Caesarean-Section

A caesarean section (c-section) is a surgical procedure for delivering a baby when vaginal birth is considered unsafe. A surgical incision is made through a mother's abdomen (laparotomy) and uterus (hysterotomy).

Reasons for c-section
Your doctor may suggest a c-section when a vaginal birth is not possible or safe for you or your baby. Nearly one in four babies in the United States is delivered this way. Possible reasons for having a c-section include:

• a developmental abnormality, such as hydrocephalus (fluid on the brain)
• premature labor
• multiple birth
• an unusually small, scarred, or deformed uterus
• an usually large baby
• problems with the cervix or birth canal, such as an active genital herpes infection.
• problems with the placenta (for example, placenta previa or placenta abruptio)
• a labor that stalls or progresses very slowly
• problems with the umbilical cord or placenta that deprive the baby of oxygen
• fetal distress as reflected by abnormalities in the fetal heartbeat
• a baby with a large head
• breech (buttocks first) or transverse (crosswise) position of the fetus
• medical condition such as high blood pressure or preeclampsia

The procedure
Some c-sections are scheduled well in advance. Most are the result of complications that arise during labor.

An emergency c-section is done to save the life of the mother or the baby. If you have an emergency c-section the doctor may use general anesthesia that takes effect almost immediately and renders you unconscious. However, very few emergency c-sections are needed.

In all other cases, a regional anesthetic (such as a spinal or an epidural) is used to numb the lower half of your body but leave you awake and alert.

After the anesthesia takes effect, an incision is made through the abdomen. A “bikini cut,” a horizontal incision just above the pubic bone, is most often used. In an emergency, the doctor may make a vertical cut, which extends from the pubic area to the navel and allows quicker access to the baby.

The doctor next makes an incision in the uterus (horizontal or vertical, depending on the situation), suctions out the amniotic fluid, and gently pulls the baby out.

While the doctor cuts and clamps the umbilical cord, an assistant will suction mucus from the baby's nose and mouth and makes sure he or she is breathing well.

After the baby is delivered, the placenta is removed and the uterus is closed with dissolvable stitches. Dissolvable stitches or surgical staples (which are removed after about four days) are then used to close the incision in your abdomen.

Recovery
After the surgery, you will be moved to a recovery room. Nurses will monitor your condition closely for a few hours. You will be encouraged to get up and walk around as soon as the anesthetic wears off. Such movement reduces the risk of a blood clot (pulmonary embolism).

You should be discharged from the hospital in two to four days. Recovery from a c-section is often longer and more uncomfortable than recovery from a vaginal birth. Get plenty of rest. Avoid driving and lifting objects heavier than about 10 pounds until your incision is healed. If you have other children, you should not lift them, and you should probably make plans to have some one help with their care during the six weeks of your recovery.

Risks
A cesarean section is major surgery. Risks include an adverse reaction to anesthesia; internal bleeding; blood clots; injury to abdominal organs; and infection of the bladder, kidney, or uterus. You also may need to have a c-section for future deliveries.