What is a caesarean section?
In this procedure, a doctor makes an incision in a woman's abdomen and uterus and removes her baby through it.
Why might I need a caesarean delivery?
Doctors often don't decide to perform a c-section until labour has begun, but
that doesn't mean it's an emergency procedure. Most commonly it's something the
medical staff simply couldn't anticipate until labour was underway.
• The cervix stops dilating (arrest of dilation) or the baby stops progressing down the birth canal (arrest of descent in labour) and appropriate attempts to stimulate uterine contractions to get things moving again have failed.
• The baby's heart rate becomes irregular and the doctor determines (if she is unable to correct the situation) that the baby may not be able to withstand continued labour and a subsequent vaginal delivery.
• The umbilical cord prolapses, or slips through the cervix, where it becomes compressed, thus decreasing the baby's oxygen supply.
• If there are signs that the placenta is starting to separate from the uterine wall, a c-section is done because the baby will be in danger, as well as there being bleeding from the mother.
Under what conditions would I have a planned c-section?
Sometimes it's clear that a woman will need a cesarean even before she goes into labour. Some of the conditions that may necessitate a planned c-section include:
• There is a maternal history of invasive uterine surgery such as having had a fibroid removed [myomectomy]
• The baby is in a breech (bottom first) or transverse (sideways) position. (In some cases, a breech baby may still be delivered vaginally.)
• There are three or more fetuses.
• The mother has a low lying placenta or a placenta praevia (when the placenta is implanted so low in the uterus that it blocks the baby's exit through the cervix).
• At the time of labour, the mother is having an outbreak of genital herpes, which could be passed along to a baby delivered vaginally.
• A mother's hypertension is rapidly worsening, making it dangerous for her to delay delivery.
• The baby has a known fetal illness or abnormality that would make a vaginal birth risky.
• The baby is expected to be very large, especially in the case of a diabetic mother or if the mother had a previous fetus of the same size or smaller who suffered serious trauma during delivery.
What should I expect during a c-section?
Once the anesthesia takes effect, the doctor usually makes
a small horizontal incision in your skin above your pubic bone (called a bikini
cut), and then makes a second cut in the lower section of your uterus. Then,
it's time for your baby to make his entrance. The doctor eases him out, lifting
him so you get a glimpse of him before he's handed off to be cared for by a
pediatrician or nurse. While the staff is examining your baby, the doctor
delivers the placenta. You will be awake [if you are not given GA] and could
talk to your doctor as well as the anaesthetist.
Why a spinal anaesthesia and not general anaesthesia?
This is one of the most common questions that we face just before a caesarean section. lot of patients are apprehensive that a spinal anaesthesia [SA] could give rise to back pain later. This is untrue and there are a number of benefits of SA.
In fact most patients who were initially reluctant to have SA find after the procedure that they were very comfortable with the SA and really have no regrets
How will I recover after a C-section?
This all applies to a routine and uncomplicated case of course.
Your next delivery
Will your next delivery have to be by caesarian section? Not necessarily- if your c-section was for a "non recurrent" indication you may try for a VBAC [vaginal birth after caesarian section]. By non recurrent I mean a reason such as fetal distress where your baby's heart rate had dropped and that was what made you require a c-section. This is a reason that need not HAVE to happen the next time. However if your caesarian was done because your baby was not fitting into your pelvis then it is very likely that you will have a repeat c-section a your next delivery. This is because second babies are usually larger and if the first baby was not fitting then it is highly unlikely that a larger second baby would.