiologist remains at your head to monitor comfort and administer additional intravenous pain medications if needed.

How long will I need to stay in the hospital after a C-section?

The typical hospital stay following an uncomplicated C-section ranges from 2 to 4 days (48 to 96 hours). Discharge depends on meeting key clinical milestones: adequate oral pain management, ability to ambulate independently, normal voiding, passage of intestinal gas, and absence of fever or surgical wound complications.

How long should I wait before driving after a C-section?

Most clinicians advise waiting 2 to 4 weeks after surgery before driving. You must be completely off all opioid pain medications and able to comfortably twist your torso, apply firm brake pressure, and perform an emergency stop without experiencing abdominal pain or hesitation.

When can I safely lift heavy objects or exercise again?

You should refrain from lifting anything heavier than your newborn infant (approximately 10 pounds) for the first 6 weeks post-surgery. Strenuous exercise, core abdominal workouts, running, and heavy lifting should be deferred until formal physical clearance is granted by your obstetric provider at your 6-week postpartum clinical examination.

What does the post-operative C-section scar look like?

A standard low transverse C-section leaves a horizontal scar approximately 10 to 15 centimeters long situated 2 to 3 centimeters above the pubic hairline. Initially, the scar appears pink or raised, but over 6 to 12 months, it gradually fades to a thin, flat, pale line that is easily hidden by standard underwear or swimwear.

Can I have a vaginal birth in a future pregnancy after a C-section?

Yes. If your C-section involved a low transverse uterine incision and you have no other contraindications, you are a candidate for a Trial of Labor After Cesarean (TOLAC). According to ACOG guidelines, 60% to 80% of candidates who attempt TOLAC achieve a successful Vaginal Birth After Cesarean (VBAC).

How many C-sections can a person safely have in their lifetime?

There is no rigid maximum number, but clinical evidence shows that surgical risks increase with each subsequent C-section. Repeated operations carry higher rates of dense abdominal scar adhesions, bladder injury, surgical complexity, and life-threatening placental implantation disorders such as placenta accreta spectrum. Your clinician will evaluate your specific scar history when planning future pregnancies.

What are the warning signs of a C-section incision infection?

You should contact your healthcare provider immediately if you develop a fever exceeding 38.0°C (100.4°F), increasing redness or warmth spreading around the scar, yellow or foul-smelling drainage from the incision, sudden opening of the wound edges, or severe abdominal pain that worsens despite pain medication.

How is pain managed during recovery at home?

Home pain management focuses on a scheduled multimodal oral approach. Patients typically take non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen alongside acetaminophen at regular intervals for the first 1 to 2 weeks. Short-acting oral opioids may be prescribed for severe breakthrough pain during the first few days after discharge.

Why is early walking emphasized after a C-section?

Early walking within 6 to 12 hours of surgery is critical because pregnancy and major surgery both increase the risk of blood clots. Walking promotes circulation in the lower legs, preventing deep vein thrombosis (DVT) and pulmonary embolism (PE), while also stimulating bowel movements to relieve gas pain and intestinal sluggishness.

Does a C-section delay my breast milk from coming in?

Surgical stress and delayed initial feeding can cause a minor delay in full milk production (lactogenesis II) by 24 to 48 hours compared to vaginal delivery. However, early skin-to-skin contact, frequent nursing attempts or pumping every 2 to 3 hours, and guidance from a lactation consultant will establish a full milk supply.