Cesarean is a method of delivering a child. Natural childbirth occurs when a woman pushes the baby out of her through the vaginal channel. But Cesarean or C-section means surgically delivering a baby by making an incision on the mother’s belly and uterus. When there are complications in a normal delivery, and Cesarean is deemed to be a safer method for the baby and mother.

In Cesarean delivery, doctors cut through the skin and then the uterus, around the lower part of a female’s abdomen. The cut made can be vertical or horizontal. A horizontal or transverse incision can extend across the hairline in the pubic region. 

A transverse incision is generally used on the uterus as it can heal well and there is much less bleeding. This type of cut increases the chance of a normal delivery in case of future pregnancies. The type of cut or incision depends on the condition of the fetus and the baby.

Cesarean delivery is abdominal surgery, and a woman may be awake but numb from the chest to the leg areas. Cesarean deliveries were also practiced in the olden times with the examples of the birth of Julius Caesar.

The 8th century Rome had passed a law to practice this procedure in women who were in advanced stages of pregnancy and who were dying, and to at least save the newborn. Around 30% of women in the United States give birth via a C-section every year.

Reason for Performing a Cesarean Delivery

Choosing to deliver a baby through Cesarean delivery could be an individual’s choice or a medical requirement. Some of the common reasons for performing a Cesarean delivery are as follows:

  • Repetitive Cesarean delivery 

In a cesarean, there are two types of incisions made. The incision made on the uterus does not have to match the type of incision on the abdominal skin. A low horizontal cut across the lower part of the abdomen and uterus is usually preferred. The doctor makes a vertical cut in case of an emergency where there is more than one fetus, delivering preterm babies, and placentas that are abnormally positioned. 

Studies have shown that women who have had cesarean deliveries with a lower transverse incision can go through vaginal deliveries in future pregnancies. However, the same may not apply to women with vertical incisions. With vertical incision, the uterus becomes weaker for future pregnancies and are at a risk rupturing. The uterus may rupture before labor begins, and it can be dangerous for the fetus.

  • Earlier C-section deliveries 

 It is commonly said that once a woman goes through Cesarean, she needs to go for the same procedure for any future pregnancies as well. Women who have a history of more than one low transverse C-section are at an increased risk of uterine rupture. The risk increases furthermore is a woman has had 3 C-section deliveries.

  • Lack in the progression of labor 

 Labor progresses when a woman has contractions along with dilation of the cervix. If a woman is experiencing contractions, but there is no change in the cervix or the opening to the uterus, beyond a dilation of 3 cms, then doctors can decide to perform a C-section. It can also happen that a woman is dilated and is having contractions but is unable to get the baby out even after 2 to 3 hours of pushing. In this situation, doctors recommend a C-section.

  • Fetal status 

 The status of the fetus can be determined before delivery. If a vaginal delivery deemed unsafe due to complications, doctors could opt for Cesarean Delivery. A fetal heart rate monitor is often used by medical practitioners to determine the health of the fetus.

  • Abnormal fetal position 

 In a normal delivery, the baby comes out with head first. This position increases the success of vaginal delivery. Although the fetus can be in other positions as well, it can be very difficult for women to give birth in such a situation. If the baby’s buttocks are in the lower part of the uterus, known as the breech position, it may cause more complications. In such cases, doctors require extensive study and deliberation before going in for C-section or an attempt at normal delivery.

  • Emergency 

 If a pregnant woman has a life-threatening injury, severe illness, or something that can affect the lungs or heart function, a C-section may be the best option. Cesarean delivery performed within 6 to 10 minutes of a cardiac arrest can save the baby.

  • Sterilization 

Sterilization can be done via vaginal surgery or laparoscopic surgery. These procedures are similar to C-section.

  • Other reasons 

Other reasons for Cesarean can be – a woman’s preference, genital herpes in the mother, HIV infection of the mother, tumors in the reproductive tract or anatomical anomalies in the pelvic region or increased maternal age.

 Preparation for Cesarean Delivery

To prepare for C-section, patients are asked not to consume anything at least 12 hours before the surgery. However, the guidelines mention fasting of two hours from clear liquids, six hours from light meals and eight hours from regular meals. 

