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Labor and Birth 27

Cesarean Section

A cesarean section is a surgical procedure in which an incision is made in a woman ’ s abdomen and uterus to deliver her baby . Cesareans can save lives in the event of life-threatening complications during labor . However , a cesarean section is major abdominal surgery , and carries the same risks as any surgery for the mother and additional risks to the baby . It is best reserved for only those situations in which there is true medical necessity . Cesareans may be “ elective ” or planned in advance , they may occur during labor with time to discuss your situation and ask questions , or they may be performed rapidly in an emergency . Usually , the mother is awake and her partner is present for surgery .
Possible Reasons for Cesareans ( Planned )
• Malpresentation : breech , transverse or other
• Placenta previa : placenta is covering the cervix
• Sexually transmitted disease , such as HIV or an active herpes outbreak
• Multiple gestation : twins , triplets or more
• Medical complications in baby or mother
Possible Reasons for Cesareans ( Unplanned )
• Prolonged first or second stage ( the limit on the length of time varies greatly among providers ); also called “ failure to progress ” or labor arrest
• Fetal distress
• CPD ( cephalopelvic disproportion ): baby ’ s head won ’ t fit through mother ’ s pelvis
• Sudden medical complications in mother or baby , such as placental abruption ( placenta separates from the uterine wall prematurely ), umbilical cord prolapse ( cord is being compressed beneath baby ’ s head ) or other emergencies
If a cesarean becomes necessary , consider how to make the experience as joyful and memorable as possible , such as having your partner with you , taking photos or video , having someone describe what is happening , playing music , and having your partner announce the baby ’ s sex . You can also request skinto-skin contact with the baby in the operating room or as soon as possible and delay newborn procedures until after bonding and breastfeeding .
What to Expect
• Regional ( spinal or epidural ) anesthesia is used most often . General anesthesia is used if time is limited or there is a medical condition that does not allow for spinal or epidural anesthesia .
• An IV and bladder catheter will be placed .
• A drape will be placed in front of you to keep the surgical field sterile . Some facilities offer a clear drape to allow parents to see the birth .
• Usually one person may accompany you .
• The safest and most commonly used incision is low transverse , a horizontal cut along the bikini line . Other incisions used more rarely include classical ( a vertical cut ) or T-shaped .
• After baby and placenta are born , the incision in the uterus will be closed using sutures , then your skin will be sutured or stapled .
• After repairs are done , you will be taken to a recovery room , where your blood pressure , heart rate , and respiration will be monitored .
• Usually within 6-8 hours after birth , you will be encouraged to get up and walk .
• Be sure to notify your provider right away if you experience any signs of infection , sharp or sudden pain at your incision , or tenderness , pain , redness or swelling in your leg ( s ).
If you were hoping for a vaginal birth and your labor results in a cesarean , it is important that you allow yourself to grieve the loss of the experience you wanted . If it becomes difficult for you postpartum , consider talking to a trusted friend , counselor , or seeking help from a support group .
Labor and Birth 27