Caesarean delivery, also called cesarean section, is a procedure that involves the birth of the baby through surgery. It is performed when a vaginal birth is not possible or when natural birth would put the life of the mother or baby at risk, when a caesarean delivery has been done previously or even when the mother simply prefers this type of procedure rather than natural birth. In some cases it is performed on demand. If you are planning this type of delivery or want to prepare for the event that it becomes necessary for emergency reasons, it is important to know the details of the procedure, undergo routine exams, and set a plan with your doctor for when you will go to the hospital.
Steps
Part 1 of 3: Knowing the Procedure
Step 1. Find out why a caesarean delivery is performed
Depending on your pregnancy, your gynecologist may recommend this procedure for medical reasons that can affect your baby's health. Cesarean section is recommended as a preventive measure if:
- You suffer from certain chronic conditions such as heart disease, diabetes, high blood pressure or kidney disease;
- You have an infection such as HIV or active genital herpes
- The baby's health is at risk due to a congenital disease or feature (for example, if the baby is too old to be able to safely pass through the birth canal, the doctor may recommend a caesarean section);
- You are overweight (obesity is another risk factor that requires the surgical procedure);
- The baby is in the breech position, that is when the feet or the buttocks are lower than the head, and it is not possible to turn it;
- You have already undergone a cesarean delivery during a previous pregnancy.
Step 2. Find out how the procedure is performed
You should be given guidelines so that you can prepare yourself mentally. Typically, Caesarean delivery involves the following steps.
- Once in the hospital, the medical staff will clean the abdominal area and insert a catheter into the bladder to collect urine. A venous access will be inserted into your arm, so that you can administer fluids and medications before and during the procedure.
- In most cases, local anesthesia is performed to numb the lower body only. This means that you will be awake during the birth of the baby and have a better chance of seeing him when he comes out of the womb. Probably the anesthesia will be of the epidural type, in this case the drug is injected into the epidural space surrounding the spinal cord. If the caesarean delivery is motivated by an emergency situation that occurs during labor, general anesthesia will be performed and you will be completely asleep during the birth of the baby.
- The surgeon will make a horizontal incision through the abdominal wall, near the pubic line. If the baby has to be born quickly due to some urgent complication, the doctor will make a vertical cut from the point just below the navel to the pubic bone.
- The procedure now involves making an incision of the uterus. About 95% of cesarean deliveries occur with the horizontal cut in the lower uterus area, because in this area the muscle is thinner and the incision causes less bleeding during surgery. If the baby is in an abnormal position inside the uterus or in the lower area of the uterus, the cut should be made vertically.
- To be born, the baby will be extracted from the incision that was made on the uterus. The surgeon will use an aspirator to clear the amniotic fluid from his mouth and nose, then clamor and cut the umbilical cord. You will feel some tugging as the doctor lifts the baby out of the womb.
- At this point the placenta will be removed, a check will be made to verify that the reproductive organs are healthy and the incision will be closed with sutures. You can then hold your baby in your arms and breastfeed him on the operating table.
Step 3. Be aware of the risks associated with the surgery
Some women decide to schedule this type of birth. However, the associations of gynecologists and obstetricians advise expectant mothers and their gynecologists to opt for a natural birth, unless a caesarean section is absolutely necessary. You should only schedule this type of delivery after thoroughly discussing the procedure with your doctor and fully understanding the possible associated risks.
- Cesarean delivery is considered a major surgery and involves more profuse blood loss than vaginal delivery. Recovery times are much longer with surgery and you will need to stay in the hospital for about two to three days. It is still an invasive operation on the abdomen and it takes six weeks to heal completely. If you choose this type of birth, you will be more prone to possible complications during future pregnancies. Your gynecologist will advise you to continue to perform caesarean sections for future births as well, to avoid the risk of uterus ruptures during a vaginal birth, when the organ tears at the scar line caused by the previous caesarean section. However, based on where the birth takes place and the reasons that lead a woman to choose a caesarean, in some cases a natural birth can be attempted after a cesarean.
- There are also risks associated with the surgery itself, as you will need to undergo regional anesthesia which can create adverse reactions. You are at increased risk of developing blood clots in the veins of your legs or pelvic organs from a caesarean section, as well as the fact that the wound from the incision may become infected.
- Caesarean delivery can also lead to health problems for the baby, including respiratory diseases such as transient tachypnea, where the baby breathes abnormally during the first days of life. Also, if the surgery is done too early, before the thirty-ninth week of pregnancy, the baby's risk of breathing problems increases. Not to mention the fact that the baby can also be injured during the procedure, for example the surgeon may accidentally cut his skin with a scalpel.
