Cesarean Section

Description This surgical method of delivery requires that an incision be made in the mother's stomach and uterus so the baby can be removed through the incisions. Supposedly, Roman emperor Julius Caesar was born in this manner, thus, the procedure's name. Cesarean sections are a good way to manage emergency situations that put either the mother or baby, or both, at risk. This method of delivery is not recommended "on demand" as a way to avoid the labor associated with a vaginal delivery. A natural childbirth should be encouraged. If a cesarean section is inevitable, it is usually for the following reasons. Indications Maternal causes Pelvis is smaller than the baby's head. Severe toxemia of pregnancy (gestosis) An STD has infected the uterine neck or vagina, putting the baby at risk of infection if delivered naturally. Water breaks early, and the umbilical cord is exposed. Placenta previa: The placenta is blocking the uterine opening. A multiple pregnancy, which can result in possible premature birth and delays in delivery. Induced labor has failed The mother has diabetes, heart disease, high blood pressure, myoma of the uterus, or ovarian cyst, making natural birth difficult. Fetal causes Fetus is upside down or lying sideways. Abnormal pulse before or during delivery and deteriorating condition that may cause a stillbirth Fetus is too big to fit through the pelvis. Procedure If you need to have a cesarean birth, you will receive an epidural, spinal, or general anesthesia. If you have epidural or spinal anesthesia, you can be awake during your surgery and you can see your baby right after he/she is born. A presurgical fast is required for at least 8 hours, as well as a basic preoperative evaluation, such as a blood test that includes blood typing, urine test, liver function test, and an electrocardiogram. The surgical region is shaved and disinfected, and a catheter is inserted to discharge urine. An IV is started to facilitate the administration of drugs. General anesthesia, epidural anesthesia, or spinal anesthesia is then administered. The uterine incision is then made down to the amniotic sac (fetal membranes or bag of water). Once the incisions are made, the baby is removed-the fetal head or buttocks are delivered through the uterine incision, followed by the rest of the body-in 5-10 minutes The umbilical cord is cut, the placenta is completely removed before the incision is closed (the layers of the abdominal wall are sutured, and then the skin closed with either suture or staples), and the mother is taken to the recovery room after the incision has been closed. Total surgical time, from anesthesia to stitches, is 40 minutes to an hour. Complications Medical advances have greatly reduced the dangers associated with cesarean sections. Still, compared to a natural childbirth, there are risks, sometimes life-threatening for the mother, associated with this procedure. Newborn Dyspnea A baby born comfortably in the absence of labor pains, or few labor pains, has less ability to adjust to the uncomfortable and irritating outside world, and has a higher risk for developing dyspnea, i.e., difficulty breathing. During a normal vaginal birth, the baby's chest is pressed by the birth canal, pushing amniotic fluids and other secretions out of its lungs, but this action becomes weak in surgery. If the baby is parturient and healthy, problems rarely occur; if the baby is weak, it will have trouble spitting and develop dyspnea. Hysterorrhexis, Metrorrhexis The incision on the uterus may heal well, but there will be a scar on the uterine muscle and the uterus may not recover to its original state. Most scarred areas are weak and occasionally become paper thin, which can rupture during the next pregnancy or labor. The danger for rupture increases when the uterus has been cut vertically because of placenta previa and cross birth (transverse presentation). Mothers who have received vertically cut cesarean sections should remember this and remind their physician, in the event of subsequent births. Pregnancy at the region of the incision Chances are high that the next pregnancy will occur where the uterine incision was made, thereby increasing the possibility of placenta previa. If an embryonic sack grows on the outside of the incision region, there is a danger of hysterorrhexis (metrorrhexis) early in the pregnancy. Appropriate measures should be taken to avoid an extrauterine pregnancy (ectopic pregnancy). Limited Number of Operations Women often receive abdominal incisions (celiotomy, laparotomy) because of uterine and ovarian abnormalities or extrauterine pregnancies. A cesarean section adds to the overall number of surgeries. Most women who undergo a cesarean section receive another with each additional pregnancy, continuously burdening the body. Therefore, it is recommended that a natural birth be attempted with the first pregnancy.

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