by Editorial Staff and Contributors
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Definition
In a cesarean birth (C-section), the baby is delivered through an incision in the mother's abdomen and uterus (womb). In the US, 15%-40% of all births are delivered by C-section.
Parts of the Body Involved
Reasons for Procedure
The following situation may require a C-section:
- Large baby
- Maternal medical conditions (eg diabetes, high blood pressure, herpes infection)
- Placenta previa —the placenta (the organ that links the mother and the baby) blocks the path of exit from the uterus
- Multiple births
- Failure of labor to progress —labor stops before the baby is born
- Health of the baby—the baby shows signs of distress, such as a worsening abnormal heart rate during delivery
- Previous cesarean birth—in some cases after one cesarean birth, it is best to have other babies delivered by cesarean
- Fetal anomalies—fetal problems that have been diagnosed with prenatal testing
Cesarean rates can be influenced by nonmedical factors including:
- Individual philosophy and training
- Convenience of doctor or patient
- Patient's socioeconomic status
- Peer pressure
- Fear of litigation
- Financial gain
What to Expect
Prior to Procedure
C-section is often unplanned and only occurs when a problem is encountered.
Anesthesia
You will have general or regional anesthesia (eg epidural or spinal block). Many women prefer regional anesthesia so they are conscious and can see their new baby immediately.
During Procedure
- Your abdomen will be washed and shaved before the surgery
- A catheter (tube) will be placed in your bladder to empty it
- A small tube will be placed in a vein of your arm or hand to provide fluids and medication during surgery
Description of the Procedure
The doctor will make incisions in the abdomen and uterus and deliver the baby.
- There are two different types of skin incisions: vertical or horizontal
- There are three different types of incisions for the uterus:
- Low transverse incisions—most common type, usually bleed less, form stronger scars, and present less danger of rupture during future labors
- Classical incisions (high vertical incisions)—associated with the highest risk of bleeding and future rupture of the uterus, used only in emergency situations
- Low vertical incisions—used to deliver a baby in an awkward position or if the incision may need to become a classical incision
The uterus will be closed with stitches that later dissolve on their own. Stitches or staples will be used to close the abdomen.
After Procedure
The baby is immediately examined by medical personnel. Depending on the condition of you and your baby, you may be allowed to hold the baby.
After the procedure, be sure to follow your doctor's instructions.
How Long Will It Take?
45-60 minutes
Will It Hurt?
Anesthesia prevents pain during the surgery. You may feel some pressure and tugging as the uterus is opened and the baby and placenta are removed. You will receive pain medications after to manage pain.
Average Hospital Stay
2-4 days
Postoperative Care
You may require antinausea and pain medications For several days after surgery, you may need to eat a lighter, blander diet than usual You may be given special compression stockings to decrease the possibility of blood clots forming in your leg. For lung health, you may be asked to use an incentive spirometer to breathe deeply and cough frequently You'll be encouraged to walk very soon after surgery You will experience heavy vaginal bleeding, as after any delivery, and will need to use an absorbent sanitary napkin Avoid lifting anything heavier than your baby for the first weeks after surgery Delay having sexual intercourse until you've had your 6-week check-up Breastfeeding is encouraged Risks
Cesarean birth is major surgery and risks are involved. The estimated risk of a woman dying after a cesarean birth is less than one in 2,500 (the risk of death after a vaginal birth is less than one in 10,000). Other risks include:
- Infection— uterus or nearby pelvic organs, such as the bladder or kidneys, can become infected
- Increased blood loss—the average loss is about twice as much with cesarean birth as with vaginal birth
- Decreased bowel function—the bowel sometimes slows down for several days after surgery, resulting in distention, bloating, and discomfort
- Respiratory complications—general anesthesia can sometimes lead to pneumonia
- Longer hospital stay and recovery time—cesarean stay is 3-5 days in the hospital, less than 1-3 days for a vaginal birth
- Reactions to anesthesia—the mother's health could be endangered by unexpected responses to anesthesia or other medications
- Risk of additional surgeries—may include hysterectomy or bladder repair
Outcome
You should heal quickly and completely after a C-section. Talk with your surgeon about the type of incision used and its effect on future births.
You may need some help learning breastfeeding positions so that you won't put pressure on your incision. You may also notice some uterine cramping, pain, and an increase in vaginal bleeding at the beginning of nursing.
Call Your Doctor If Any of the Following Occurs
If you have just had a cesarean section, call the doctor immediately if you:
- Develop a fever
- Become dizzy or faint
- Experience nausea and vomiting
- Become short of breath
- Have pain, swelling, and redness at the incision site
RESOURCES:
American College of Obstetricians and Gynecologists
http://www.acog.org/
March of Dimes Birth Defects Foundation
http://www.marchofdimes.com
CANADIAN RESOURCES:
The Society of Obstetricians and Gynaecologists of Canada
http://sogc.medical.org/
Women's Health Matters
http://www.womenshealthmatters.ca/index.cfm
References:
Cesarean Fact Sheet. International Cesarean Awareness Network website. Available at: http://www.ican-online.org . Accessed June 10, 2008.
Cesarean section. Childbirth.org website. Available at: http://www.childbirth.org/section/section.html . Accessed June 10, 2008.
Cesarean section. Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/cesareansection.html . Accessed June 10, 2008.
Last reviewed November 2008 by Jeff Andrews, MD, FRCSC, FACOG
Last Updated: 11/17/08
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