CESAREAN SECTION

Cesarean delivery also known as a C-section is a surgical procedure used

to deliver a baby through incisions in the mother's abdomen and uterus.

A C-section might be planned ahead of time if you develop pregnancy

complications or you've had a previous C-section and aren't considering vaginal
birth after cesarean (VBAC). Often, however, the need for a first-time C-section
doesn't become obvious until labor is underway.

If you're pregnant, knowing what to expect during a C-section both during the
procedure and afterward can help you prepare.

Sometimes a C-section is safer for you or your baby than is a vaginal delivery.
Your health care provider might recommend a C-section if:

Your labor isn't progressing. Stalled labor is one of the most common
reasons for a C-section. Perhaps your cervix isn't opening enough despite
strong contractions over several hours or the baby's head is too big to pass
through your birth canal.

Your baby isn't getting enough oxygen. If your health care provider is
concerned about your baby's oxygen supply or changes in your baby's
heartbeat, a C-section might be the best option.

Your baby or babies are in an abnormal position. A C-section might be

the safest way to deliver the baby if his or her feet or buttocks enter the birth
canal first (breech) or the baby is positioned side or shoulder first (transverse).
When you're carrying multiple babies, it's common for one or more of the
babies to be in an abnormal position.

You're carrying multiples. A C-section might be needed if the babies are

being born early or if there are other problems.

There's a problem with your placenta. If the placenta covers the opening
of your cervix (placenta previa), C-section might be the safest way to deliver
the baby.
 There's a problem with the umbilical cord. A C-section might be
recommended if a loop of umbilical cord slips through your cervix ahead of
your baby or if the cord is compressed by the uterus during contractions.

You have a health concern. A C-section might be recommended if you

have health conditions, such as complex heart problems, high blood pressure
requiring urgent delivery or an infection that could be passed to your baby
during vaginal delivery such as genital herpes or HIV.

Mechanical obstruction. You might need a C-section if you have a large

fibroid obstructing the birth canal, a severely displaced pelvic fracture or your
baby has severe hydrocephalus, a condition that can cause the head to be
unusually large.

You've had a previous C-section. Depending on the type of uterine

incision and other factors, it's often possible to attempt a vaginal birth after a
previous C-section. In some cases, however, your health care provider might
recommend a repeat C-section.
Some women request C-sections with their first babies to avoid labor or the
possible complications of vaginal birth or to take advantage of the convenience of
a planned delivery. However, this is discouraged if you plan on having several
children. Women who have multiple C-sections are at increased risk of placenta
problems as well as heavy bleeding, which might require a hysterectomy. If you're
considering a planned C-section for your first delivery, work with your health care
provider to make the best decision for you and your baby.

Risk
Recovery from a C-section takes longer than does recovery from a vaginal birth.
And like other types of major surgery, C-sections also carry risks.

Risks to your baby include:

Breathing problems. Babies born by scheduled C-section are more likely

to develop transient tachypnea a breathing problem marked by abnormally
fast breathing during the first few days after birth. C-sections done before 39
weeks of pregnancy or without proof of the baby's lung maturity might
increase the risk of other breathing problems, including respiratory distress
syndrome a condition that makes it difficult for the baby to breathe.

Surgical injury. Although rare, accidental nicks to the baby's skin can
occur during surgery.
Risks to you include:
 Inflammation and infection of the membrane lining the uterus. This
condition known as endometritis can cause fever, foul-smelling vaginal
discharge and uterine pain.

Increased bleeding. You're likely to lose more blood with a C-section than
with a vaginal birth. However, transfusions are rarely needed.

Reactions to anesthesia. Adverse reactions to any type of anesthesia are

possible. After a spinal block or combined epidural-spinal anesthesia
common types of anesthesia for C-sections it's rare, but possible, to
experience a severe headache when you're upright in the days after delivery.

Blood clots. The risk of developing a blood clot inside a vein especially
in the legs or pelvic organs is greater after a C-section than after a vaginal
delivery. If a blood clot travels to your lungs (pulmonary embolism), the
damage can be life-threatening. Your health care team will take steps to
prevent blood clots. You can help, too, by walking frequently soon after
surgery.

Wound infection. Infections are more common with C-sections compared

to vaginal deliveries. C-section infections are generally found around the
incision site or within the uterus.

Surgical injury. Although rare, surgical injuries to nearby organs such

as the bladder can occur during a C-section. Surgical injuries are more
common if you have multiple C-sections. If there is a surgical injury during
your C-section additional surgery might be needed.

Increased risks during future pregnancies. After a C-section, you face a

higher risk of potentially serious complications in a subsequent pregnancy
including problems with the placenta than you would after a vaginal
delivery. The risk of uterine rupture, when the uterus tears open along the
scar line from a prior C-section, is also higher if you attempt vaginal birth after
C-section (VBAC).

If your C-section is scheduled in advance, your health care provider might

suggest talking with an anesthesiologist about any possible medical conditions
that would increase your risk of anesthesia complications.

Your health care provider might also recommend certain blood tests before your
C-section. These tests will provide information about your blood type and your
level of hemoglobin the main component of red blood cells. These details will
be helpful to your health care team in the unlikely event that you need a blood
transfusion during the C-section.

