Cesarean section, cesarean birth, or C-section is a method of surgical delivery of the baby and placenta. This method of delivery is considered when there are potential risks for vaginal delivery. This can be done as a planned C-section if risks are identified during prenatal care or in emergencies such as if ongoing vaginal delivery arrests or has life-threatening complications to the mother or the baby.
According to World Health Organization (WHO), there is a global rise in the use of the cesarean section, accounting for more than one in five (21%) of all childbirths. WHO also indicates that the number is set to increase in the coming decade. Although it is a lifesaving procedure, there are complications and risks, and it is not recommended if there is no medical requirement (1).
Read this post to know more about the indications, complications, and risks of a cesarean section procedure.
Types Of C-Section Delivery
C-sections can be of two types based on the skin incision (2).
- Horizontal or side-to-side C-section (bikini cut) is when the incision is made across the pubic hairline. This type is more frequently done since it heals well and bleeding is less compared to other types.
- Vertical or up-and-down C-section is where an incision is made from the belly button to the pubic hairline. This is often done in emergencies.
Vertical or horizontal incisions are made based on maternal and fetal health factors. Although horizontal incisions are cosmetically better, it may take more time to deliver the baby.
Indications For C-Section Delivery
C-section delivery is indicated if there is a risk to the mother or the baby during vaginal delivery. Your doctor may discuss the risks and benefits and choose the better method of delivery for you. The following conditions could be the reason for cesarean delivery (2)(3)(4).
- Labor dystocia is a condition when the labor fails to progress. Abnormally slow or protracted labor during the first stage of labor (from contractions until cervical dilation) and the second stage (from complete cervical dilation until childbirth) are common reasons for emergency C-section deliveries.
- Indeterminate or abnormal (non-reassuring) fetal heart rate tracing is an indication to do C-section delivery. Fetal heart rate during labor indicates how well the fetus is doing, and the normal rates may vary between 120 to 160 beats per minute. If the heart rate is low, or there is an issue, doctors may try giving IV fluids and oxygen to the mother or change the mother’s position to improve it. Emergency cesarean delivery is indicated if the abnormal fetal heart rate is not improved.
- Fetal macrosomia is a condition in which the baby is too large for gestational age. C-section is suggested in cases of suspected fetal macrosomia since cephalopelvic disproportions (CPD) can cause problems in vaginal delivery. CPD is when there is a size mismatch between the mother’s pelvis and the baby’s head.
- Fetal malpresentation or abnormal position of the fetus could require cesarean section since vaginal delivery can be difficult in abnormal presentations.
- Multiple gestations with twins or other multiples can indicate C-section delivery since the vaginal delivery may need more time, and there is a risk of malpresentation after one delivery.
- Placental conditions that could risk the baby’s or mother’s life and prevent vaginal delivery. Placenta previa is a condition in which the placenta completely or partially blocks the uterus neck. This may interfere with normal vaginal delivery, so a C-section is indicated. Premature detachment of the placenta, such as abruption cases, may also need C-section delivery.
- Previous classical uterine incisions or C-sections can be a contraindication for vaginal delivery since the uterine scars from a previous incision have an increased risk of rupture during uterine contractions.
- Active herpes sores in the cervix or vagina and other maternal conditions such as diabetes, high myopia with risk for retinal detachment, HIV infection, heart problems, high blood pressure, and preeclampsia are also indications for cesarean sections based on individual risk and benefits.
- Fetal conditions, such as alloimmune thrombocytopenia, may make it necessary to have a C-section. Alloimmune thrombocytopenia is a condition where there is a maternal-fetal platelet incompatibility, and maternal antibodies destroy fetal platelets, leading to severe internal bleeding in the baby. Although a C-section has a better outcome, it is not mandatory in this condition. It may often be treated during prenatal care.
- Maternal contraindications to vaginal delivery such as inflammatory bowel disease, cervical leiomyoma that could prevent vaginal delivery, large lower-uterine segment, or perineal or rectal fistula could make C-section delivery the appropriate option.
In addition to this, cesarean section deliveries can also be performed if the mother requests. Mothers may choose the most suitable delivery method after counseling with their doctor and understanding the benefits and risks of the procedure.
Risk And Complications Of C-Section Delivery
C-section is usually a safe surgical procedure. However, like any other surgery, this also has a risk of causing certain complications. The likelihood of having C-section risk may vary based on whether it is a planned or emergency procedure and maternal health status. Usually, doctors or midwives may discuss the risk and complications before the procedure.
Common maternal complications and risks of C-section delivery may include the following (5).
- Wound infection, causing pain, redness, swelling, and discharge from the incision wound.
