by Karen Schroeder, MS, RD
Anatomy and Physiology
A vaginal delivery is the natural and preferred method of giving birth. Delivery begins with labor. During labor, the uterus contracts to push the baby through the cervix and into the vagina. The vagina, or birth canal, enlarges to allow the baby to pass through and be delivered.
During pregnancy, the placenta, which filters nutrients from the mother's blood, is the source of nourishment for the fetus. The umbilical cord extends out from the baby's navel and connects to the placenta. After the baby is delivered, the umbilical cord is clamped and cut, and within the next 20 minutes the placenta is delivered.
Reasons for Cesarean Section Procedure
Sometimes a vaginal delivery is not possible or safe for the mother or the baby. In these cases, a baby can be delivered by cesarean section, also called C-section. This is a surgical procedure in which incisions are made in the mother's abdomen and uterus, and the baby is gently removed directly from the uterus.
Common reasons for cesarean section include: prolonged and unproductive labor, possibly due to weak contractions or a baby's head that's too large for the birth canal; breech presentation, where the baby is lined up to come out buttocks first, instead of head first.
Another common indication for cesarean section is fetal distress. This is when a baby's health is in danger from receiving insufficient oxygen from the placenta through the umbilical cord.
Fetal distress is usually detected by abnormal changes in the baby's heart rate and may occur for a variety of reasons. For example, the baby may become distressed if the umbilical cord: is tightly wrapped around the baby's neck; is compressed between the uterine wall and part of the baby's body; passes through the birth canal before the baby, known as a prolapsed umbilical cord.
Problems with the placenta may also lead to cesarean birth. These include: placental abruption, where the placenta separates from the uterine wall too soon, decreasing the baby's oxygen supply, placenta previa, where the placenta is too low in the uterus and blocks the cervix and birth canal.
Other conditions that may require a cesarean section include: two or more babies in the womb, active genital herpes or other infections, uncontrolled diabetes or hypertension, severe heart disease, Rh blood incompatibility, previous cesarean delivery, though many women who have had an uneventful cesarean section may safely deliver vaginally in the future.
Your doctor may use ultrasound testing and a fetal heart monitor to help decide if your baby should be delivered by cesarean. If vaginal delivery is deemed too risky, a cesarean delivery will be recommended.
In some cases, your doctor may try other means before resorting to a cesarean. If labor is not progressing, for example, walking around may promote uterine contractions. Another option is to use the drug oxytocin, also known as Pitocin-AE, to increase the force of contractions. If the baby is breech, your doctor may try to reposition the baby manually. If these attempts to induce a vaginal delivery are unsuccessful, you may need a cesarean.
Your doctor may determine that a cesarean delivery is necessary sometime during your pregnancy, in which case he or she will schedule a date for surgery, usually as close to your due date as possible.
Often, however, the decision to do a cesarean arises once labor has begun and there are signs that a vaginal delivery would be unsafe. This is called either an urgent or emergent cesarean section depending on the indication and how quickly delivery needs to occur.
In the days leading up to a previously scheduled cesarean section: arrange for a ride to and from the hospital and for help at home as you recover. Pack a bag for at least a three-day stay in the hospital. The night before, eat a light meal and do not eat or drink anything after midnight. If you take any medications, herbs, or dietary supplements, your doctor may recommend temporarily discontinuing them. Do not start taking any new medications, herbs, or dietary supplements before consulting your doctor.
Before surgery, an IV line will be inserted to provide fluids and administer medications. Your abdomen will be washed and a portion of your pubic hair may be shaved.
Spinal anesthesia, which will numb the lower half of your body but allow you to stay awake during the delivery, is the usual choice for a cesarean. If general anesthesia is used instead, you will be asleep for the duration of the procedure. A catheter will also be inserted into your bladder to drain your urine; this is usually done immediately after the onset of anesthesia.
Your surgeon will begin by making an incision in your lower abdomen. In most cases, the incision will be horizontal, across and just above the pubic bone. This is called a "bikini cut." In rare cases, a vertical incision, from just below the navel to the top of the pubic bone, is used instead.
Your doctor will then make a second incision on the lower part of the uterus. This incision may be either horizontal or vertical. Once the uterus is opened, your doctor will rupture the amniotic sac, if it is still intact, and drain the amniotic fluid. During pregnancy, amniotic fluid surrounds and protects the fetus. At birth, it is no longer necessary for the health of the baby.
Your doctor will gently maneuver the baby out of the uterus. The baby will be cleaned and evaluated in much the same way as after a vaginal delivery. Depending on the reason for the cesarean, however, the baby may be monitored more carefully. The time from the first incision to birth is usually about five minutes.
Your doctor will then cut the umbilical cord and remove the placenta. Finally, he or she will tightly suture the incision in your uterus and stitch or staple your abdomen closed. This all takes about 45 minutes.
Risks and Benefits
The risks of cesarean section include: infection of the incision, uterus, or nearby organs, blood loss, which may require a blood transfusion, weakened uterine wall at the site of the incision, which may make future vaginal births difficult, blood clots in the legs or pelvic organs, injury to the bowel or bladder.
A baby born by cesarean section is at greater risk for a condition called transient tachypnea, or rapid breathing, due to excess fluid in the lungs. This condition usually responds within a few hours or days to oxygen treatment, known as continuous positive airway pressure or CPAP.
The benefit of a cesarean section is that it provides an alternate means of childbirth when vaginal delivery could lead to serious harm or death for the mother or her baby. Under these circumstances, cesarean delivery is considered safer than vaginal delivery.
In a cesarean section, or any procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it's the most appropriate treatment choice for you.
After the Procedure
You'll stay in the hospital for 3-5 days. During this time, you will be encouraged to breast-feed, nap when the baby sleeps, and get out of bed often. Walking helps prevent blood clots and constipation. Limit stair climbing to once a day and avoid lifting anything heavier than your baby.
It is normal to have gas pains, pain at the incision, and uterine contractions. Pain medication can ease this discomfort, but it is important to discuss which medications are safe to take, particularly if you are breast-feeding. You can also expect some persistent vaginal bleeding. Be sure to arrange for help at home, as full recovery may take 6-8 weeks. Avoid tampons, douching, and sexual intercourse until after your six-week checkup.
Call your doctor if you experience any of the following symptoms: signs of infection, such as fever and chills, dizziness or fainting, nausea and vomiting, shortness of breath, increasing pain, swelling, or redness at the incision site, and/or pain or swelling in your legs.
- American College of Obstetricians and Gynecologists. Cesarean birth. Available at: http://www.medem.com/medlb/article_detaillb_for_printer.cfm?article_ID=ZZZ2T2B627CâŠ‚_cat=2001 Accessed September 8, 2004.
- American College of Surgeons. About Cesarean childbirth. Available at: http://www.facs.org/public_info/operation/cesarean.pdf Accessed September 8, 2004.
- Hendrick Health System. Cesarean section. Available at: http://www.ehendrick.org/healthy/000285.htm Accessed September 8, 2004.
- The Mayo Foundation for Medical Education and Research. C-section: a safe birthing option.Available at: http://www.mayoclinic.com/invoke.cfm?id=PR00078 Accessed September 8, 2004.
- U.S. National Library of Medicine. C-section series. Available at: http://www.nlm.nih.gov/medlineplus/ency/presentations/100191_1.htm Accessed September 8, 2004.
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