Cesarean Section

What is the Cesarean Section?

Cesarean Section is a surgical procedure performed to deliver babies.

Alternate names

• C-section
• Cesarean Delivery

Is the Cesarean Section an elective or an emergency procedure?

This procedure can be performed on an elective basis if there are any pregnancy-related complications or if the woman has had a prior C- section. This surgery can also be performed on an emergency basis if vaginal delivery puts the baby and/or the mother at risk.

Indications

Cesarean Delivery is performed for the following reasons:

• Prolonged labor or obstructed labor
• Fetal distress
• Twin pregnancy
• Abnormal position of the baby such as a breech presentation or transverse presentation
• High blood pressure in the mother
• Rapid heart rate in the mother after amniotic rupture (water in the womb leaks out)
• Problems with the placenta
• Prolapsed umbilical cord
• Failed induction of labor
• Major health concerns for mothers such as a severe heart or brain condition
• Prior Cesarean Section
• To avoid labor
• To avoid possible complications of vaginal birth
• Mothers being positive with diseases like HIV infection, sexually transmitted diseases, etc which can cause infection to the baby during vaginal birth

Risk factors

There are no absolute contraindications for performing a Cesarean delivery, but the surgery is avoided in the following cases:

• If the mother has a severe pulmonary disease
• If the mother has a severe intrauterine infection or intra-abdominal infection
• If the mother has a severe bleeding disorder

Investigations before the procedure

Tests that are performed before a Cesarean Section are:

• Blood tests to identify blood type and hemoglobin level
• A blood sugar test is done
• Screening tests for HIV, hepatitis, syphilis are done
• Coagulation panel for PT, APTT, and fibrinogen levels
• Ultrasonography is done to check the fetal position and estimate fetal weight

Preoperative advice

If the C-Section is performed electively:

• Discontinue oral intake 8 hours before the surgery
• The site of the abdominal skin incision is shaved before the surgery

Intraoperative details

Anesthesia: The surgery can be performed under regional anesthesia or general anesthesia. Most cases are done under regional anesthesia, numbing only the lower part of the body allowing the mother to remain awake during the procedure.

Duration: It takes anywhere from 45 minutes to an hour.

Description of the procedure

An IV line is placed on the arm for intravenous fluids. Blood pressure and heart rate are monitored throughout the procedure. A urinary catheter is placed to drain the urine. The skin over the abdomen is cleaned with an antiseptic solution. A 15 cm long incision is made in the lower abdomen. The incision can be either horizontal near the pubic hairline or vertical from the navel down to the pubic bone. In most cases, the incision is performed horizontally. The abdomen is opened layer by layer. After reaching the abdominal cavity, the uterus is opened up using a low transverse incision. The incision on the uterus can also be made horizontally or vertically depending upon the baby’s position and the position of the placenta. The baby is delivered through the incision. The mouth and nose of the baby are suctioned. The umbilical cord is clamped and cut. The placenta is removed from the uterus. The uterus is checked for any blood clots or debris. Saline irrigation is done. The uterus is closed with dissolvable sutures. The abdominal skin incision is closed with sutures and stitches. Sterile dressings are applied to the incision site.

Postoperative details

Postoperatively after a Cesarean Section:

• Two to three days of hospital stay is required after the surgery
• The urinary catheter will be removed two days after the surgery
• Pain medications are provided for pain and discomfort
• Breastfeeding can be started after recovering from anesthesia
• A soft diet with liquids is started initially and gradually increased
• The abdominal incision is monitored for any signs of infection
• Vaginal bleeding may continue for 3 to 4 weeks after the delivery
• Bowel movements may be restored after a couple of days
• Stitches are removed 7 days after the surgery
• Follow-up as scheduled by the physician

Role of diet/ Exercise/ Lifestyle changes

Recovering from the surgery takes longer than vaginal birth.

Aftercare instructions include the following:

• Pain medications and heating pads can be used to relieve incisional pain
• Abdominal and back pain can continue for a few months
• Avoid heavy lifting
• Avoid strenuous physical activity for at least 8 weeks
• Avoid sexual intercourse for 6 to 8 weeks after the surgery
• Avoid sitting in a squatting position or rising from a squatting position for at least 6 weeks
• Gentle breathing exercises can be practiced. Avoid vigorous physical exercises
• A shower can be taken after the stitches are removed. Avoid tub baths for a few weeks
• Seek immediate medical attention to noticing signs of redness, swelling, discharge, fever, or worsening pain
• Contact healthcare providers on noticing signs of postpartum depression such as mood swings, loss of appetite, depression, fatigue, and difficulty bonding with the baby

Complications

Complications associated with C- Section are:

• Breathing problems in the baby
• Amniotic fluid embolism (amniotic fluid enters the bloodstream of the mother leading to serious reaction)
• Postpartum bleeding
• Adhesion formation
• Development of incisional hernias
• Postdural spinal puncture headaches
• Wound infections
• Postnatal depression

Prognosis

Childbirth through the C- section is increasing globally. The prognosis of the Cesarean Section depends on whether it is performed electively or emergently. The prognosis of the emergency C-Section is poor. Maternal death after delivery is high in this procedure rather than in vaginal delivery. Postpartum infection is the main cause of maternal death after a C-section. However, the use of antibiotic prophylaxis has decreased the risk of infection. Survival of both mother and baby has improved in recent years, making Cesarean Section a common method of childbirth.

Indications for hospitalization if required

Cesarean Section is done in hospital settings and requires hospitalization for 3 to 4 days.

Suggested clinical specialist/ Departments to consult for the procedure

• Obstetrics
• Gynecology

Additional Information

Vaginal delivery after a prior Cesarean Section is also possible. With a C- Section, a woman can give birth only to two or three children.This procedure is also performed on maternal requests even without any medical necessity to have surgery. However, an elective Cesarean Section should not be done before 39 weeks of gestation.