Delivery by caesarian section

DOCTOR’S CORNER

 

GIVING birth through caesarean section has become popular nowadays. More and more babies are being born through this method as more women opt for the operation rather than vaginal delivery.

We will compare these two methods and look at the advantages and disadvantages of the methods later. For now, we will introduce the method to you.

A caesarean section, also known as C-section or caesar, is a surgical procedure in which incisions are made through a mother’s abdomen to deliver one or more babies. It is usually performed when a vaginal delivery would put the baby’s or mother’s life or health at risk, although in recent times it has been also performed upon request for childbirths that could otherwise have been natural.

Babies born by caesarean come out through incisions in your uterus and abdomen.

If you decide to have a caesarean, or, more likely, you are advised to have one in advance of labour, it’s called an “elective” caesarean. One that takes place after you’ve already gone into labour is called an emergency caesarean.

Reasons you might need a caesarean include:

l your baby’s head is too large to fit through your pelvis, or the baby is overly large;

l prolonged labour or failure to progress;

l the shape or size of your pelvis makes vaginal birth more difficult;

l the placenta is lying low in the uterus (placenta praevia), blocking your baby’s exit;

l you’re expecting twins or triplets (one of whom may be in a difficult position);

l your baby’s lying across the uterus (transverse), or is breech (bottom or feet first);

l once labour has begun, your baby becomes distressed (suffering from a lack of oxygen) and isn’t far enough down the birth canal for certain instrumental methods to be used such as the forceps or vacuum extractor;

l you have problems with high blood pressure in pregnancy (eclampsia or severe pre-eclampsia);

l you’re ill, or become exhausted in labour;

l the umbilical cord coming out in front of the foetal head causing strangulation (cord prolapse);

l uterine (womb) rupture from too strong contractions or other pre-existing risk factors

l HIV infection of the mother; and

l sexually transmitted infections such as genital herpes (which can be passed on to the baby if the baby is born vaginally), but can usually be treated and does not require a caesarean section).

How it’s done

You’ll be given an anaesthetic (if you haven’t had one already). The anaesthetic used may be the one that allows you to stay awake such as the epidural or the spinal anaesthetic. Sometimes a general anaesthetic is used which is when you are put to sleep.

Each of these methods have their advantages and disadvantages which you can discuss with your doctor to decide on the one most suitable to you.  

If you’re conscious, you can have someone with you in the operating theatre. Neither you nor your companion will be able to see what’s going on, as a screen will be placed across your abdomen.

The surgeon makes an incision on your abdomen, just above your pubic hairline, and cuts through the uterus. The baby is then helped out. You might feel quite a bit of tugging and pulling when this happens.

Once the baby is delivered, the cord is clamped and cut. If everything’s all right, you can hold him. The placenta and the membranes are then delivered and you are stitched up. The whole thing takes about 45 minutes.

Recovery

It’s normal to feel very tired for a few days after a caesarean and you may experience some pain, just as you would with any abdominal operation. You can take pain relief to help with this.

Recovery after a caesarean can take longer than a vaginal birth. There may also be after-effects, such as infection, which is why you’ll probably be advised to take antibiotics.

On the first day or so, you may be attached to a tube that collects any blood pooling under the scar. A drip in your arm makes sure you remain hydrated. At the very beginning, you may also need a catheter or bedpan to help you urinate.

Ask what sort of stitches you have. They may dissolve or need removing later, or you may have clips that will need removing once you’ve healed.

How you’ll feel

Some women feel disappointed at having an emergency caesarean. If you feel like this, talk to the medical staff about the reasons why a caesarean was necessary. Understanding this can sometimes help you come to terms with it.

You may have no negative feelings at all about your caesarean. This, too, is fine.

Next time

You may be able to have a vaginal birth in the future, depending on the underlying cause of your caesarean. There’s no evidence that “once a caesarean always a caesarean”.

There’s a very small risk that the scar on your uterus might start to rupture when you go into labour, but with proper care this can be spotted before it becomes a problem.

Can I choose to have a caesarean?

You won’t automatically be given a caesarean on request, but your doctor should listen to your reasoning. If your doctor and midwife are reluctant to grant your request, it may be because they feel there’s no medical reason for it.

Generally, according to international guidelines ALL women should have a trial of labour before a caesarean is considered unless there are specific medical reasons that contradict this such as if a woman has already had two previous C-sections then they cannot be allowed to go through with labour because the risk of rupture of the womb is increased.

A woman with one previous C-section will therefore be given a trial of labour. This came about because it was realised that the operation poses many risks and complications.

Understanding what happens during birth might be one way of coping with any anxieties you have about vaginal birth. As mentioned above, we are going to have a feature highlighting the advantages and disadvantages of vaginal delivery compared to caesarean section.

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