Fluids are injected through an IV, and pre-operative samples for the lab are withdrawn. Backups in the form of matching blood are kept ready. The patient is linked with an external fetal monitor and is analyzed by the anesthesiologist and the surgeon. Additional steps are also performed as follows:

  • Tests

The first thing at the start C-section is to screen complete blood count. Doctors draw the blood sample for hepatitis B antigens and HIV antibodies along with screening for syphilis. In many cases, doctors take the blood sample for reference in case there might be an emergency. 

The CBC count and screen is submitted if the patient is going to have a C-section, in case of any medical history of bleeding disorders or hemorrhaging. Sometimes a coagulation profile may also be taken to help the anesthesiologist in attempting an epidural. 

Any pre-existing conditions like thyroid, or hemophilia that could affect, circulatory, cardiac or respiratory functions must be declared in advance. Some may require the blood to be cross-matched, and hence, requires blood tests.

  • Pre-operative Monitoring

A blood pressure cuff and monitors are set up to keep an eye on the patient’s pulse, oxygen, and blood pressure before giving anesthesia. A Foley catheter is placed before surgery to help the patient in releasing fluids. Preoperative antibiotics are also observed, which also reduces the risk of endometriosis after Cesarean.

  • Skin Preparation

The surgeon evaluates the skin on which the incision is made before using anesthesia. The area may require shaving if the hair causes disruptions during surgery. A chlorhexidine solution used to clean the skin can decrease the chances of a deep wound and superficial infection.

  • Anesthesia

Doctors evaluate each patient for anesthesia, and most women get general anesthesia. But it also depends on the patient’s medical history. Once the anesthesia reaches the required levels, the screen is scrubbed with 4% chlorhexidine or an iodine scrub.

  • Prevention of Complication

The outcome of the C-section depends on the gestational age. The outcome is more positive due to advances in medicine and techniques. There is a chance of cerebral palsy in the case of a C-section. An antenatal treatment is a quick treatment for cerebral palsy. Detailed study and examination of the patient can help doctors decide on the best ways to prevent fetal complications.

What happens during a Cesarean Delivery

A C-section is performed in a special delivery room or an operation theatre, and the procedures vary based on the mother’s condition and practices of the healthcare provider. Usually, the woman is awake during the procedure and only in rare cases is a woman put under general anesthesia. 

C-sections are generally performed with regional anesthesia like a spinal or epidural. Through this, the woman does not feel anything from the waist downwards, but she will be conscious and can very well hear and see the child being born. Cesarean follows the process detailed below:

  • The woman will change into a hospital gown and will be positioned on an exam or operating table.
  • The doctors can use a urinary catheter on the patient, followed by an IV line in the arm.
  • In most cases, doctors strap legs to hold the woman in the place.
  • The surgical area is shaved to remove any hair, and the area is wiped with antiseptic liquid.
  • The belly is covered in sterile material while covering the chest with a drape.
  • An anesthesiologist will be watching over-breathing, heart rate, blood oxygen level, and blood pressure.
  • Once the anesthesia is in effect, the doctor will make an incision above the pubic bone and will continue doing it while separating tissues and muscles to reach the uterine wall.
  • Then a final incision is made to the uterus.
  • The amniotic sac is cut open, and the fetus is taken out of the womb. The woman may have a pulling sensation at this time.
  • The umbilical cord is severed, and medicine to contract the uterus and removal of the placenta will be administered through the IV.
  • The doctor will remove the placenta and examine the uterus for pieces of the placenta or any tears.
  • The uterine muscles would be sutured closed, and the uterus would be repositioned in its place.
  • Muscles and the layers of tissue will also be sutured, and skin incision would also be closed up surgically. The last step is the application of a sterile bandage.

Post Operative Care

For the first 2 hours post-procedure, the vital signs are noted after every 15 minutes. The urine output is monitored regularly. The routine assessment of palpitating fundus and monitoring of vaginal bleeding. 

