“Doctor, I have been told I need a cesarean section (C-section). Do you think it is necessary?”
This type of questions are common now-a-days. And no mistake, the number of Cesarean Section that are performed today has been increased to a much higher level. This is so much that in some cases even when the c-section is not required still vaginal delivery is not considered. Among these c-section how much is genuine and how much is artificially inflated, this is a question that will probably never be answered. In the present world, women give more importance to their career and postpone childbearing to the later age when their tissues are not optimally supporting a vaginal delivery and today’s common problem such as high blood pressure further increases the complications. There are more chances of various problems like growth-restricted baby or prolonged labor with the pregnancy. Naturally, the issues of c-section increases day-by-day.
In just recent past women would have at least 4-5 offsprings. Just a few generations back it was common to see of having a dozen of siblings. But in the present world people expect only the best, couple expect to have only one or two progeny with the best outcome. There is no place for imperfect. All these issues has probably also increases the operative deliveries. Peoples are not willing to accept any kind of unfavorable incidences such as depressed baby if the delivery occurred vaginally. People cannot accept the fact if anything wrong could occurred naturally was not necessarily related to the route of delivery while by doing a c-section doctor has done his level best to deliver an optimal outcome!
Cesarean delivery also called a cesarean section or C-section is the surgical delivery of a baby by an incision through the mother’s abdomen or belly and uterus or womb. This procedure is done when it is determined to be a safer method than a vaginal delivery for the mother, baby, or both.
In Cesarean Section, an incision is made in the skin and into the uterus or womb at the lower part of the mother’s abdomen. The incision in the skin may be:
- Vertical or longitudinal.
- Transverse or horizontal.
And the incision in the uterus may be:
Types of c-section (Cesarean Section)
There are two types of c-section:
- Lower segment cesarean section (LSCS).
- Classical section.
Out of the two, the LSCS is mostly preferred and the classical section is less commonly used. In LSCS the cut on the uterus is placed at its lower end and this has many advantages both during the surgery and for post-operative recovery because it heals well and there is less bleeding. LSCS also increase the chance for vaginal birth in a future pregnancy. A classical section is done when the lower end of the uterus is not accessible for some reasons. However, the type of incision depends on the conditions of the mother and the fetus.
When and why Cesarean Section is done?
If a woman is unable to deliver vaginally, the fetus is delivered surgically by performing a cesarean delivery. Some cesarean deliveries are planned and scheduled, while others may be done as a result of problems that occur during labor. An advance well-planned c-section is known as elective LSCS and the emergency LSCS is done suddenly.
Doctors always try to do the LSCS when the baby reached the optimal maturity but in some cases it may have to be done earlier.
A preterm c-section may due to the following two reasons:
- Non-maturation of the uterus by its size.
- The baby required special care in neonatal (of or for babies that were just born) intensive care unit(ICU).
For example, c-section becomes absolutely necessary in the interest of both mother and baby if the mother starts profuse bleeding at the starting of eighth month because of the separation of the placenta which causes praevia (Placenta covers the opening in the mother’s cervix).
Some of the other factors which compel the Cesarean Section:
- The birth canal may two narrow.
- There may be some obstruction in the canal.
- Dysfunctional labor that is uterus may not co-operate during labor.
- Cervical dystocia, which means cervix may refuse to dilate.
- Abnormal position of the fetus during birth. The normal position for the fetus during birth is head-down, facing the mother’s back. However, sometimes a fetus is not in the right position, making delivery more difficult through the birth canal.
- Baby is too large to be delivered vaginally.
- Sometimes the fetus may be so growth restricted and fragile that the fetus cannot withstand the rigours of a normal labour.
- Twins or other multiples.
Elective and emergency LSCS
In electively planned LSCS, the mother is admitted either in the night prior to or early in the morning on the day of surgery, unless the mother is already admitted for some other reasons. Doctor told to the mother to remain starving for 6-8 hours prior to the surgery, or in case of emergency LSCS the mother may have a full stomach, in this case the mother may develop aspiration pneumonia if she is to be operated under general anesthesia due to the passage of acidic gastric contents from the stomach into the respiratory tract. Doctors try to neutralize the acidic contents by administering basic medicines or by entering a tube into the stomach he may suck out the contents.
Possible Risk Factors of C-section
It is clear that in any kind of surgical procedure, complications may occur. Below some possible complications of a c-section are listed:
- Abnormal separation of the placenta, most occurs in women with previous cesarean delivery.
- Infection in the uterus.
- Infection in the incisions.
- Injury to the bladder or bowel.
- UTI or urinary tract infection or Difficulty in urination.
- Delay in normal bowel function.
- Blood clots may form.
- The mother may or may not be able to have a vaginal birth in a future pregnancy, which depends on the type of uterine incision used for the Cesarean Section, the scar may not be strong enough to withstand the force of labor contractions.
