Cesarean section: procedure, risks and postpartum
Cesarean section occurs when natural birth is not possible or is highly inadvisable. It can be planned or not, but in both cases it is advisable to be prepared and informed to face it in the best way.
In this article you will find all the information about the intervention, the risks associated with the operation and postpartum information regarding breastfeeding, returning home and trying for a new pregnancy.
Before starting, I'll leave you some useful information:
- To get your sweet pregnancy journey off to a good start, I recommend you take a look at the multidisciplinary prenatal video course , designed for you by Doctor Maria Chiara Alvisi, the midwife at the Yule Center .
- You can also find us on Instagram with the profile @drsilva.com_official
Cesarean section: introduction
Cesarean section is a real operation with the aim of giving birth to the baby through the abdominal wall of the mother. The operation consists of an incision in the uterine wall , in medical terms it is called laparotomy .
The mother cannot choose to undergo a cesarean section; this is performed only when vaginal delivery is contraindicated.
Where does the word cesarean come from? There are two theories:
- From Julius Caesar because he seems to have been born that way;
- From “Lex Caesarea” (from the Latin “caedo”, meaning cut) which provided for performing a caesarean section on women who died during labor in an attempt to save the baby and baptize it.
Types of Cesarean Section
We can distinguish 4 types of cesarean section. Let's see them in detail
Elective
This type indicates a caesarean section scheduled in advance as natural vaginal birth is contraindicated.
The most common example is when the baby is in the breech position at the end of the pregnancy. Obviously, if at the end the baby turns, the labor and natural birth will occur.
Iterative
Recurrent delivery refers to a second cesarean section , meaning the mother undergoes the procedure again in a subsequent pregnancy .
In fact, if the mother gave birth by cesarean section in her first pregnancy, in her second pregnancy she will discuss the options with the midwives and gynecologist. Then, she will be able to choose whether to have the procedure again or try a natural birth ( VBAC ). We will talk about the latter in the next chapters.
Urgently
In this case the conditions of the mother and/or baby fall into the green/yellow code and require early delivery or more rapid completion .
Here are a couple of examples:
- Altered values of the mother and/or child before the end of the pregnancy;
- Failure or blockage of dilation during labor;
- Umbilical cord too short or baby's position complicated for natural labor.
In emergency
This is the case of a red code where the life of the mother and/or the child is in danger .
This includes premature placental abruption or an abnormal heartbeat of the baby.
What does the procedure consist of?
As with all operations, anesthesia is required, which can be spinal, epidural or general. Spinal is usually chosen so that the mother remains conscious and can see her baby immediately after birth.
Before the operation, the woman is given a pubic hair removal procedure and a bladder catheter is placed. The latter has a dual function:
- It will be useful for women who temporarily lose sensation from the trunk down;
- It will allow you to empty your bladder before surgery to prevent a bladder tear.
The duration of the procedure is 45-60 minutes and is carried out in a sterile operating room. The incision area is thoroughly disinfected and then the procedure is carried out. An incision is made in the suprapubic area , usually transversally, but longitudinally is also possible.
A complete and multidisciplinary team will be present in the operating room:
- Gynecologists;
- Midwives;
- Neonatologists;
- Nursery nurse;
- Anesthetists;
- Obs.
Unfortunately, the father will not be able to attend the surgery and will have to wait for the mother to leave the room so he can hug her and welcome their baby.
When is a cesarean section performed?
Caesarean section is performed only when it is not possible or not recommended . In fact, vaginal delivery is always safer and preferable to caesarean section if the pregnancy is physiological and proceeds without problems.
Let's see, however, the main situations in which a cesarean section is indicated:
- Breech presentation;
- Previous cesarean section ;
- Placenta previa : when the placenta implants near the cervix in the lower part of the uterus;
- Placental abruption : causes bleeding from the uterus and a lack of oxygen and nutrients for the baby;
- Suspected fetal macrosomia : usually when the baby is suspected to weigh more than 4kg;
- Presence of significant uterine myomas (benign tumors);
- Fetal heart rate abnormalities ;
- Preeclampsia/eclampsia : represents the increase in blood pressure;
- Twin pregnancy, with first twin in breech position ;
- Uterine rupture ;
- Umbilical cord prolapse : the umbilical cord is prolapsed and during labor it would be compressed by the fetus;
- Fetal malposition/malpresentation ;
- Induction failure : failure to reach the active phase of labor after 12 hours of oxytocin infusion;
- Fetal pathologies .
The risks of the operation
All operations carry the possibility of risks and complications . Consequently, even caesarean section. Let's see the main ones:
- Laparotomy wound infection;
- Infection of the uterine cavity;
- Increased risk of thrombosis;
- Possible difficult adaptation of the newborn;
- Slower recovery than natural birth;
- More abundant blood loss;
- Bladder injury (usually does not occur due to bladder catheter);
- Increased risk of uterine rupture in subsequent pregnancies (we will see this aspect in the last chapter).
Post-cesarean section
Cesarean section, being a surgical procedure , requires a different hospital stay than natural birth. In addition, the mother is advised to take some precautions for a better recovery.
In the hospital
At the end of the operation, the mother will be monitored , kept under observation and subjected to several routine checks:
- Vital parameters (blood pressure, blood oxygen, temperature, …)
- Checking the uterine fundus;
- Control of blood loss;
- Control of urination ability;
- Wound check.
Additionally, you will be given painkillers for the pain.
Even the mother who has had a cesarean section, if there are no complications, is offered bonding and breastfeeding. As for breastfeeding, you will find all the information in the next chapter.
If the recovery goes well, the new mother is discharged after 3 days .
At home
Usually, post-operative recovery is a little longer than that after natural childbirth. In fact, the pain from the wound could cause some difficulty in the first few days.
However, it is important to try to exercise to promote recovery and reduce the risk of thrombosis.
The wound should be kept dry and clean to prevent infection. Obviously, if there is redness, swelling, pain or pus, you should contact your doctor promptly.
The use of girdles to aid the recovery of the abdominal muscles is not recommended .
As with natural birth, a gynecological check-up is recommended after 4-6 weeks for:
- Check the situation;
- Talk about resuming sexual intercourse;
- Evaluate possible contraceptives.
Furthermore, it is important to take care of the pelvic floor by implementing some precautions that you can find in the video course “ Pelvic Floor ” by the midwife Maria Chiara Alvisi.
The psychological aspect
One aspect that is perhaps not given much consideration is how the mother feels after the cesarean section. If the operation was an emergency, the mother may experience the experience with disappointment and regret .
It is not an isolated case where a new mother feels wrong for not having been able to give birth naturally.
Added to this aspect is the delayed milk flow (as we will see later) resulting in further stress .
It is important, therefore, not to underestimate this aspect and to give support and love , even simply by listening .