Obstetrics - Physician care

 

Cesarean section

There are many reasons why a cesarean birth may be used to deliver your baby. It may be the best approach for both you and your baby. A cesarean delivery may be planned in advance when certain conditions are known. In some cases, if problems arise, the decision is made during labor. Sometimes a woman requests a cesarean delivery without a clear-cut medical indication. This “cesarean section by patient request” is a complex issue that should be carefully considered and discussed with the doctor and/or midwife.

Cesarean sections are indicated for many reasons:

 

• Multiple gestation: women having two or more babies may need to have a cesarean delivery. Many women having twins are able to have a vaginal delivery. However, if the babies are being born too early or are not in good positions in the uterus, a cesarean birth may be needed. The likelihood of having a cesarean birth increases with the number of babies a woman is carrying.
• Failure to progress: about one third of cesarean births are done because labor does not progress normally. In these cases, contractions may not open the cervix enough for the baby to move through the vagina. Sometimes, the doctor can start or speed up labor with medication if labor is moving slowly. It may take a number of hours to determine that labor is not progressing well. Because of this, doctors may watch for several hours before deciding a cesarean birth is needed.
• Abnormal placenta: placenta previa is a condition in which the placenta is below the baby and covers part or all of the cervix. This will block the baby's exit from the uterus. Another problem that may arise is placental abruption. This is when the placenta separates before the baby is born and cuts off the flow of oxygen to the baby. Both of these conditions can cause heavy bleeding and may require a cesarean birth.
• Previous cesarean birth: having had a cesarean birth before plays a part in whether you will need to have one again. Many women who have had a cesarean birth before may be able to give birth vaginally. However, a vaginal delivery after a previous cesarean delivery is not a good option for women when there is a significant risk of rupture of the uterus. In deciding if you can have a vaginal delivery after having had a prior cesarean delivery, one factor is the type of incision in the uterus—not the skin incision—used in your previous cesarean delivery. Sometimes, a vertical incision is used (called a classical incision) which will increase the risk of the uterus rupturing in labor. If you have had this type of incision, you should not try to deliver vaginally.

The procedure

At Danbury Hospital, your birth partner may stay with you in the operating room for the cesarean birth. Patients are limited to one birth partner only. However, this may depend on whether you are awake for the surgery and the urgency of the surgery. Birth partners are generally no permitted in the cesarean section room when the surgery is performed as an emergency.

 

Before you have a cesarean delivery, a nurse will prepare you for the operation. You may be given a medication that will help reduce acid in your stomach. This will help prevent stomach acids from entering your lungs and causing problems. Your abdomen will be washed and may be shaved. A catheter (tube) is then placed in your bladder. Keeping the bladder empty lowers the chance of injuring it during surgery. An intravenous (IV) line will be put in a vein in your arm or hand. This allows you to get fluids and medications during the surgery.

 

Anesthesia will be given so that you do not feel pain during surgery. You will be given either general anesthesia, an epidural block, or a spinal block. If general anesthesia is used, you will not be awake during the delivery. An epidural block numbs the lower half of the body. An injection is made into a space in your spine in your lower back. A small tube may be inserted into this space so that more of the drug can be given through the tube later, if needed. That way, you won't need to be given another injection. A spinal block is similar to the epidural block. It also numbs the lower half of your body. You receive it the same way, but the drug is injected directly into the spinal fluid.

 

The type of anesthesia used depends on many factors, including your well-being and that of your baby. The doctor will talk with you about the types of anesthesia and take your wishes into account.

 

The doctor will make an incision through your skin and the wall of the abdomen. The skin incision may be transverse (horizontal) or vertical, just above the pubic hairline. The muscles in your abdomen are moved and, in most cases, do not need to be cut. Another incision will be made in the wall of the uterus. The incision in the wall of the uterus also will be either transverse or vertical. When possible, a transverse incision in the uterus is preferred because it is done in the lower, thinner part of the uterus and results in less bleeding. It also heals better. Sometimes, however, a vertical incision is needed—for instance, if you have a very premature baby and the baby's head is not in the vertex (head down) position.

 

The baby will be delivered through the incisions, the umbilical cord will be cut, and then the placenta will be removed. The uterus will be closed with stitches that will dissolve in the body. Stitches or staples are used to close your skin.

 

Like any major surgery, cesarean birth involves risks. These problems occur in a small number of women and usually are easily treated:

• The uterus, nearby pelvic organs, or skin incision can get infected.
• You can lose blood, sometimes enough to require a blood transfusion.
• You can develop blood clots in the legs, pelvic organs, or lungs.
• Your bowel or bladder can be injured.
• You can have a reaction to the medications or types of anesthesia that are used.
  

 

After the birth

If you are awake for the surgery, you can probably hold your baby right away. You will be taken to a recovery room or directly to your room. Your blood pressure, pulse rate, breathing rate, and abdomen will be checked regularly. If you are planning on breastfeeding, be sure to let your doctor or nurse know. Having a cesarean delivery does not mean you won't be able to breastfeed your baby. You should be able to begin breastfeeding right away.
You may need to stay in bed for a while. The first few times you get out of bed, a nurse or other adult should help you. Soon after surgery, the catheter is removed from the bladder. You will receive IV fluids after your delivery, until you are able to eat and drink. The abdominal incision will be sore for the first few days. Your doctor can prescribe pain medication for you to take after the anesthesia wears off. There are many different ways to control pain. Talk to your doctor about your options.

 

A hospital stay after a cesarean birth is usually 2-4 days. The length of your stay depends on the reason for the cesarean birth and on how long it takes for your body to recover. When you go home, you may need to take special care of yourself and limit your activities. It will take a few weeks for your abdomen to heal. While you recover, you may have:

• Mild cramping, especially if you are breast-feeding
• Bleeding or discharge for about 4–6 weeks
• Bleeding with clots and cramps
• Pain in the incision
  

 

To prevent infection, for a few weeks after the cesarean birth you should not place anything in your vagina or have sex. Allow time to heal before doing any strenuous activity. Call your doctor if you have a fever, heavy bleeding, or the pain gets worse.

 

Back to top ^