- Excess bleeding, which may require blood transfusion or other surgical procedures to stop bleeding.
- Uterine lining infection (endometritis) causes abdominal pain, heavy vaginal bleeding, fever, and abnormal vaginal discharge.
- Latrogenic damages (damages during a medical procedure) of the bladder, kidneys, or fallopian tube may rarely occur, requiring further surgeries.
- Deep vein thrombosis (DVT) is a blood clot in the leg, causing pain and swelling. It is a rare complication of a C-section. Although it is rare, it is dangerous since the clot can move to the lungs and result in life-threatening pulmonary embolism.
Giving antibiotics before surgery to reduce infections, compression stockings, adequate mobility to prevent clots, and surgery by experienced professionals may reduce a mother’s risks of experiencing complications.
C-sections may pose the following risks to newborns (5).
- Breathing issues, especially if born before 39 weeks of gestation. However, the breathing issues usually improve within a few days in most babies, and they are closely monitored in the hospital during this period.
- Skin cuts may happen accidently while opening the uterus. This is usually minor and heals without complications.
Risks To Future Pregnancies
Most women who undergo C-sections may not have problems in future pregnancies. Some women can also safely have a vaginal delivery for their next pregnancy; it is known as vaginal birth after cesarean (VBAC). However, some women may need C-sections for their next delivery too.
Although rare, C-sections may pose the following risks to future pregnancies (5).
- Abnormal attachment of the placenta to the uterus walls, causing trouble delivering the placenta
- Previous C-section scar opening-up
- Stillbirth in rare cases
Risks and complications of C-section to mother, baby, and future pregnancy may vary depending on individual factors. You may talk to your obstetrician and gynecologist to plan future pregnancies accordingly.
Is C-Section Delivery Better Than Vaginal Delivery?
Pregnancy is a physiological process and naturally ends with vaginal delivery. Hormones and other changes prepare a mother’s body for vaginal birth. If there are no risks, opting for vaginal delivery is recommended by most healthcare providers. Cesarean sections are indicated only when there is a risk to the maternal or baby’s health or life during the vaginal delivery.
Dr. Ian Askew, Director of Department of Sexual and Reproductive Health and Research, World Health Organization (WHO), says that “Caesarean sections are critical for saving a life if the vaginal delivery poses risks. Therefore, health systems should ensure timely access for all women when required.”
Cesarean section can also be associated with slower recovery after childbirth, delays skin-to-skin contact and breastfeeding, and causes risk for future pregnancies. “However, not all cesarean sections are done at the moment due to medical reasons. Unnecessary procedures can be harmful to the mother and her baby,” Dr. Askew adds (1).
Vaginal delivery can be painful, but there are also epidural pain management options during the delivery. During a C-section, you may feel pressure such as pull and push during the procedure under spinal anesthesia, but you cannot feel pain. However, the recovery can be long and often requires pain medications while recovering from a C-section.
Tips To Prepare For Your C-Section
Robyn Horsager-Boehrer, M.D., Chief of Obstetrics and Gynecology at UT Southwestern Medical Center’s William P. Clements Jr. University Hospital, suggests the following tips for pregnant mothers to prepare for their C-section (6).
- Avoid solid food eight hours before the C-section
Restricting food intake before surgery reduces the likelihood of vomiting and aspiration. In earlier days, food and liquids were restricted before the procedure. However, recognizing the need for food or drink while physically and emotionally taxing events such as childbirth, pregnant mothers can drink water, juice, and sports drinks before surgery. Follow your doctor’s instructions since the intake of food beyond the recommended time may delay the procedure.
- Avoid shaving the abdomen or pubic area
Although many women may think shaving the abdomen or pubic area before surgery can be helpful, it is not. Razors can create minor cuts, small abrasions, or scrapes on the skin. This may increase the risk of infection after delivery. If hair removal is needed, nurses will take care of it with clippers on the surgery day.
- Shower using antiseptic soap
You may shower or bathe with special soaps, such as antibiotic soap, in the night or morning before you go for a C-section. You may purchase this soap from drug stores, or some hospitals may provide you during the pre-surgical visits. These soaps help kill the bacteria on your skin and reduce the risk of infection.
- Discuss about the incision closure
Various methods such as staples, glue, and stitches are available to close the skin incision of the C-section. You may discuss with your surgeon to know the best ways for you depending on the body characteristics. You may also ask the doctor about skin closure methods with better cosmetic results.
- Discuss pain management
Various possibilities of pain management after surgery can be discussed while planning the surgery itself. Immediately after surgery, pain medications are given through the epidural catheter (spinal pump) or IV (intravenous) route. When you begin to eat after surgery, doctors may switch to medications by mouth. Discussing the available medications for pain management earlier can keep everyone on the same page.
