C-Section

Naturally, expectant mothers spend a lot of time thinking about how they will give birth. Although most people believe that a vaginal birth is the best way to deliver, sometimes a c-section cannot be avoided.

What is a C-Section?

Caesarean Section, or a c-section, is the surgical method of childbirth. The doctor makes an incision through the abdomen and into the uterus, which the baby is then delivered through. In cases where the mother or baby are at a risk, it can be a life saving operation.

In cases where there are known risks for labour and delivery, c-sections are usually pre-scheduled, but most of the time a c-section only happens when complications arise during labour and it becomes too risky to continue with a vaginal birth.

Some people believe that doctors schedule unnecessary Caesareans because they are faster than normal deliveries. If you feel that you are being pushed into an unnecessary c-section, it’s your responsibility to inform yourself on the potential risks of your pregnancy and what the best option is for the health of your baby and yourself. However, an increasing number of women are choosing to schedule a c-section in order to decide when it is they will give birth. This practice is met with some controversy as not all agree that an elective caesarean (one that is done without any medical need for it) is the best choice for a baby.

By and large, caesarean births take more time to recover from than vaginal deliveries. A new mother who’s had a c-section may have to stay at the hospital for a longer period of time than she otherwise would as well as spend more time resting during the first few weeks after birth. It is important to remember that a c-section is a major operation.

When is a Caesarean Delivery Necessary?

The reasons for having a c-section include:

• You have already had more than one c-section, or you have had a caesarean with a vertical incision
• You are having multiple babies
• Your baby is expected to be very large, especially when a previous delivery with vaginal birth was complicated.
• You have had uterine surgery
• Your baby is in a breech, or bottom first, position; or a transverse, or sideways, position.
• The baby has a known defect or illness that may make a vaginal birth risky
• Your placenta is low and it is covering the cervix
• You are HIV positive
• You have a serious health problem, such as high blood pressure, or diabetes

Reasons for an unplanned c-section include:

• Your cervix stops dilating and the baby is unable to move through the birth canal
• The umbilical cord slips through your cervix
• Your placenta starts separating from the uterine wall, which may block the baby’s oxygen supply
• The foetal heart rate is abnormal and it may not take the load of a continued labour
• When you go into labour, you show presence of the genital herpes virus in your body, which may infect the baby

Procedure

Once the doctor has decided to go forward with a c- section, the anaesthesiologist will review what kind of pain management will be best suited to your needs. The most common pain meds are the epidural and the spinal block. Both allow you to remain alert while dulling the pain.

A catheter will be inserted, to drain urine, an IV will be administered and after the anaesthesia takes effect, a screen will be erected to block your view of the operation.

Many hospitals and clinics allow a partner or close relative to be there while the operation is going on to lend moral support to the mother. However, if your c-section is an emergency, the operating room may be closed to all but essential personnel.

After the anaesthesia takes effect, the doctor makes a small incision on the skin above the pubic bone. This is usually a horizontal incision, but can also be vertical. Layer by layer, the tissue is incised until the uterus is reached. The lower section of the uterus is cut horizontally. Only rarely, usually when the baby is premature, is a vertical cut made.

Once the uterus is opened, the baby is pulled out, the cord is cut and the baby is examined. The doctor then removes the placenta and stitches up the wound. The final layer of the skin may be stitched or stapled. The process of closing usually takes longer than opening and could take up to 30 minutes.

Once the operation is complete, you will be moved to the recovery room, where you will be monitored for three to 4 days. You may be allowed to see your baby there, if both of you check out as healthy.

Caesarean Section Recovery

Not all caesarean sections are alike. Because of the differences in the age, operating conditions and body type, different mothers may take a longer or shorter time to recover. Since it is a major operation, a c-section is not to be taken lightly.

Initially you may have to deal with a lot of pain due to the incision, the uterine contraction and gas pain. The doctor may give you morphine to relieve some of the discomfort. You may have to continue to use pain medications for a few weeks. Your stitches will be removed in four to five days or when the doctor feels you’ve healed sufficiently.

During your recovery, you must not lift anything heavy and take as much rest as possible. Even at home, the golden rule is to rest, but also to walk around a bit, to hasten the recovery process. Some mothers have found breathing exercises are a nice way to take control of your body. Though a little exercise is important, don’t jump into your usual routine too soon.

The decision whether or not to breastfeed is totally up to you. You may start breastfeeding as early as the end of the operation, but sometimes mothers with c-sections find it hard to start because they tend to have less milk supply. Remember that the sooner you start breastfeeding, the better for both you and your child.

Generally, the caesarean scar is light pink and puffy, but continues to shrink every day. By six weeks, it will be lot smaller, about 1/16 of an inch and closer to the colour of your skin. As the scar is very low in your abdomen, it will soon be hidden by your pubic hair and not visible.

Risks

As with any other major operation, there are certain risks involved with a c-section. These are separate from personal risks such as heart problems or diabetes, which may create extra complications for a particular person.
The risks to the mother include:

• High blood loss
• Decreased bowel function
• Infection of the uterus, kidney, bladder or other pelvic organs
• Respiratory problems
• Unexpected response to anaesthesia
• Longer recovery time
• Sometimes additional surgeries such as bladder repair or hysterectomy may be needed.
• Blood clot in the pelvic organs, legs or lungs

Risks for the baby include:

• Premature birth if the due date was not calculated accurately
• Breathing problems
• Foetal injury, though this is rare
• Risk of jaundice

As just one week can make a big difference in the complete development of the baby, do be very careful as to when in the pregnancy you are having your c-section.

Vaginal Birth after Caesarean

It is a general notion that once a mother has had a caesarean section she will always have to deliver that way, but around 80% of women are able to have a vaginal delivery after having a c – section.

Some mothers worry that their c- section scar will tear during a subsequent vaginal birth. This is actually very unlikely, but be sure to talk to your doctor about doubts you might have.

The most important thing is to find a gynaecologist who is ready to cooperate with your needs and wishes, and does not rush into a c – section when a vaginal birth is a possibility.

Still got questions on Caesareans? Or do you have questions about pregnancy complications? Find answers to your questions at Pregnancy.