If your C-section is planned before 39 weeks for a non-emergency reason, your

baby's lung maturity might be tested before the C-section. This is done with
amniocentesis a procedure in which a sample of the fluid that surrounds and
protects the baby in the uterus (amniotic fluid) is removed from the uterus for
testing. Maturity amniocentesis can offer assurance that the baby is ready for
birth.

Even if you're planning a vaginal birth, it's important to prepare for the
unexpected. Discuss the possibility of a C-section with your health care provider
well before your due date. Ask questions, share your concerns and review the
circumstances that might make a C-section the best option. In an emergency,
your health care provider might not have time to explain the procedure or answer
your questions in detail.

After a C-section, you'll need time to rest and recover. Consider recruiting help
ahead of time for the weeks following the birth of your baby.

During the procedure

While the process can vary, depending on why the procedure is being done, most
C-sections involve these steps:

At home. While research suggests the benefit is unclear, you might be

asked to bathe with an antiseptic soap before your C-section to reduce the
risk of infection. Don't shave your pubic hair. This can increase the risk of
surgical site infection. If your pubic hair needs to be removed, it will be
trimmed just before surgery.

At the hospital. Before your C-section, your abdomen will be cleansed. A

tube (catheter) will likely be placed into your bladder to collect urine.
Intravenous (IV) lines will be placed in a vein in your hand or arm to provide
fluid and medication. You might be given an antacid to reduce the risk of an
upset stomach during the procedure.

Anesthesia. Most C-sections are done under regional anesthesia, which

numbs only the lower part of your body allowing you to remain awake
during the procedure. A common choice is a spinal block, in which pain
medication is injected directly into the sac surrounding your spinal cord. In an
emergency, general anesthesia is sometimes needed. With general
anesthesia, you won't be able to see, feel or hear anything during the birth.
 Abdominal incision. The doctor will make an incision through your
abdominal wall. It's usually done horizontally near the pubic hairline (bikini
incision). If a large incision is needed or your baby must be delivered very
quickly, the doctor might make a vertical incision from just below the navel to
just above the pubic bone. Your doctor will then make incisions layer by
layer through your fatty tissue and connective tissue and separate the
abdominal muscle to access your abdominal cavity.

Uterine incision. The uterine incision is then made usually horizontally

across the lower part of the uterus (low transverse incision). Other types of
uterine incisions might be used depending on the baby's position within your
uterus and whether you have complications, such as placenta previa when
the placenta partially or completely blocks the uterus.

Delivery. The baby will be delivered through the incisions. The doctor will
clear your baby's mouth and nose of fluids, then clamp and cut the umbilical
cord. The placenta will be removed from your uterus, and the incisions will be
closed with sutures.
If you have regional anesthesia, you'll be able to hear and see the baby right after
delivery.

After the procedure

After a C-section, most mothers and babies stay in the hospital for two to three
days. To control pain as the anesthesia wears off, you might use a pump that
allows you to adjust the dose of intravenous (IV) pain medication.

Soon after your C-section, you'll be encouraged to get up and walk. Moving
around can speed your recovery and help prevent constipation and potentially
dangerous blood clots.

While you're in the hospital, your health care team will monitor your incision for
signs of infection. They'll also monitor your movement, how much fluid you're
drinking, and bladder and bowel function.

You will be able to start breast-feeding as soon as you feel up to it. Ask your
nurse or a lactation consultant to teach you how to position yourself and support
your baby so that you're comfortable. Your health care team will select
medications for your post-surgical pain with breast-feeding in mind. Continuing to
take the medication shouldn't interfere with breast-feeding. Pain control is
important since pain interferes with the release of oxytocin, a hormone that helps
your milk flow.

Before you leave the hospital, talk with your health care provider about any
preventive care you might need, including vaccinations. Making sure your
vaccinations are current can help protect your health and your baby's health.

When you go home

While you're recovering:

Take it easy. Rest when possible. Try to keep everything that you and your
baby might need within reach. For the first few weeks, avoid lifting from a
squatting position or lifting anything heavier than your baby.

Support your abdomen. Use pillows for extra support while breast-
feeding. A pregnancy belt might provide additional support.

Drink plenty of fluids. Drinking water and other fluids can help replace the
fluid lost during delivery and breast-feeding, as well as prevent constipation.

Take medication as needed. Your health care provider might recommend

acetaminophen (Tylenol, others) or other medications to relieve pain. Most
pain relief medications are safe for women who are breast-feeding.

Avoid sex. Don't have sex until your health care provider gives you the
green light often four to six weeks after surgery. You don't have to give up
on intimacy in the meantime, though. Spend time with your partner, even if it's
just a few minutes in the morning or after the baby goes to sleep at night.
Contact your health care provider if you experience:

Any signs of infection such as a fever higher than 100.4 F (38 C), severe
pain in your abdomen, or redness, swelling and discharge at your incision site

Breast pain accompanied by redness or fever

Foul-smelling vaginal discharge

Painful urination

Heavy bleeding that soaks a sanitary napkin within an hour or bleeding that
continues longer than eight weeks after delivery

Postpartum depression which can cause severe mood swings, loss of

appetite, overwhelming fatigue and lack of joy in life is sometimes a concern
as well. Contact your health care provider if you suspect that you're depressed.
It's especially important to seek help if your signs and symptoms don't fade on
their own, you have trouble caring for your baby or completing daily tasks, or you
have thoughts of harming yourself or your baby.