Before the c-section (Cesarean Section)
Your doctor will explain the whole procedure to you and you will get the chance to ask any questions that you might have about the procedure or any other.
You will be given a consent form for signing, that gives your permission to do the c-section. Before filling read the form carefully and ask questions if something is not clear to you. If you want to prevent the future pregnancy permanently, you must sign a consent form for this procedure in which a tube known as fallopian tube will be blocked by cutting or any other means.
If your cesarean delivery is a planned procedure and requires general, spinal, or epidural anesthesia, you will be asked to fast that is not to eat or drink anything for eight hours before the procedure.
Tell your doctor if you are sensitive to or are allergic to any medications, latex, iodine, tape, and anesthetic agents.
Tell your doctor if you are taking any kind of medications and herbal supplements.
Tell your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant, aspirin, or other medications that affect blood clotting. You may need to stop these medications prior to the procedure, therefore, make your doctor aware of all these things.
Doctor may give medicines to decrease the acid in your stomach and to help dry the secretions in your mouth and breathing passages.
Plan to have someone stay with you for caring after cesarean delivery. You may have pain in the first few days and you will need help with the baby.
Depending upon your medical history, your doctor may give you to do other things to be ready for this surgery.
During C-section procedure
You will be taken in an operating room or a designated delivery room. Type of c-section may vary depending on your condition and your doctor’s practices.
In most cases, you will be awake for a Cesarean Section delivery. These are rare situations when the mother will be given general anesthesia for c-section. The present cesarean deliveries are mostly done with a regional anesthesia such as an epidural or spinal. With these types of anesthesia, you will have no feeling from your waist down, and you will be awake and able to hear and see your baby as soon as he/she is born.
Following are the processes of a Cesarean Section/ C-section Procedure
- The mother will be asked to undress completely and put on a hospital apron.
- The mother will be positioned on an operating or examination table.
- A urinary catheter may be fitted if it was not done before coming to the OT.
- An intravenous (IV) line may be started in your arm or hand for fluid.
- For safety reasons, straps will be placed over your legs to secure your position on the table.
- Hair around the cutting area may be shaved and the skin will be cleaned with an antiseptic solution.
- Your abdomen will be draped with sterile material. A cloth will also be placed above your chest to screen the abdomen.
- The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the Cesarean Sectiontion.
- After complete action of anesthesia, an abdominal incision will be made. You may hear the sounds of an electrocautery machine that is used to seal off bleeding.
- The incisions will be made further deep through the tissues and muscle until the uterine wall is reached then the final incision will be made in the uterus.
- The bag known as amniotic sac will be opened, and the baby will be delivered through the opening. You may feel some pressure and/or a pulling sensation.
- The umbilical cord will be cut.
- Medications will be given for uterine contraction which expels the placenta and it will be removed.
- Sutures will be used to close the incision in the uterine muscle and the uterus will be repositioned in the pelvic cavity.
- The muscle and tissue layers will be closed with sutures and the skin incision will be closed with sutures or surgical staples.
- A sterile bandage or dressing will be done.
After the procedure
*In the hospital
The mother will be taken to the recovery room for observation. Doctors will monitor your blood pressure, breathing, pulse, bleeding, and the firmness of your uterus.
Generally, your baby can be brought to you while you are in the recovery area after c-section. In some cases, babies born by cesarean will first need to be monitored in the nursery for a short time. Breastfeeding can begin in the recovery area as like a vaginal delivery.
After about one to two hours in the recovery area, you will be moved to your room for the rest of your hospital stay.
After releasing the effect of anesthesia, you may receive pain medication as needed through a device connected to your intravenous line. In some cases, pain medication may be given through the epidural catheter until it is taken off.
Your urinary catheter is removed the day after surgery.
Depending on your situation, you may be given liquids to drink a few hours after c-section. Your diet may be gradually advanced to more solid foods as tolerated by your digestive system.
You may be given antibiotics here and a prescription to continue the antibiotics at home.
*At home after hospital
The mother will need to wear a diaper for bleeding. It is normal to have vaginal bleeding for several days after birth, followed by a discharge that changes from dark red/brown to a lighter color over several weeks.
You should have sex until the time recommended by your doctor. You may also have other restrictions on your activity, including no strenuous activity, driving, or heavy lifting.
Take regular medicines as prescribed by your doctor.
You should visit with your doctor, usually two to three weeks after the surgery if you do not face any problem before.
Inform your doctor if you have any of the following problems:
- Heavy bleeding.
- Foul-smelling drainage from your vagina.
- Fever and/or chills.
- Leg pain.
- Severe abdominal pain.
- Increased pain, redness, swelling, or bleeding or other drainage from the incisions.
The suggestion and instructions may vary a little bit from here to your doctor depending on your particular situation. Hope you find this article very helpful. If you have any doubts, comment below or you can ask your doubts to our experts.