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Cesarean Section

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Cesarean section is a surgical procedure to deliver the baby. This article explains why a cesarean section is done, its risks, procedures, and follow-ups.

Written by

Dr. Asha. C

Medically reviewed by

Dr. Natasha Bansal

Published At May 26, 2022
Reviewed AtJanuary 4, 2024

What Is a Cesarean Section?

The cesarean section, also known as C-section or Cesarean birth, is a surgical procedure used to deliver a baby when a vaginal delivery is not considered safe or when the health of the baby or the mother is at risk. It is done by making a cut in the abdomen and uterus to deliver a baby. A C-section might be planned before the patient develops pregnancy complications, or the patient has had a previous C-section and is not considering vaginal birth after a cesarean. However, the need for a first-time C-section does not become obvious until labor is underway.

Depending on the health of the mother and the fetus, the type of incision is decided. The abdominal incision made in the skin may be:

  • Vertical (Up-and-Down) - This incision is made from the belly button to the pubic hairline.

  • Horizontal (Across From Side-to-Side) - This incision is made across the pubic hairline. A horizontal incision is commonly used because it heals well and produces less bleeding.

Why Is Cesarean Section Carried Out?

Cesarean delivery is planned if any of the following conditions exist:

  • Cephalopelvic Disproportion (CPD) - CPD means the mother's pelvis is very small to deliver a normal-sized baby, or the baby's body or head is large to pass safely through the mother's pelvis.

  • Previous Cesarean Birth - Even though vaginal birth after an earlier Cesarean is possible, it is not an option for all mothers. Depending on the type of cut made in the uterine and the risk of uterine rupture, the health care provider might recommend a repeat C-section.

  • Abnormal Baby Positions - In some cases, if the baby is in an abnormal position, a C-section might be the safest way to deliver the baby. If the baby's buttocks or feet enter the birth canal first, also called a breech, or the baby is positioned side or shoulder preferably, also called transverse, and the baby cannot be turned through abdominal manipulation, a cesarean delivery is recommended.

  • Multiple Pregnancies - Cesarean might be needed in the case of twins, the leading baby is in an abnormal position, or the case with triplets or more babies.

  • Placenta Previa - It is a condition where the placenta is attached too low in the uterine wall and covers the opening of your cervix by blocking the baby's exit through the cervix.

  • Cord Compression - If the umbilical cord is twisted around the baby's neck or body or looped between the baby's head and the mother's pelvis, an immediate C-section is recommended.

  • Stalled Labor - This is the most common reason for cesarean section. In this condition, the cervix might not open enough despite strong contractions over several hours, or the baby may stop moving down the birth canal.

  • Fetal Distress - The baby might develop problems that cause an irregular heart rate during labor. So, the doctor might decide on cesarean delivery.

  • Prolapsed Cord - If a loop of umbilical cord comes out of the cervix before the baby, a C-section is preferred.

  • Mother's Health Concern - If the mother has a severe health problem, a C-section might be recommended, such as a brain or heart condition or any infectious disease like genital herpes at the time of labor.

  • Mechanical Obstruction - In cases with a large fibroid obstructing the birth canal, baby’s head is huge, or a severely displaced pelvic fracture, a C-section is recommended.

What Are the Risks of Having a C-Section?

Cesarean section is becoming a more common delivery type; it is still a major surgery that can cause risks for both mother and child. Vaginal birth is always preferred because of its low risk of complications.

The risks of a C-section include the following:

  • Bleeding.

  • Abnormal separation of the placenta, especially in women with previous Cesarean delivery.

  • Injury to the bladder or bowel.

  • Infection in the uterus.

  • Reactions to the drugs used during surgery.

  • An embolism occurs if a blood clot breaks off and enters the bloodstream.

  • Risks from general anesthesia.

  • Trouble during urination or urinary tract infection.

  • Delayed return of bowel function.

  • Blood clots.

  • Longer recovery time compared with vaginal birth.

  • Complications of abdominal surgery like adhesions, and hernia.

How Is a C-Section Performed?

