Delivery of a baby through an incision made through the abdomen and into the uterus

PARTS OF THE BODY INVOLVED

Abdomen, uterus

REASONS FOR PROCEDURE

  1. Malposition of baby (including certain types of breech positions)
  2. Fetal distress
  3. Placenta previa (placenta positioned over the cervical opening)
  4. Abruptio placentae (premature separation of the placenta from the uterine wall)
  5. Umbilical cord prolapse (umbilical cord slips out of the cervical opening before the baby's head)
  6. Multiple gestation (two or more babies, particularly if the babies are malpositioned)
  7. Previous emergency c-section performed with vertical incision into the uterus
  8. Previous uterine surgery, with scarring and weakening of the uterine wall
  9. Abnormally shaped uterus
  10. Very large baby unlikely to fit through the birth canal
  11. Acute genital herpes infection
  12. Non-progressing labor (cervix is not dilating properly, or baby is not descending after cervical dilation is complete)
  13. Previous delivery via c-section (although vaginal birth after c-section is encouraged, some women and their doctors still choose to schedule a c-section for deliveries after previous c-section)

RISK FACTORS FOR COMPLICATIONS DURING THE PROCEDURE

  1. Obesity
  2. Smoking
  3. Malnutrition
  4. Alcoholism or drug use
  5. Hemorrhage prior to the c-section (for example, due to placenta previa or placental abruption)
  6. High blood pressure
  7. Eclampsia

WHAT TO EXPECT

Prior to Procedure - Often the decision to deliver a baby by c-section occurs during the course of a woman's labor, when some kind of problem is encountered. If the cesarean delivery is planned in advance, you may be instructed to do the following:

  1. Eat a light meal the night before your procedure and do not eat or drink anything after midnight
  2. Take a laxative or a home-use enema the night before your procedure, to completely empty your bowels, possibly
  3. Shower the morning of your procedure, and use special antibacterial soap, if supplied by your doctor
  4. Arrange for a ride to and from the procedure
  5. Arrange for help at home after returning from the hospital
  6. Once you are at the hospital, the following preparations may be made (if you are already in labor, some of these interventions may already be in place):
  7. An IV line will be placed to provide medications and fluids
  8. A catheter may be placed to keep your bladder drained
  9. A small, flexible tube may be placed (using a needle) into your lower back, to deliver an epidural anesthetic and pain medications
  10. You may need to have your abdomen shaved

During Procedure - IV fluids, catheter, anesthesia, possibly sedation
Anesthesia - General, spinal, or epidural. Many women prefer spinal or epidural anesthesia so they are fully conscious during the surgery and can see their new baby immediately.
Description of the Procedure - If you are conscious during the c-section, a screen is put up so that you are not able to watch the surgery taking place. The surgeon cuts through the abdominal muscles to reach the uterus, and an incision is made in the uterus. A horizontal incision, low in the uterus, is preferred because it is usually safe for a woman who has had such an incision to deliver subsequent babies vaginally. Although a vertical incision in the uterus usually means that future babies will have to be born by scheduled c-section, it may be necessary in some emergency situations.
After the uterine incision is made, the uterus is opened enough to reveal the baby. Even before the baby is totally removed from the uterus, the surgeon suctions his/her nose and mouth, so that the baby can safely draw a first breath. The baby's umbilical cord is clamped and cut, the surgeon hands the baby to other medical personnel in the room, and the placenta is delivered. The surgeon then carefully inspects the uterus and surrounding organs. If all appears normal, the surgeon closes the uterus with stitches. The abdominal layers are closed with either stitches or staples and a dressing is applied. The stitches or staples are removed about a week after the surgery.
After Procedure - Baby is immediately examined by medical personnel. Depending on your condition and the baby's condition, you may be allowed to hold the baby, even while the surgeon is still sewing up the incision.
How Long Will It Take? 45-60 minutes
Will It Hurt? Anesthesia prevents pain during the procedure, although you may feel some pressure and tugging sensations as the uterus is opened and the baby and placenta are removed. After the surgery, if you have an epidural in place, your surgeon may give you pain medication through the epidural tube to keep you comfortable. Otherwise, you'll receive pain medications through your IV and/or by mouth.

POSSIBLE COMPLICATIONS:

  1. Infection
  2. Excess bleeding
  3. Blood clots
  4. Weakening of the uterine wall
  5. Excess scarring within the abdomen
  6. Damage to bladder or other abdominal organs

AVERAGE HOSPITAL STAY:

2-4 days

POSTOPERATIVE CARE:

  1. You will probably require anti-nausea and pain medications
  2. For several days after surgery, you may need to eat a lighter, blander diet than usual
  3. You may be given special compression stockings to wear after surgery, to decrease the possibility of blood clots forming in your legs
  4. You may be asked to use an incentive spirometer, to breathe deeply, and to cough frequently, in order to improve lung function after general anesthesia
  5. You'll be encouraged to walk very soon after surgery
  6. You will experience heavy vaginal bleeding, as after any delivery, and will need to use an absorbent sanitary napkin
  7. Avoid lifting anything heavier than your baby for the first weeks after surgery
  8. Delay having sexual intercourse until you've had your 6 week check-up

OUTCOME

You should heal quickly and completely after a c-section. If you are hoping to have additional children, talk with your surgeon about the type of incision used, so that you'll know whether you can attempt a vaginal delivery in the future.
If you are breastfeeding, you may need some help learning to position and hold the baby in a manner that doesn't put pressure on your abdominal incision. You may also notice some uterine cramping, pain, and an increase in vaginal bleeding at the beginning of each nursing session.

CALL YOUR DOCTOR IF ANY OF THE FOLLOWING OCCURS

  1. Nausea and/or vomiting that you can't control with the medications you were given after surgery, or which persist for more than two days after discharge from the hospital
  2. You pass several golf-ball sized clots from your vagina
  3. Saturating more than one sanitary napkin per hour
  4. An unpleasant odor to vaginal discharge
  5. Signs of infection, including fever and chills
  6. Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  7. Cough, shortness of breath, or chest pain
  8. Pain, burning, urgency, or frequency of urination
  9. Pain and/or swelling in your feet, calves, or legs

SOURCES:

Obstetrics: Normal & Problem Pregnancies, 3rd ed. Churchill Livingstone, 1996.
Conn's Current Therapy 2000, 52nd ed. W.B. Saunders Company, 2000.

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