Cesarean Section

The cesarean section (also spelled as caesarean and c – section for short) is a surgical operation where the newborn baby is delivered through an incision in the abdomen and uterus. This type of surgery is also called:

  • Cesarean delivery
  • Cesarean birth

caesarean-section

Types of cesarean cuts

Classical cesarean section

The classical cesarean section is performed during the early weeks of pregnancy. This type of incision enlarges the space to deliver the newborn.  It involves a longitudinal incision on the midline, leaving the lower part of the uterus unformed.

Mothers who underwent the classical cesarean section are safe to have an elective repeat section for the succeeding deliveries.

Lower uterine segment section

The lower uterine segment section is the most commonly performed cesarean cut, since it lessens the instances of blood loss and other complications. It involves a transverse incision just above the upper part of the bladder.

Pregnancy week by week

Mothers who underwent a lower uterine segment section are safe and allowed to consider having a vaginal birth in their next pregnancy.

Cesarean hysterectomy

The cesarean hysterectomy is a cesarean delivery which is accompanied by total hysterectomy (complete removal of the uterus). This type of uterine incision is done when the placenta is firmly attached to the uterus, which causes intractable bleeding.

Pfannenstiel incision

The Pfannenstiel incision (also called as bikini line incision) involves a slightly curved horizontal cut (transverse suprapubic approach) just above the pubic symphysis.

This type of uterine incision is done for Hernia repair and aesthetic purposes (for the scar to be hidden behind the pubic hair).

EXIT procedure

The EXIT (ex utero intrapartum treatment) procedure is considered as a specialized cesarean delivery surgery. The EXIT procedure is performed to deliver a baby with an airway compression.

Misgav Ladach method

The Misgav Ladach method for cesarean section involves a straight transverse incision above the pubic symphysis (higher than the Pfannenstiel incision) where the midline together with its subcutaneous tissue is left untouched.

The Misgav Ladach method is developed by Michael Stark which is based on the modified Joel Cohen incision. The name came from the general hospital in Jerusalem where Michael Stark works as a director.

Classifications of the Cesarean delivery section

Planned cesarean

A planned cesarean (also called as scheduled cesarean) is when the operation is arranged ahead of the estimated due date, usually after the 39 weeks of gestation.

Emergency cesarean section

An emergency cesarean section is when a vaginal / natural birth has been planned in advance. However, the indication of a cesarean delivery is likely to be considered.

Resuscitative hysterotomy

A resuscitative hysterotomy (also called as peri – mortem cesarean delivery) involves resuscitation and removal of the aortocaval compression spawned by a gravid uterus.

This type of cesarean section falls under the emergency cesarean delivery. Resuscitative hysterotomy is performed in cases of maternal cardiac arrests, where the mother’s welfare comes first before the baby.

Cesarean delivery on maternal request

Cesarean delivery on maternal request (CDMR) is considered as an unnecessary cesarean operation. This is because only the pregnant mother has suggested and requested to undergo the procedure without any medical factors to consider why.

Vaginal birth after cesarean

Did you know that about 90% of women who underwent cesarean deliveries are candidates for vaginal birth after cesarean (VBAC)? VBAC is the practice of birthing an infant vaginally.

In fact, mothers who had a previous cesarean section are more likely to undergo the same birthing operation in subsequent pregnancies compare to those who did not.

Factors which lead to a scheduled Cesarean birth section

There are many reasons why an expectant mother needs to schedule for a Cesarean birth section (whether she requests for it or not). A medical practitioner will explain why a Cesarean delivery is necessary due to the following contributing factors:

Pregnant in multiples

Most women who are pregnant in multiples (that is twins, triplets, and the like) are required to undergo a cesarean delivery due to the following contributing factors:

  • Having a very difficult and prolonged period of pushing during labor
  • When the first twin is not in a head – down position during the starting point of labor

Breech birth

A breech birth (also called as bottom – down position) refers to the birth of a baby in a breech presentation. This type of fetal positioning and presentation is when the buttocks and feet are burrowed deep in the pelvis.

The breech presentation imposes risks to the baby, if birth vaginally (vaginal breech birth) which is why cesarean delivery must be scheduled.

Certain chronic conditions

Scheduling a cesarean delivery for women who suffer from certain chronic conditions is necessary. This is because a vaginal delivery for this matter is dangerous and stressful to the body. In line with this, such chronic conditions are:

  • Cardiovascular diseases
  • Diabetes
  • Hypertension
  • Kidney diseases

Pre – eclampsia and eclampsia

Expectant mothers who left a pre – eclampsia and eclampsia untreated are required to undergo a cesarean delivery to protect both the mother and the baby.

