A cesarean section, also known as a C-section is the procedure where surgery is used to deliver the baby. This medical process is generally necessary when a normal delivery could put the baby or the mother at risk. There are several reasons – twin birth, high blood pressure in the mother, breech position or problems with the placenta or umbilical cord. This delivery process is undertaken when there is any likelihood of danger to the mother or the infant’s well being.
Frightening as it may sound, for both the mother and the family, the C-section made its inception centuries ago. Ever since, ample number of deliveries through surgery have been performed world over. In recent times, the number of C-section deliveries in India are reported to be increasing, and there are many factors that account for it. However with the advancement of science and technology, there is no reason to fear a delivery through surgery, if it is the need of the hour.
Why Do Some Women Have A Scheduled/Planned C-Section?
There are a few medical conditions where the doctor recommends that the patient undergoes a cesarean delivery. For example a patient could be advised to undergo a C-section if:
- The mother has had a case of “vertical uterine incision”(a very rare case).
- The mother has had one or more C-sections previously.
- It is a precious pregnancy, conceived after many previous attempts/ birth loss.
- Medical problems in the mother wherein the continuation of the pregnancy/normal delivery may result in endangered well-being of both the mother and the child.
However, if the mother has had only one cesarean delivery with a “horizontal uterine incision” before, and if sufficient time has lapsed, one could consider normal delivery as an option after seeking medical advice.
A few other cases that demand a C-section delivery are if:
- The mother has had some other kind of uterine surgery for the removal of fibroids.
- The mother is carrying more than one baby (medical advice needed).
- The baby is in breech (baby is coming down with the leg first) or transverse position (baby is coming out shoulder first).
- The mother is near full term but has placenta previa (a low placenta in the uterus that covers the cervix ).
- There is an obstruction, such as a large fibroid.
- The baby has some malformation or abnormality that could cause a risk during normal delivery.
- The mother is HIV positive or has had early pregnancy complications.
In these cases, the doctor would strive to deliver the baby after week 39, so as to ensure complete development of the baby, unless there is some medical condition that requires early attention.
Why Do Some Mothers Have A Sudden/Unplanned C-Section?
There are a few cases that could call for an emergency C-section and can only be decided by the doctor. A few of these conditions are:
*If the patient contracts genital herpes while going into labor or if the water breaks, it is safer to deliver the baby by a C-section to avoid infection.
*If the cervix stops dilating or if the baby stops moving down the birth canal.
*If the baby’s heart rate during labor is a cause of concern.
*If the umbilical cord slips through the cervix (prolapsed cord), creating the risk of oxygen supply to the baby being cut off.
*If the placenta starts separating from the uterine wall (placental abruption), again risking the supply of oxygen to the baby.
What Are The Risks Involved?
Though C-section deliveries are prevalent in our country, one must understand that it is a major surgery and does involve certain risks to both mother and child. A few of them are:
*Breathing problems for the baby (if the surgery is carried out before the 39th week)
*Injury to baby during surgery
*Longer healing time for the mother
*Probability of infection due to surgery
Preparation For A C-Section
In most cases, the doctor or medical practitioner sits the anxious patient and the family down for a briefing section and explains the medical reports of the patient. The family representative is generally asked to sign a consent form.
As with all pregnancies, prenatal appointments with a doctor involve routine health check-ups and blood checks that determine the health condition of the mother and the baby and could suggest if a C-section is warranted.
The doctor would make a record of the type of blood group of the mother (just in case a blood transfusion may be required during the surgery, which is a rare phenomenon). An anesthesiologist will review various options, as it is rare these days for one to be given general anesthesia, unless there arises an extreme emergency, or if the patient cannot have an epidural or a spinal block.
The patient is prepared for the operation. A catheter is inserted into the urethra to drain urine during the procedure and IV is started for fluids and medicines. The top section of the pubic hair is shaved before entering the operation theater. In some cases, the patient is asked to drink an antacid before the surgery, as a precautionary measure.
Antibiotics are administered through IV to help prevent infection after the operation. Anesthesia is administered to numb the body below the waist and the patient is ready for surgery. A screen is raised above the waist to avoid the patient from beholding the incision. The patient is fully aware of what is happening to her, but she cannot feel the pain.
Once the anesthesia has taken effect, the belly is wiped/rubbed with antiseptic and the doctor begins by making a small ‘C’ incision above the pubic bone. The doctor then cuts through the tissue and slowly moves down towards the uterus. She then separates the muscles to feel the uterus. She again makes a small incision called the low- transverse uterus incision. Then the doctor gently pulls out the baby. Once the cord is cut the mother is made to view the baby for a brief moment before the baby is handed over to a pediatrician or nurse. The next step would be to remove the placenta and close up the incision which would all take about 30 minutes.
The uterus is closed with stitches that will dissolve over a period of time. The final layer or the skin is closed up with either stitches or staples that are removed within a week’s time. In some cases, the doctor may choose to use dissolvable stitches. After the surgery, the patient is wheeled into a recovery room where she is closely monitored for at least 12-24 hours. The patient will be on IV until she starts eating. If the baby is doing fine, he will be placed beside the mother in the recovery room and a bystander will be permitted to stay close by.
A mother who undergoes a C-section may have to stay longer at the hospital (3-5 days) than one who has undergone a normal delivery. Further, as her physical moment is restricted, extra help and support will be required for both the mother and the child. Breastfeeding can be done comfortably if the mother and the baby lie facing each other.
Postoperative pain is generally controlled by IV and prescribed safe, painkillers. The patient is encouraged to walk a few steps each day. It aids in faster healing and preventing blood clots and constipation.
Once a patient is discharged, she is expected to take as much rest as possible. Few other precautions include:
- Avoid climbing the stairs.
- Using correct posture to support the abdomen (using a postpartum recovery garment, sitting straight or with back support – a small pillow or rolled up towel in the hollow of the back, using supportive pillows for nursing).
- Drinking plenty of fluids (vegetable and meat soups, fresh fruit juices, milk).
- Taking medication as prescribed.
- Going for a follow-up session to the doctor.
- Avoiding sex for 4-6 weeks.
- Having someone to help do chores at home and to help with baby care.
One must seek medical help or consult a doctor if one experiences any of the following symptoms:
- Swelling, redness or discharge at the incision.
- Breast pain accompanied by a fever.
- Foul smelling vaginal discharge or bleeding with large clots.
- Abdominal pain due to residues.
- Pain while urinating
Though childbirth is a period that every mother eagerly awaits, it brings along its own set of difficulties and anxieties especially when it is a C-section delivery. The mother’s movement is restricted for a long period and this makes her dependent on external help. Following a routine can help to speed up the recovery. It is important that the new mother gets plenty of rest, takes extra care while getting out of bed/ lying down, avoids lifting weights and doing exercise for a few months. Incorporating more fresh and seasonal fruits into the mother’s diet in addition to coconut water, aids in the healing process. .After all, the better the care, the quicker the recovery!