If a long-acting analgesic was not administered with the regional anesthetic, then narcotics can be administered intravenously or orally. The patient must get 3-4 liters of IV fluid for the first 24 hours and then gradually adding clear liquids and finally, an advanced diet. The catheter is removed between 12 to 24 hours after the surgery.

  • At Hospital 

The patient is kept under observation carefully in the recovery room. After 2 hours, she can be moved to a different room. There might be pains from gas as the intestinal tracts begin their function, and the doctor may prescribe medicines for this. The uterus will contract and get smaller, and patients will get antibiotics.

  • At Home

The woman will need to wear sanitary pads to manage the bleeding. It is normal to have vaginal bleeding and cramps post-surgery. There may be discharges that are dark in color over the next few weeks. The patient should avoid douching, intercourse or use of tampons until the doctor gives an OK. Patients must be careful and avoid strenuous activities. Patients have to go for follow up visits around three weeks post-surgery. 

The medical practitioner must be immediately informed if the woman suffers from foul-smelling liquid draining out, heavy bleeding, chills or fever, abdominal pain, leg pain, trouble breathing, palpitations or increased swelling, redness and discharge from the incision area.

Risks Associated with Cesarean Delivery

C-section is a surgical procedure, and there are risks involved. Depending on the medical condition of the patient, operation, and post-operation procedure, the risk can be short term or long term. The risks involved are as followed:

  •  Short Term Risk

The short-term risks of a C-section can be maternal death due to complications, thromboembolism (a leading cause of maternal mortality), hemorrhage or blood loss, infection, surgical injuries, extended hospital stay, pain, emergency hysterectomy, and poor birthing experience. Although doctors take care to manage these risks, there may be times when there are serious risks involved, leading to negative outcomes.

  • Long Term Risk

Long-term risks include rehospitalization due to post-surgery complications or infection of the incision. There might be pain and adhesion formation along with infertility issues.

  • Risk for Baby

The riskiest outcome of a C-section is neonatal death. Although Cesareans are quite common and babies come out fine, there may be cases where the condition of the patient or fetus deteriorates drastically, causing death. Babies can be prone to the risk of asthma, respiratory difficulties, trauma, failing to breastfeed, and Iatrogenic prematurity.

Important FAQs about Cesarean Delivery

  • Can women breastfeed after a Cesarean delivery?

Women can breastfeed after delivery. Although some babies may take time latching on and getting it established, breastfeeding is acceptable. If a woman is having difficulty in this, they can talk to the nurses and doctors to get it sorted.

  • What type of health problems can women face after Cesarean delivery?

Studies show that there is a risk of lower pelvic dysfunction in mothers with reduced urinary incontinence and pelvic organ prolapse. Also depending on the type of incision made, there is a chance of the uterus rupturing in future pregnancies.

  • Does a planned Cesarean delivery guarantee good health to both mother and child?

A planned C-section may not guarantee good health, but it helps in planning as the patient knows when the baby will be born. The risk of emergency surgery is less and provides ample planning time for a smooth procedure.

  • How difficult does it get to get pregnant again after a Cesarean delivery?

A woman must wait for a certain period before getting pregnant again, as the body needs time to heal. There should not be any difficulty in conception post-C-section unless there is a different medical condition.

  • Does Cesarean delivery leave a deep scar on the abdomen?

The answer to this question is the same as when you have a surgical procedure. Scars heal and lighten over time. A scar may or may not completely vanish, depending on the skin and the patient. For some, it lightens and cannot be seen easily, but for some, it can be seen. The focus must be on healing rather than appearance.

  • How many times can women go for Cesarean delivery?

Health risks can increase with each C-section. Research has not established a specific number of cesareans a woman can have. Each body is different and takes the surgery differently. Talk to your doctor for more information on this.

  • How long should a woman wait after a Cesarean delivery before conceiving again?

Research suggests waiting 18 to 60 months before getting pregnant again. But talking to the doctor will give you a better idea of how soon you could try for another child.

Final Thoughts

Cesarean delivery is like a surgery done when a vaginal delivery looks difficult. C-section is quite common these days and often a quick procedure. However, there is a long healing time and risk of another C-section in a second pregnancy. Studies have shown that its relatively safe and is managed well with the current medical practices and advances.

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