Various congenital conditions

Women who are affected with various congenital conditions are required to schedule a cesarean delivery. This is because a certain congenital disease imposes risk to the baby during the course of labor and delivery.

Various infections

Women who are affected with various infections are required to schedule a cesarean delivery. This is because viruses can be transmitted to the baby during the course of delivery. In line with this, such viruses are:

  • HIV positive
  • Active genital Herpes infection

Macrosomia

Macrosomia is the medical term for a big baby. It is a labor complication where the baby’s size is too large for his gestational age.

Expectant mothers with macrosomic baby – to – be’s are necessary to schedule a cesarean delivery. This is because the baby – to – be will likely have a hard time to move through the birth passage.

Obesity

Expectant mothers who are obese are necessary to schedule a cesarean delivery due to the following contributing factors:

  • Obesity often accompanied with gestational diabetes
  • Obese expectant mothers tend to have prolonged labors which increase the risks of ending up in the operation anyway

Older expectant mothers

The more an expectant woman’s age increases, so does the risk of undergoing a cesarean delivery. Although being older does not guarantee and/or require the said operation.

Various placental complications

Expectant mothers who suffer from various placental complications are required to schedule a cesarean delivery, since it is the safest operation way out. Enlisted below are the different forms of placental complications:

  • Placenta previa
  • Placental abruption
  • Placenta Accreta

Process of the Cesarean birth

After the doctor has listed the factors why the Cesarean delivery section is necessary, the patient will be asked to sign a consent form. If the pre – natal practitioner is a midwife, the patient will be referred to an obstetrician – gynecologist to perform the following:

Pre – surgery

  1. The anesthesiologist comes to review the patient’s pain – management opitons. Then the laboring mother is administered with anesthesia, depending on her situation. There are different types of anesthesia:
  • General anesthesia – is normally used for emergency cesareans due to its quick effectivity while the mother – to – be is sedated
  • Regional anesthesia – is commonly used since it allows the mother to be awake during the process of cesarean birth. This then allows her to interact with the newborn as soon as the operation has ended. In fact, regional anesthesia is used in 95% of all cesarean deliveries
  • Spinal anesthesia – is a type of regional injection using a local anesthesia into the subarachnoid space
  • Epidural anesthesia – is a type of regional anesthesia that blocks the nerve impulses to numb the lower part of the spine
  • Combined spinal and epidural anesthesia (CSE) – is a regional anesthetic technique from the name itself, is a combination of spinal and epidural effects

To ensure the patient’s complete numbness, she will be given extra medication before the surgery begins.

  1. Routine intravenous (IV) lining is placed in a vein on her hand or arm to supply fluid and medication.
  2. The operating room staff inserts catheter into the urethra to drain and collect urine.
  3. For precautionary measures, the patient will drink an antacid medication. An antacid neutralizes the gastric acid to leave the lung tissues undisturbed.
  4. Then sterile drapes are placed over the abdomen. Some hospitals provide a sterile garb outfit for the patient’s doula or husband and they are allowed inside the cesarean section.
  5. A screen is raised above the patient’s waist, to block the patient’s view as the incision being made (the patient may request to lower or remove the screen if she opts to witness the Cesarean process).
  6. The abdominal hair is shaved if necessary and is cleansed with an antiseptic solution.

During the surgery

  1. The doctor makes an incision through the abdominal wall (the type of incision depends on the doctor and the patient’s situation).
  2. Abdominal muscles are separated manually.
  3. Then the uterus is incised and the amniotic fluid is suctioned out.
  4. The newborn is delivered with his head first, then his nose and mouth are cleaned out to allow him to breathe.
  5. Once the umbilical cord is cut, the doctor lifts and hands the newborn safely to the mother. However, most doctors transfer the newborn onto the nurse or pediatrician for evaluation.
  6. Afterwards, the placenta is delivered.
  7. Then the suturing process begins which can last for 30 minutes.

After the surgery

  1. The patient is wheeled into the recovery room for close monitoring
  2. Anesthesia is administered again.
  3. Antibiotics are applied in the routine IV lining to prevent infection (most of the hospitals require giving the said medicine before surgery). Fluids will also be supplied until the newborn mother can eat and drink normally again.
  4. After the fetal examination, the pediatrician or nurse hands the newborn to the doula or husband. If the baby turns out fine, they can visit and be with the mother inside the recovery room

Cesarean birth recovery

The uterine sutures will dissolve in the body and the belly skin’s surface is closed with sutures or staples. The surface sutures and staples are removed after 3 – 7 days, some doctors use sutures that dissolve on their own.