During your pregnancy your doctor will be carefully monitoring your progress. If your doctor believes that a normal vaginal delivery will prove to be difficult or impossible, your baby will be delivered by cesarean section.
There are a number of reasons for choosing a cesarean section. A high risk pregnancy (and obstetrically a woman over the age of 35 is high risk), or some multiple pregnancies may require a cesarean section. Other reasons your doctor may choose to perform a cesarean section are if there is a clear case of cephalopelvic disporportionA condition in which the size of the baby's head is markedly larger than the size of the maternal birth canal. In some instances it is possible for the baby to be born vaginally although the most usual and safest course of action is delivery by cesarean section.
Visit our comprehensive glossary for more pregnancy terms and definitions. (CPD), or placenta previa.
In most cases your doctor will probably be able to tell whether you need a cesarean section before you enter labor. This 'elective cesarean' gives both you and your doctor time to discuss and prepare for it. When the need for a cesarean section is determined after labor has started it is called an 'emergency cesarean.'
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If your doctor feels that a cesarean section is necessary, he or she will describe to you the reasoning for the operation. When you agree to it, you will be asked to sign a consent form to allow the doctor to perform the surgery.
Prior to entering the operating theater, there are a number of tests you will be asked to undergo. These include a complete blood count, blood type, its clotting ability and your Rh factor. These tests are necessary in case a blood transfusion is required during the operation.
If your cesarean section is elective, then you will probably have the opportunity to meet with an anestheologist who will discuss with you the various pain relief options you have.
In the United States about twenty percent (1 in 5) of all babies are delivered by cesarean section (25% in the UK, and only about 12% in Sweden). The Centers for Disease Control (CDC) in Atlanta recommend a goal of limiting cesarean deliveries to fifteen percent (7 in 100), but many doctors, concerned about liability, consider cesarean delivery a safer option than pursuing some vaginal deliveries. Many researchers believe that the high first time cesarean delivery rate in the United States is a result of obesity. They suggest that if all women were within normal weight ranges for their height and age the first time cesarean rate would fall to about twelve percent (3 in 25) and the repeat rate would be about three percent (1 in 33). This is backed up by statistics that show the incidence of cesarean section among women who are medically obese before pregnancy is sixty percent higher than among women of average weight.
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There are many reasons your doctor may feel you need a cesarean section. Sometimes the reasons are simple. Perhaps your baby's head is too big to pass through the birth canalThe passage through which the baby passes during delivery from the inlet of the true pelvis to the vaginal orifice.
Visit our comprehensive glossary for more pregnancy terms and definitions., or your baby is in a complicated breech presentation. Other reasons can be more complicated. Perhaps your baby is lying across your pelvis (transverse lie), or you have placenta previa. Certain medical conditions such as diabetes mellitus or active herpes type II, tend to require a cesarean section.
Doctors used to require a cesarean section if you had delivered by cesarean section previously. This was because there were fears that the previous scar would open up during a subsequent vaginal delivery.
Today doctors employ horizontal 'bikini' cuts instead of the previously popular vertical cuts. These have proven stronger and your doctor will often permit vaginal delivery to begin; a procedure called vaginal birth after cesarean or VBAC. If everything is normal the baby is delivered vaginally.
A cesarean section is performed by delivering the baby through an incision in the abdomen. Once in the operating theater a nurse will insert a Foley catheter into your bladder to keep it drained for the duration of the operation. If the doctor feels it is necessary you will also be fitted with an intravenous drip. The nurse will also shave your pubic hair at this time to clean and prepare the area in which the doctor will make the incision.
You will lie on the operating table on your back, and in many cases your legs will be strapped to the table in order to prevent them from moving during the surgery. The nurses and anestheologist present will take great care to monitor your blood pressure and heart rate on the EEGAbbreviation of electroencephalogram. A monitoring device which uses electrodes placed on the head to measure electrical activity produced by the brain cells. The resulting lines, labeled alpha, beta, delta and theta according to the frequencies they record and which range from 2 to 12 cycles per second, are drawn on a sheet of scrolling paper. Brainwave activity can be used to measure differing neurological conditions, psychological states and varying levels of conciousness.
Visit our comprehensive glossary for more pregnancy terms and definitions..