How Is A Cesarean Delivery Performed?
If there are indications for C-section delivery, doctors conduct pre-surgical and pre-anesthetic evaluations and plan the date for surgery. Sometimes, C-sections are done in emergencies if there are sudden complications, or the vaginal delivery is not progressing as expected.
Doctors may often ask not to consume food or drink a few hours before surgery and take a shower using antiseptic soap. Usually, pregnant mothers are asked to reach the hospital three to four hours before the surgery time. However, this may vary based on the healthcare setting policies and individual factors.
- Doctors obtain an informed consent signed by you before the procedure after informing you about the procedure, alternatives, risks, and complications. You have the right to ask any concerns and queries to the healthcare provider during this time.
- Change to a hospital scrub and check for your vitals such as heart rate, blood pressure, and baby’s heartbeat.
- IV (intravenous) line is placed on the arm to deliver medicines and fluid as per requirement.
- An antacid injection is given to neutralize stomach acid.
- Pregnant mothers are taken to the operating room approximately half an hour before the procedure. ECG leads from the chest and pulse oximeter from the fingers are connected to monitors.
- DVT pump or DVT stockings are put on legs to prevent blood clot formation.
- Spinal (regional/local) anesthesia is given in a sitting or side-lying position, and you may lay down after the anesthesia. General anesthesia is rarely given in specific situations. You may feel tingling or warmness on the legs and soon feel numb below chest level.
- A screen is placed on chest level from you to maintain the operating area’s sterility and avoid seeing the procedure.
- Oxygen mask is placed to increase the oxygen supply to the body.
- Intravenous antibiotics are given to avoid infections.
- A foley catheter (tube) is placed in the urinary tract to drain urine.
- The abdomen and pelvic area will be sterilized with antiseptic, and the incision is made on the skin and then uterus, and the baby is delivered.
- The umbilical cord is clamped, and the placenta is delivered, and the incisions are closed.
While the obstetric surgeon is closing the incision, neonatologists evaluate the APGAR score of the newborn. If the baby is stable, neonatologists place your baby on your chest for skin-to-skin contact and breastfeeding. Otherwise, they shift the baby to NICU for further evaluation and treatment.
Duration And Recovery Of C-Section Procedure
The C-section procedure may last about 45 minutes. Delivery of the baby can take as little as five to 15 minutes from the time incision is made. However, more time is needed to close the incision on the uterus and abdomen after the baby is delivered. Although C-section delivery is done quickly during emergencies, additional time is still needed to close the incisions (8).
After the procedure, the mother and baby are shifted to the post-operative area for observation. Most women are shifted to their room in two to three hours. Doctors may restrict food or drinks by mouth up to six to 12 hours after a C-section, and you may receive intravenous fluids as needed. Doctors may ask you to drink fluid and have soft foods after this time (8).
The urinary catheter is removed after 12 hours, and women are encouraged to move at this time. Most women can walk with support the next day. However, you may have to stay in hospital for three days after a C-section. It may take up to four to six weeks to recover completely after a C-section, and doctors prescribe medications for pain management during healing.
C-Section Recovery Tips
The following tips may help you recover from C-section delivery (9).
- Take pain medications as prescribed.
- Keep the incision area clean and dry. You may wash the incision area with soapy water, and pat dry it during the shower.
- Avoid using cleaning products on the incision site since this may slow down the healing process.
- If the incision is covered with tape strips, let it fall on its own.
- Physical activity such as walking or moving a little can be beneficial. However, you may avoid lifting heavy objects and tiring activities until you recover completely.
- Do not use tampons or douche until recommended by the doctor.
- Take showers to clean up. Avoid soaking in baths or using public hot baths or pools until the incision is healed and the postpartum bleeding ceases.
- Delay intercourse until recommended by the doctor.
- Consume a well-balanced, fiber-rich meal and plenty of water to cope with nutritional requirements for recovery and breastfeeding. Take the supplements as prescribed. Avoid crash diets to reduce weight immediately after delivery. You will lose weight eventually due to breastfeeding and the right diet.
Seek medical care if you have any physical symptoms such as fever, breathing issues, or incision site pain after returning home. In addition, emotional changes, such as troubling thoughts and depression, may also require medical attention in the postpartum phase.
It is ideal to opt for a C-section when the doctor suggests it due to possible risks during vaginal delivery. Discuss with your doctor about the procedure in detail and follow instructions before and after surgery as directed. Taking care of yourself in the postpartum period is as important as taking care of the newborn. Give proper rest and nutrition to your body to enhance recovery.
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