Caesarean section, also known as C-section or caesarean delivery, is a very common surgical procedure used to deliver a baby. A caesarean section is often necessary when a vaginal delivery would put the baby or mother at risk. Caesarean section is one of the oldest and most controversial surgical procedures and many individuals are still have questions about this very old procedure.
Types of caesarean sections
A caesarean section is a procedure used to deliver a baby through incisions in the mother’s abdomen and uterus. In most cases a C-section is a life-saving option procedure, despite the many controversies associated with it.
The obstetrician might recommend that a pregnant woman needs a planned caesarean section. This is often termed elective. In some cases, the C-section is done as an emergency procedure often when it is considered that a vaginal delivery of the baby is too risky.
The clear majority of planned C-sections are done around the 39th week of pregnancy.
Reasons for caesarean section
Many pregnant women have a successful vaginal delivery, but there are instances when this is not possible. There are many reasons for a caesarean section. They include the following:
• Abnormal position of the developing fetus such as transverse lie, where the baby is in the wrong position
• The placenta or afterbirth is very low (placenta praevia)
• You have pregnancy-related high blood pressure (pre-eclampsia)
• You have certain infections such as a first genital herpes infection occurring late in pregnancy
• abnormalities or scars in the uterus
• The baby is not getting enough oxygen and nutrients. Sometimes this may mean the baby needs to be delivered immediately (fetal distress)
• The woman’s labour is not progressing, or there is excessive vaginal bleeding
• There is a problem with the umbilical cord, for instance, cord prolapse
Risks associated with C-sections
A caesarean section is generally a very safe procedure but, like any type of surgery, it does carry a risk of complications.
The level of risk will depend on things such as whether the procedure is planned or carried out as an emergency, and the general health of the pregnant woman.
Risks to the pregnant woman
Some of the main risks to the pregnant woman having a caesarean include:
• infection of the womb (common) – causing redness, swelling, increasing pain and discharge from the womb
• infection of the womb lining (common) – symptoms include a fever, tummy pain, abnormal vaginal discharge and heavy vaginal bleeding
• excessive bleeding (uncommon) – this may require a blood transfusion in severe cases or possibly further surgery to stop the bleeding
• deep vein thrombosis (DVT) (rare) – a blood clot in the leg which can cause pain and swelling and could be very dangerous if it travels to the lungs (pulmonary embolism)
• damage to urinary bladder or the tubes that connect the kidneys and bladder (rare)
Women are now given antibiotics before having a caesarean which should mean infections become much less common.
Risks to the baby
A caesarean does not affect the risk of some of the rarest and most serious birth complications such as an injury to the nerves in the neck and arms, bleeding inside the skull, or death.
A caesarean can sometimes cause the following problems in babies:
• a cut in the skin (common) – this may happen accidentally as the womb is opened, but it is usually minor and heals without any problems
• breathing difficulties (common) – this most often affects babies born before 39 weeks of pregnancy; it will usually improve after a few days and the baby will be closely monitored in hospital
Risks to future pregnancies
Women who have a caesarean will usually have no problems with future pregnancies.
Most women who have had a caesarean section can safely have a vaginal delivery for their next baby – known as vaginal birth after caesarean (VBAC). Sometimes another caesarean may be necessary.
Although uncommon, having a caesarean can increase the risk of certain problems in future pregnancies, including:
• the scar in your womb opening up
• the placenta being abnormally attached to the wall of the womb, leading to difficulties delivering the placenta
• stillbirth
Do you have to go to sleep to have a C-section?
It depends. Most obstetricians prefer to perform a C-section when the patient uses a spinal or epidural as a form of anaesthesia. This mean you will be awake, but the lower part of your body is numbed so you would not feel any pain. In some cases, the anaesthetist might prefer for the patient to have a general anaesthesia.
The procedure
The operation usually takes between 40 and 60 minutes from start to finish.
The obstetrician will make an incision through the abdominal wall. It is usually done horizontally near the pubic hairline (bikini incision). If a large incision is needed or your baby must be delivered very quickly, the doctor might make a vertical incision from just below the navel to just above the pubic bone. Your doctor will then make incisions – layer by layer – through your fatty tissue and connective tissue and separate the abdominal muscle to access your abdominal cavity.
Uterine incision The uterine incision is then made — usually horizontally across the lower part of the uterus (low transverse incision). Other types of uterine incisions might be used depending on the baby’s position within your uterus and whether you have complications, such as placenta praevia — when the placenta partially or completely blocks the uterus. The fetus/baby is then delivered through this incision.
The obstetrician would then close all incisions made.
Recovering from a caesarean
Recovering from a caesarean usually takes longer than recovering from a vaginal delivery. You might need to stay in hospital for two or three days, compared with one or two days for a vaginal birth. Pain after surgery might be severe requiring painkillers.
The patient will need more assistance when she goes home and might need to avoid some activities.
Caesarean section rates
The Caesarean section rates vary from one country to another . It is illogical to expect all countries to have the same caesarean section rate as the profiles of patients vary tremendously from one country to another. Is important to avoid unnecessary section but this should not be done to make vaginal delivery unsafe for the pregnant woman and her offspring.
Conclusion
If you are pregnant, knowing what to expect during a C-section — both during the procedure and afterward — can help you prepare and have a successful pregnancy and delivery. A Caesarean section is a surgical procedure in which a baby is delivered through a mother’s abdomen. Most C-sections in Anguilla are carried out because of a risk to mother or child. As with any surgical procedure, there are benefits and disadvantages to C-sections that need to be carefully considered.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field ARE ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge MB BS DGO MRCOG, is an Obstetrician/Gynaecologist and Family Doctor who has over thirty-two years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
