A cesarean section also known as C-section or cesarean delivery is the surgical removal of one or more babies from the mother’s womb. In this procedure an incision or cut is made into the woman’s abdomen then uterus and the baby is then removed. The Center for Disease Control reports that in 2015, thirty-two (32%) of the births were via cesarean section.
A cesarean birth may be planned or occur because of an emergency. When planned a specific date is given for admission and delivery when the woman has reached 39 weeks or more of pregnancy. Waiting this long is to ensure that the baby is mature and healthy. The goal of a planned C-section is to ensure the safest delivery for the baby based on knowledge of a pre-existing conditions in the mother. These conditions may be maternal heart disease, some sexually transmitted infections such as gonorrhea, active genital herpes, and HIV positive mothers with high viral loads at the end of pregnancy.
Diabetes is another condition that may warrant a C-section. This condition tends to produce very large babies (macrosomic babies) which may pose a challenge to be delivered vaginally. Large tumors such as fibroids in the uterus might also be a reason for cesarean section. These tumors especially if located in the lower aspect of the uterus, will compromise the normal delivery process. Another reason for a planned C-section is if the baby is not positioned for normal vaginal delivery. The best position for normal vaginal delivery is the head first position or cephalic position. If the baby is instead positioned in a bottom first or breech position, a C-section would be needed for delivery.
Multiple babies may also be another reason to schedule a C-section. This is necessary if babies are large or if they are in positions not favorable for natural birth. Lastly, a woman who has had a previous cesarean section or surgery on her uterus would be likely to have a planned cesarean section. Previous surgery on the uterus increases the risk of uterine rupture in vaginal deliveries
There are emergency circumstances that can occur during pregnancy or during the labor process that will warrant an emergency cesarean section being done. Some of these circumstances are severe preeclampsia and eclampsia, this is a state of extremely high blood pressure that can lead to death. Abruptio placentae, in this condition the placenta suddenly tears away from the uterine wall. This state threatens to compromise the oxygen supply to the baby so immediate removal would be necessary.
Another reason may be sudden decrease in fetal heart rate, this might indicate that the baby is in trouble or in fetal distress. A prolapsed cord which is the cord coming before the baby may also be another reason for an emergency C-section. In this condition the weight of the baby might compress the umbilical cord, thereby decreasing blood and oxygen supply to the baby. All these situations described propose to severely threaten the life of the mother and or the baby.
Every type of delivery method has risks, however having a cesarean section carries its own set of risks to both the mother and the baby. There are maternal risks of, wound infection at the incision. Blood loss can also be a complication and lowered hemoglobin levels as a result. There can be blood clots that occur due to decreased activity of mommy.
This can be dangerous as clots can travel causing major complications such as pulmonary embolism, which is a clot in the lungs. There can also be injury to nearby organs such as the bladder and the intestine. Allergic reactions to medication given during the procedure or the anesthesia given can also occur suddenly. The baby(s) may be at risk for surgical injury which is rare. The baby may also develop breathing difficulties especially for babies born before 39 weeks.
The prospect of a cesarean section would be discussed with the parents by the obstetrician. The reason for the procedure would need to be explained. The risks involved, and potential complications would need to be highlighted as well. In these discussions both parents would have the opportunity to ask questions before signing a consent form. In an emergency however, these discussions may not be lengthy as quick decisions would need to be made and consent would need to be given to preserve the life of mother and baby.
The anesthesiologist would discuss methods of pain management for the procedure with mommy. In recent times the most common options are an epidural or spinal block. In these methods medication is delivered into the spinal column resulting in pain relief and decreased sensation to the lower half of the woman’s body, while she remains conscious. If the woman was already in labor and given an epidural, then a little more medication may be given to prolong its effect as the anesthetist sees fit. General anesthesia is another method used where the woman is put to sleep and is not aware of her surroundings. This method is less common and mostly used in an emergency C-section.
A urethral catheter is put in to empty the bladder of urine during the surgery. The woman also receives an IV or intravenous line that will be used to give her fluids for hydration and medication such as pain medication or antibiotics. Women who were already in labor would likely have had one of these already. Pre-surgery stomach medication such as antacids are often given as a part of the preparation as well.
During the procedure a screen placed over the woman that separates her upper body from her abdomen as the doctor removes the baby. After the baby is removed the cord is clamped and cut and the baby shown to mommy briefly before being taken for examination by the pediatrician and clean up. The doctor then delivers the placenta and closes the cut with sutures or staples. The sutures are oftentimes dissolvable and do not need to be removed.
After the cesarean section mommy often remains in hospital and is monitored carefully for 2 to 4 days before being sent home. It is expected that there will be pain at the surgical site and mommy will receive pain medication for this. There may also be abdominal cramps and the pain medication should also help with this. During the recovery moms are encouraged to avoid strenuous and sexual activity, until cleared by the doctor. Keeping hydrated is very important and having healthy nutritious meals as this will help with wound healing. It is also important to take all medication as prescribed and remember to rest well.
The experience of a cesarean section does not have to be a negative one. It is important for all pregnant women to prepare for possible cesarean section even when the plan is for vaginal delivery. It is in preparation that anxiety is reduced and new parents have wonderful birthing experiences.
Author: Katerina Reid RN