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Jai Ganesh

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Cesarean delivery

Cesarean delivery

Gist

Cesarean section, C-section, or Cesarean birth is the surgical delivery of a baby through a cut (incision) made in the mother's abdomen and uterus. Health care providers use it when they believe it is safer for the mother, the baby, or both. The incision made in the skin may be: Up-and-down (vertical).

Cesarean delivery is defined as the delivery of a fetus through surgical incisions made through the abdominal wall (laparotomy) and the uterine wall (hysterotomy).

Summary

A caesarean section (c-section or ‘caesarean’) is a surgical procedure in which a baby is born through an incision (cut) made in the mother’s abdominal wall and the wall of the uterus (womb). Your baby will need to be born by caesarean section if there are problems that prevent the baby being born by a normal vaginal birth.

A caesarean section may be planned (elective) if there are signs that a vaginal birth is risky, or unplanned (emergency) if there are problems during labour.

If you have no serious problems with your pregnancy or labour, a vaginal birth is usually the safest way for your baby to be born. Most women have vaginal births (about 2 in every 3 births).

You have a right to be involved in and to make decisions about your care. A caesarean can only be performed if you give your written permission. Your partner or next of kin can give written permission if you are not able to.

Details

A cesarian section is a surgical alternative to vaginal birth. It may be beneficial for preventing complications when vaginal birth comes with high risks to the birthing parent or fetus.

What is a cesarean delivery?

A cesarean delivery — also known as a C-section or cesarean section — is the surgical delivery of a baby. It involves one incision in the mother’s abdomen and another in the uterus.

It’s a common procedure that’s used to deliver nearly one-third of babies in the United States, according to the Centers for Disease Control and Prevention.

Cesarean deliveries are generally avoided before 39 weeks of pregnancy so the child has proper time to develop in the womb. Sometimes, however, complications arise and a cesarean delivery must be performed prior to 39 weeks.

Why a cesarean delivery is done

A cesarean delivery is typically performed when complications from pregnancy make traditional vaginal birth difficult, or put the mother or child at risk.

Sometimes cesarean deliveries are planned early in the pregnancy, but they’re most often performed when complications arise during labor.

Reasons for a cesarean delivery include:

* baby has developmental conditions
* baby’s head is too big for the birth canal
* the baby is coming out feet first (breech birth)
* early pregnancy complications
* mother’s health problems, such as high blood pressure or unstable heart disease
* mother has active genital herpes that could be transmitted to the baby
* previous cesarean delivery
* problems with the placenta, such as placental abruption or placenta previa
* problems with the umbilical cord
* reduced oxygen supply to the baby
* stalled labor
* the baby is coming out shoulder first (transverse labor)

The risks of a cesarean delivery

A cesarean delivery is becoming a more common delivery type worldwide, but it’s still a major surgery that carries risks for both mother and child. Vaginal birth remains the preferred method for the lowest risk of complications. The risks of a cesarean delivery include:

* bleeding
* blood clots
* breathing problems for the child, especially if done before 39 weeks of pregnancy
* increased risks for future pregnancies
* infection
* injury to the child during surgery
* longer recovery time compared with vaginal birth
* surgical injury to other organs
* adhesions, hernia, and other complications of abdominal surgery

You and your doctor will discuss your birthing options before your due date. Your doctor will also be able to determine if you or your baby are showing any signs of complications that would require a cesarean delivery.

How to prepare for a cesarean delivery

If you and your doctor decide that a cesarean delivery is the best option for delivery, your doctor will give you complete instructions about what you can do to lower your risk of complications and have a successful cesarean delivery.

As with any pregnancy, prenatal appointments will involve many checkups. This will include blood tests and other examinations to determine your health for the possibility of a cesarean delivery.

Your doctor will make sure to record your blood type in case you need a blood transfusion during the surgery. Blood transfusions are rarely needed during a cesarean delivery, but your doctor will be prepared for any complications.

Even if you aren’t planning to have a cesarean delivery, you should always prepare for the unexpected. At prenatal appointments with your doctor, discuss your risk factors for a cesarean delivery and what you can do to lower them.

Make sure all of your questions are answered, and that you understand what could happen if you need to have an emergency cesarean delivery before your due date.

Because a cesarean delivery takes additional time to recover from than normal birth, arranging to have an extra set of hands around the house will be helpful. Not only will you be recovering from surgery, but your new baby will need some attention as well.

How a cesarean delivery is performed

Plan to stay in the hospital for three to four days while you recover from your surgery.

Before the surgery, your abdomen will be cleaned and you’ll be prepared for receiving intravenous (IV) fluids into your arm. This allows doctors to administer fluids and any type of medications you may need. You will also have a catheter put in to keep your bladder empty during the surgery.