Before the surgery, the abdomen will be cleaned, and intravenous (IV) fluids and any medications needed are administered into the arms. A catheter will also be placed to keep the bladder empty during the surgery. Three types of anesthesia are administered to delivering mothers, depending on the requirement. They are spinal block, epidural, and general anesthesia.

After anesthesia, the doctor will make a horizontal or vertical incision above the pubic hairline. A vertical incision is given during emergencies. After creating an incision into the abdomen, the uterus is exposed, and the doctor will make an incision on the uterus. The baby will be removed from the uterus after the second incision. The baby's nose and mouth are cleaned to remove the fluid, and the umbilical cord is cut off. The baby is then handed to the hospital staff, and they will make sure the baby is breathing normally and prepare the baby to be put into the mother's arms. If the patient is confident of no more children, the doctor ties the tubes (a tubal ligation) simultaneously. Finally, the doctor will repair the uterus with dissolving stitches and close the abdominal incision with sutures.

What Should Be Followed After the Cesarean Delivery?

After cesarean delivery, the newborn and the mother will stay in the hospital for about three days. After the anesthesia wears off, the painkillers will be delivered into the bloodstream through intravenous (IV) lines.

Standing up and walking around is advised to prevent constipation and blood clot. The doctors will recommend home care after the surgery, which are

  • Take enough rest, especially for the first few weeks.

  • To support your abdomen, use the correct posture.

  • Drink plenty of fluids.

  • Take pain medications as needed.

  • Avoid sex for four to six weeks.

If the mother is experiencing symptoms of postpartum depression, consult a doctor.

If the mother is experiencing any of the following, immediately call a doctor,

  • Severe breast pain accompanied by a fever.

  • Bleeding with large clots or foul-smelling vaginal discharge.

  • Pain and discomfort while urinating.

  • Signs of infection like a fever over 100 degrees Fahrenheit, swelling, redness, or discharge from the incision.

Conclusion:

Cesarean section is a surgery done to deliver a baby if vaginal delivery is not possible. Nowadays, C-section is becoming common among everyone; it has added complications compared to vaginal birth like bleeding, infections, injury to bowel and uterus, etc. However, proper surgical procedures and home care can reduce the complications of c-section.

Frequently Asked Questions

1.

What to Expect Before Cesarean Delivery?

Before the procedure, an IV needle will be inserted to give medicine and fluids. A catheter will also be inserted into the bladder to empty it during the surgery. Before the surgery, a spinal block or epidural will be given to numb the region below the waist. This kind of anesthesia will let the patient be aware of what is going on. In some cases, general anesthesia will be given.

2.

When Is a Cesarean Section Indicated?

C-sections can be performed in different situations, the following are the most common indications;
- Breech presentation.
- Other malpresentation like an unstable lie, transverse lie, or oblique lie.
- Twin pregnancy.
- Maternal medical conditions like cardiomyopathy where labor will turn out dangerous for the mother.
- Fetal compromise, where it is thought the baby does not cope with labor.
- Transmissible diseases like HIV.
- Primary genital herpes in the third trimester can be transmitted from the mother to the baby.
- Placenta previa.
- Maternal diabetes, so the baby's weight is estimated to be greater than 4.5 kg.
- History of shoulder dystocia.
- Maternal request.

3.

How Long Is the Recovery Period After Cesarean?

Recovery after a C-section differs from person to person, typically, it takes six weeks after the surgery to recover. The incision made is usually horizontal and it can take more than two weeks to heal. During this period, it is recommended not to lift heavy objects, exercise, and have sex.

4.

How Is a Cesarean Section Performed?

Before the procedure, anesthesia will be administered. The abdomen is cleaned with an antiseptic solution, and an oxygen mask is placed over the mouth and nose of the patient to increase oxygen to the baby. Then an incision is made in the skin of the abdomen. A horizontal incision is placed beneath the belly button. Sometimes vertical or transverse incisions may be made. Then a 3 to 4-inch incision is made in the uterus walls, and the baby is removed through the incisions. Then the umbilical cord is cut, and finally, the placenta is removed, and the incisions are sutured.

