Cesarean

A cesarean section or C-section refers to a surgical process in which one or more incisions are created in a mother’s abdomen (laparotomy) and uterus (hysterotomy) for delivering one or more babies. A cesarean section is generally performed when a natural vaginal delivery would cause harm to the baby’s or mother’s life or health

A cesarean may either be planned in advance (elective cesarean section) or it could be performed at short notice, especially if there are certain complications associated with the labour (emergency section). An elective cesarean section is usually performed one to two weeks prior to the due date of the baby.

Reasons for Cesarean section

There are various factors that might require you to have a cesarean delivery. Some of these are:

Placenta previa

Placenta previa condition occurs when the placenta is located low in the uterus and either partially or entirely covers the cervix. It is estimated that 1 in every 200 pregnant women usually experience Placenta previa during their third trimester. The treatment basically involves bed rest and consistent monitoring. In case a complete or partial Placenta previa has been diagnosed, a cesarean is usually recommended. However, if a marginal placenta previa has been diagnosed, a vaginal delivery can be considered as an option.

Placental Abruption

Placental abruption refers to the separation of the placenta from the lining of the uterus. This condition generally occurs in the third trimester. Due to this problem, the mother will tend to experience bleeding in the site of the separation and intense pain in the uterus. This could eventually disrupt the smooth supply of oxygen to the baby. Based on the severity of the condition, an emergency cesarean may be performed.

Uterine Rupture

The uterus may tear during pregnancy or labor. This could result in hemorrhaging in the mother and disrupt the oxygen supply to the baby. This could call for an immediate cesarean.
Breech position: In the case of a breech baby, a cesarean delivery is mostly the one and only option. If the baby is premature, is in great distress or has cord prolapsed, a cesarean may be immediately required.

Cord Prolapse

A cord prolapse generally occurs when the umbilical cord slips through the cervix and projects from the vagina before the birth of the baby. The contraction of the uterus creates pressure on the umbilical cord. This, in turn, reduces the flow of the blood to the baby.

Fetal distress

One of the most common causes of fetal distress is lack of oxygen supply to the baby. In such a condition, an emergency cesarean may be performed.

Failure to progress in labor

This condition can occur when the cervix has not completely dilated, labor has either slowed down or suddenly stopped, or the baby is not in an appropriate delivery position.

Repeat cesarean

Approximately 90% of women who have had a cesarean earlier are potential candidates for a Vaginal Birth after cesarean for their next birth (VBAC). However, the greatest risk involved in a VBAC is uterine rupture. This often happens in 0.2-1.5% of VBACs. Hence, it is better to consult your doctor about your current situation and the various options.

Cephalopelvic Disproportion (CPD)

This condition occurs when the head of the baby is too large or a mother’s pelvis is too small to enable the baby to pass through.

Active genital herpes

If the mother is suffering from active genital herpes, a cesarean may be performed to prevent the baby from getting exposed to the virus while passing through the birth canal.

Gestational diabetes

Developing gestational diabetes during your pregnancy could result in a series of complications. In such cases, a cesarean would be the best option.

Preeclampsia

Preeclampsia refers to high blood pressure during pregnancy which prevents the placenta from getting the sufficient amount of blood and reduces the flow of oxygen to the baby. A cesarean is recommended in the case of severe preeclampsia.

Birth defects

If the baby has been diagnosed with a complicated birth defect, a cesarean may be performed to reduce further risks during delivery.

Multiple births

Generally, twins are delivered vaginally based on their positions, weight and gestational age. However, multiples of three or more are likely to be delivered through C-section.

Cesarean section procedure

The normal cesarean procedure generally lasts for 45 minutes to an hour. Prior to the surgery, the doctor will administer either a general, spinal, or epidural anesthetic based on the requirement.

Surgery

First of all, the doctor will create an incision in the abdomen wall. In an emergency cesarean, a vertical incision, starting from the navel to the pubic region, will be made to facilitate faster delivery of the baby. However, the most common incision is made horizontally, a little above the pubic bone. The stomach muscles will be pulled apart so that the doctor can gain easy access to the uterus.

A vertical or horizontal incision will be made in the uterus. The vertical incision is generally reserved for risky situations such as Placenta previa, emergencies, or for babies with defects. The most common incision used is the low transverse incision, which has lesser complications and enables most women to undergo a VBAC in their next pregnancy.

The doctor will then suction out the amniotic fluid and then the baby will be delivered. The baby’s head is delivered first. This enables the baby to breath smoothly. The baby will be passed on to the nurse for evaluation. Lastly, the placenta will be delivered, following which the surgical team will do the close up process.

After the Surgery

After the cesarean surgery, you might experience nausea and trembling. However, these symptoms typically pass quickly and can be succeeded by drowsiness. If your baby is completely healthy, you can start breastfeeding and bonding. The mother and the baby will be continuously monitored for any potential risks. The doctor will advise you on the appropriate post-operative care.

Risk factors/Complications for the mother

  • Infection in the incision site, uterus and in other pelvic organs.
  • Hemorrhage or increased blood loss resulting in anemia or a blood transfusion
  • Severe injury to organs such as the bowel or bladder
  • Formation of Scar tissue or Adhesions inside the pelvic region that results in blockage and severe pain. Adhesions can also lead to pregnancy risks in future
  • Extended hospital stay i.e. 3-5 days following the birth, if there are no risks.
  • Extended recovery time, ranging from weeks to even months.
  • Negative reactions to certain medications or anesthesia
  • Risk of additional surgeries such as hysterectomy, bladder repair or another cesarean
  • In the case of a cesarean, the maternal mortality rate is extremely higher than a vaginal birth.
  • Some women may experience difficulties with initial bonding with their baby.

Risks and Complications for the baby

  • Premature birth
  • Breathing and respiratory disorders
  • Low APGAR scores could be the result of anesthesia, fetal distress prior to the delivery or significant lack of stimulation during delivery
  • Fetal injury

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