Step 4. Learn about the possible benefits of surgery
The scheduled caesarean section helps you organize yourself for the birth, you can have more control over when the event will occur, and you can predict with a certain margin of safety when labor and delivery will occur. Unlike emergency cesarean delivery, scheduled cesarean delivery carries less risk of complications, such as infections, and many expectant mothers do not have a negative reaction to anesthesia or accidental abdominal organ injuries. In addition, this type of procedure can avoid any damage to the pelvic floor during labor, which could lead to incontinence problems.
If the baby is very large, if a fetal macrosomia is diagnosed, or you have a twin or multiple birth, your gynecologist may recommend a caesarean delivery as a safer option than the natural one. With the surgical procedure there is less risk of passing an infection or virus to the baby
Part 2 of 3: Set a Plan with the Gynecologist for Caesar Delivery
Step 1. Undergo the necessary medical tests
Your gynecologist will recommend some blood tests to prepare you for the surgery. This way your doctor will get important information about your health, such as your blood type and hemoglobin levels, which can be useful in case of a blood transfusion during surgery.
- You should also tell your doctor if you are taking any medications, as they may interfere with the surgical procedure.
- The gynecologist will invite you to speak to the anesthetist to rule out any medical conditions that could increase the risk of complications when you are under anesthesia.
Step 2. Schedule the day of surgery
Your surgeon will tell you the best time for a caesarean delivery, depending on your medical needs and those of the baby. Some women decide to have their child delivered during the thirty-ninth week, based on the advice of their doctor. If you have had a healthy pregnancy, your gynecologist will recommend a day close to the expected natural delivery date.
Once you have chosen the date, you will need to include it in your plan for the baby's birth and fill out all the documentation required by the hospital in advance to continue with the procedure
Step 3. Know what to expect the night before surgery
Your doctor will want to work out the protocol with you for the night before the birth, and will then instruct you not to eat, drink or smoke after midnight. You have to avoid eating anything, even candy or chewing gum, and you don't even have to drink water.
- Try to get a good night's sleep the night before birth. You will need to take a shower before going to the hospital, but don't cut your pubic hair, as this may increase the risk of infections. The medical staff will take care of this task once hospitalized, if necessary.
- If you have an iron deficiency, your doctor will advise you to increase your iron intake by eating foods that are rich in iron or by taking supplements. Since cesarean delivery is considered a major surgery, you may lose blood and a high level of iron can help you in the healing process.
Step 4. Decide who will be present in the operating room during delivery
When planning the event, you need to let your partner or support person know what to expect before, during and after the surgery. You must specify whether your husband or the person you want to have with you will be present during the procedure and if he will be able to stay with you and the baby at the end of the caesarean section.
Many hospitals allow a support person to stay close to the woman during the surgery and take pictures of the birth. The doctor will allow you to have at least one person next to you
Part 3 of 3: Healing from Caesarean Delivery
Step 1. Plan to stay and rest in the hospital for at least two or three days
Once the effects of anesthesia wear off, a PCA device is provided in some hospitals that allows you to adjust the dosage of the intravenously injected painkiller. Your surgeon will advise you to start walking a little immediately after the operation to speed up recovery and avoid constipation and blood clots.
The medical staff will also want to monitor your cut for any signs of infection, as well as check how much fluids you are drinking, how your kidneys and intestines are working. You will need to start breastfeeding your baby as soon as you feel able to, because skin contact and breastfeeding are key steps in creating the bond between you
Step 2. Ask your doctor what pain relievers you can take and what treatment to follow at home
Before you leave the hospital, your doctor will give you basic information about the medications you can take and the preventative treatments that may be needed, such as vaccinations. You will need to undergo regular booster vaccinations to protect your health and the baby's.
- Keep in mind that if you are breastfeeding you should avoid taking medications or ask your doctor which ones are safe for you and your baby.
- The gynecologist will describe the process of "involution" of the uterus, called lochia, during which the uterus contracts to return to its original size before birth. The process involves profuse loss of bright red blood for up to six weeks. In this phase you will have to wear sanitary pads with a high degree of permeability, which are often provided in the hospital after the birth; however, do not put internal tampons during convalescence.
Step 3. Take care of yourself and the baby when you get home
It will take a month or two to recover from cesarean delivery, so take your time to recover and reduce physical activities. Do not lift any objects that are heavier than the child and do not do housework.
- Use postpartum bleeding (lochia) as a measure of the level of activity you can perform; if the bleeding increases, it means you are exerting too much effort. Over time the appearance of the blood changes from a pale pink or dark red to a more yellowish or light color. Do not put on internal tampons and do not do vaginal douches until the lochial discharge has stopped. Don't even have sex until your doctor tells you it's safe for you.
- Stay hydrated by drinking plenty of water, eat a healthy and balanced diet. In this way you help the body to heal and avoid the formation of intestinal gas, as well as constipation. Try to keep all the equipment needed to change and feed the baby close to you so you don't have to get up too often.
- Pay special attention to any high fever or abdominal pain, as both could be signs of infection. In this case, go to the emergency room.