The operating theater can be quite crowed with eight to eleven people present. Of course you and your baby are in the room. Some doctors may also allow your partner to be present as well. In addition there will be the surgeon and their assistant. Your anestheologist will be monitoring your vital signs on the monitors, and the scrub nurse will hand the instruments to the doctor. If necessary a circulating nurse will be present to fetch more instruments and supplies, and in some cases a nursery nurse and labor room nurse as well as your pediatrician who will also be present.
There are two types of incision used during a cesarean section. A vertical incision can be made from the top of the pubic bone to the navel. More commonly a horizontal 'bikini cut' is made about two finger widths above the pubic bone.
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After the initial cut the abdominal muscles are separated and the abdominal lining, the peritoneum, is cut. Once inside the abdomen the bladder is moved out of the way and an incision is made into the uterus (either horizontally or vertically). The baby is delivered through the openings, then the umbilical cord is clamped and cut as in a vaginal delivery. Following the delivery of the placentaThe placenta is a large disk shaped membrane responsible for providing nourishment to the fetus during pregnancy. It consists of three parts, the fetal part made up from the chorion membrane surrounding the fetus, the maternal part, formed from the decidua basalis layer of the uterine lining, and the intervillous space between the two plates. It is connected to the fetus by the umbilical cord and consists of tissue from both the mother and the embryo.
Its function is complex. It has been described as a simple organ that combines the functions of a kidney-dialysis machine, heart and lung machine and intravenous drip. It consists of enormous numbers of blood vessel branches that permit the exchange of nutrition and oxygen, from the mother's bloodstream to the fetus and the removal of wastes to the mother to be excreted. The placenta's remarkable quality is that it does so without the blood of the mother mixing with that of the baby.
It also is responsible for the production of vital hormones including, estrogen, progesterone, and human chorionic gonadotropin. After birth, the placenta is delivered, and is sometimes referred to as the afterbirth.
Visit our comprehensive glossary for more pregnancy terms and definitions., the uterine and abdominal incisions are closed. Usually the operation takes about 45 minutes to an hour from start to finish (with the actual surgery taking 10 - 15 minutes). In some cases it can be completed more quickly, and in an emergency can be performed in about 4 minutes.
A cesarean section is surgery like any other. The stitches inside you will dissolve naturally, although you will be asked to return to the hospital to remove the external stitches or staples. Do not worry about the incisions reopening, since they are individually sewn, and the chances of damaging the wounds are very small.
The nurses will encourage you to rest and recover after the operation, teaching you how to cough up the anesthetic that has pooled in your lungs if you elected to have a general anesthetic. You will be taught how to change your dressings, and encouraged not to lift anything heavy for about six weeks after the operation.
You will experience many different emotions when you have a cesarean section. If your cesarean section is elective try to prepare yourself for the operation by talking to your doctor, anestheologist and other women who have experienced a cesarean section. If you are truly brave you might ask to watch a video of a cesarean section to prepare yourself for the experience.
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After delivery many women feel conflicting emotions. Like all new mothers, they are pleased to meet their baby for the first time after nine months of pregnancy. But many women feel cheated that they didn't experience the vaginal birth they were expecting. Don't hide these emotions, but discuss them with your partner. Many mothers like their partners to describe the cesarean section to them in detail, so that they can visualize and accept the birth.
Will a cesarean affect the baby: the simple answer is yes and no. Unlike a baby that has traveled through the birth canal, a cesarean baby has a smooth rounded appearance. But a cesarean baby also needs more time to adjust to its new surroundings because it arrived far more suddenly. Its circulation may also need gentle stimulation because it has missed traveling through the birth canalThe passage through which the baby passes during delivery from the inlet of the true pelvis to the vaginal orifice.
Visit our comprehensive glossary for more pregnancy terms and definitions. which also clears amniotic fluidThe liquid, which is produced by both the fetal membranes and the fetus that surrounds the baby during pregnancy. The liter of fluid at term serves to protect the fetus during pregnancy and also provide active chemical exchange.
The amniotic fluid consists of maternal and fetal plasma in varying concentrations. The pH of the fluid is almost neutral and clear, although lipids and desquamated fetal cells can make it cloudy.
Visit our comprehensive glossary for more pregnancy terms and definitions. from its lungs. The nurses present will be prepared for this and make sure your baby adjust quickly to its new environment.
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