5.

What Are the Procedures After the Cesarean Surgery?

After a cesarean section, a longer recovery will be required. Depending on the condition of the patient, stay in the hospital will be from two to five days. Once the anesthesia wears off, the patient may feel the pain of the incisions, gas pains, and trouble taking deep breaths. Vaginal bleeding due to the shedding of the uterine lining after the surgery may also take place.

6.

Is Vaginal Delivery Possible After a Cesarean Delivery?

Vaginal delivery is possible after cesarean delivery in a future pregnancy. Depending on the following factors, the chances of vaginal delivery after cesarean are greatly increased:
When a low transverse incision was made into the uterus during the cesarean surgery.
- When the pelvis is not too small.
- If there are no multiple pregnancies.
- If the first cesarean was due to the breech presentation of the baby.

7.

What Are the Types of Cesarean Sections?

- Traditional Cesarean Section - In this type, a long, vertical cut is made from the midline of the abdomen.
- The Lower Uterine Segment Cesarean Section (LUCS) - In this type, a horizontal cut is made from the pubic hairline above the bladder.
- Cesarean Hysterectomy - In this type, the uterus is removed along with the C-section delivery.

8.

Which Type of Cesarean Delivery Is More Preferred?

A low horizontal incision is preferred in 95 percent of C-sections because it is done in the lowest part of the uterus and so the bleeding is less. It also heals fast and makes vaginal birth possible after a C-section.

9.

How Many Cesarean Deliveries Can Women Have?

Every woman is different and unique, so it is important to analyze each woman's history, health, and concerns before deciding on a cesarean. To prevent any complications, doctors suggest waiting 18 to 24 months before the next delivery.

10.

How Long Does Pain After Cesarean Surgery Last?

After the cesarean delivery, the wound will feel bruised and sore for a few weeks. The doctors will recommend taking painkillers for at least 7 to10 days after a C-section.

11.

What Causes Back Pain After Cesarean Delivery?

Back pain after a C-section can be due to several reasons, such as the following;
- Hormonal changes.
- Weight gain.
- Lifting or carrying a new baby.
- Effect of anesthesia received during delivery.
- Breastfeeding.

12.

How Can Healing Fasten After the Cesarean Delivery?

Healing can be fastened by the following few steps:
- Resuming physical activities and being active.
- Start walking slowly.
- Taking adequate rest.
- Taking proper medications.
- Drinking adequate amounts of water.
- Maintaining a good nutritious diet.
- Taking probiotics and iron supplements.
- Use abdominal or belly binder.

13.

Will There Be Increased Weight Gain After C-Section?

Weight gain due to cesareans is the biggest myth. The weight gain is not due to cesarean but can be due to lifestyle changes and postpartum care for cesarean delivery.

14.

How to Reduce Tummy After Cesarean Delivery?

Tummy can be reduced by several techniques after cesarean like;
- Using a tummy binder.
- Breastfeeding.
- Drinking lots of water.
- Eating nutritious foods.
- Avoiding junk and oily foods.
- Doing exercises.

15.

What Are the Side Effects of Cesarean Delivery?

Risk to the Baby -
- Breathing difficulty.
- Effect of anesthesia.
- Injury during delivery.
Risk to the Mother -
- Infection.
- Excess bleeding.
- Injury to the bladder and the bowel.
- Deep vein thrombosis.
- Effects of anesthesia.
- Risks in a future delivery.

16.

Is the Uterus Removed During C-Section?

During a cesarean, the top of the uterus is usually taken outside of the body after the delivery of the baby. This makes it easier for the doctor to see the incision and quick repair. This usually takes 10 to 20 minutes. After the incision of the uterine, the doctor puts it back into the pelvic cavity.

17.

Is It Advisable to Wear a Belly Belt After a C-Section?

It is advised to wear the tummy belt during the daytime immediately after pregnancy. It is not advisable to wear it during nighttime.
Source Article IclonSourcesSource Article Arrow
Dr. Natasha Bansal
Dr. Natasha Bansal

Obstetrics and Gynecology

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