There are three types of anesthesia offered to delivering mothers:

*spinal block: anesthesia that’s injected directly into the sac that surrounds your spinal cord, thus numbing the lower part of your body
* epidural: a common anesthesia for both vaginal and cesarean deliveries, which is injected into your lower back outside the sac of the spinal cord
* general anesthesia: anesthesia that puts you into a painless sleep, and is usually reserved for emergency situations
When you have been properly medicated and numbed, your doctor will make an incision just above the pubic hairline. This is typically horizontal across the pelvis. In emergency situations, the incision may be vertical.

Once the incision into your abdomen has been made and the uterus is exposed, your doctor will make an incision into the uterus. This area will be covered during the procedure so you won’t be able to see the procedure.

Your new baby will be removed from your uterus after the second incision is made.

Your doctor will first tend to your baby by clearing their nose and mouth of fluids and clamping and cutting the umbilical cord. Your baby will then be given to hospital staff and they will make sure your baby is breathing normally and prepare your baby to be put into your arms.

If you’re sure you do not want any more children, and have signed the consent, the doctor can tie your tubes (a tubal ligation) at the same time.

Your doctor will repair your uterus with dissolving stitches and close your abdominal incision with sutures.

Following up after a cesarean delivery

After your cesarean delivery, you and your newborn will stay in the hospital for about three days. Immediately after surgery, you will remain on an IV. This allows for adjusted levels of painkillers to be delivered into your bloodstream while the anesthesia wears off.

Your doctor will encourage you to get up and walk around. This can help prevent blood clots and constipation. A nurse or doctor can teach you how to position your child for breastfeeding so there’s no additional pain from the cesarean delivery incision area.

Your doctor will give you recommendations for home care after the surgery, but you should generally expect to:

* take it easy and rest, especially for the first few weeks
* use correct posture to support your abdomen
* drink plenty of fluids to replace those lost during your cesarean delivery
* avoid physical relationship for four to six weeks
* take pain medications as needed
* seek help if you experience symptoms of postpartum depression, such as severe mood swings or overwhelming fatigue

Call your doctor if you experience the following symptoms:

* breast pain accompanied with a fever
* foul-smelling vaginal discharge or bleeding with large clots
* pain when urinating
* signs of infection — for example, fever over 100 °F, redness, swelling, or discharge from the incision.

Additional Information

Caesarean section, also known as C-section or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen, often performed because vaginal delivery would put the baby or mother at risk. Reasons for the operation include obstructed labor, twin pregnancy, high blood pressure in the mother, breech birth, shoulder presentation, and problems with the placenta or umbilical cord. A caesarean delivery may be performed based upon the shape of the mother's pelvis or history of a previous C-section. A trial of vaginal birth after C-section may be possible. The World Health Organization recommends that caesarean section be performed only when medically necessary.

A C-section typically takes 45 minutes to an hour. It may be done with a spinal block, where the woman is awake, or under general anesthesia. A urinary catheter is used to drain the bladder, and the skin of the abdomen is then cleaned with an antiseptic. An incision of about 15 cm (6 inches) is then typically made through the mother's lower abdomen. The uterus is then opened with a second incision and the baby delivered. The incisions are then stitched closed. A woman can typically begin breastfeeding as soon as she is out of the operating room and awake. Often, several days are required in the hospital to recover sufficiently to return home.

C-sections result in a small overall increase in poor outcomes in low-risk pregnancies. They also typically take longer to heal from, about six weeks, than vaginal birth. The increased risks include breathing problems in the baby and amniotic fluid embolism and postpartum bleeding in the mother. Established guidelines recommend that caesarean sections not be used before 39 weeks of pregnancy without a medical reason. The method of delivery does not appear to have an effect on subsequent sexual function.

In 2012, about 23 million C-sections were done globally. The international healthcare community has previously considered the rate of 10% and 15% to be ideal for caesarean sections. Some evidence finds a higher rate of 19% may result in better outcomes. More than 45 countries globally have C-section rates less than 7.5%, while more than 50 have rates greater than 27%. Efforts are being made to both improve access to and reduce the use of C-section. In the United States as of 2017, about 32% of deliveries are by C-section. The surgery has been performed at least as far back as 715 BC following the death of the mother, with the baby occasionally surviving. A popular myth claims that the Roman statesman Julius Caesar was born via caesarean section and is the namesake of the procedure, but this is inaccurate. Descriptions of mothers surviving date back to 1500 AD. With the introduction of antiseptics and anesthetics in the 19th century, survival of both the mother and baby, and thus the procedure, became significantly more common.

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