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Tests and procedures
Cesarean section
Overview
A cesarean delivery (C-section) is a surgical procedure used to deliver a fetus through an incision in the abdomen and uterus.
A C-section can be planned early in your pregnancy if you’ve had pregnancy complications or you’ve had a C-section before and aren’t considering a VBAC. However, the need for a first C-section often isn’t clear until labor occurs.
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If you’re pregnant, knowing what to expect during a C-section — during and after the procedure — may help you prepare for it.
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Why is this being done
Sometimes a C-section is safer for you or your baby than a natural birth. Your health care provider might recommend a cesarean delivery if:
If labor is not progressing. One of the most common causes of cesarean delivery is labor interruption. Your cervix may not open enough despite strong contractions that occur over a period of several hours.
If your fetus is not getting enough oxygen. If your health care provider is concerned about a change in your baby’s heartbeat, a cesarean delivery may be the best option.
If the fetus or fetuses are in an abnormal position. A C-section can be the safest way to deliver a baby if the baby’s feet or butts are in the birth canal forward (breech position) or if the baby is in a lateral position, or if the baby’s shoulder is forward (transverse position).
If you are pregnant with twins. A cesarean delivery may be necessary if you are carrying twins and the first child was in an abnormal position, or if you are carrying three or more children.
If there is a problem with the placenta. If the placenta covers the opening of the cervix (placenta previa), a C-section may be the safest way to deliver the baby.
If there is a problem with the umbilical cord. A C-section may be recommended if a loop of umbilical cord has slipped through the cervix before your baby.
If you have health problems. A cesarean delivery may be recommended if you have a severe health problem. Ex: heart or brain problems. A cesarean delivery may also be recommended if you have an active genital herpes infection during labour.
In case of mechanical obstruction. You may need a C-section if you have a large fibroid blocking the birth canal, a severely displaced pelvic fracture, or your baby has severe hydrocephalus. It is a condition that can make the head unusually large.
If you have had a previous caesarean section. Depending on the type of uterine incision and other factors, a vaginal birth can often be attempted after a previous C-section. In some cases, your health care provider may recommend a repeat C-section.
Some women request a cesarean delivery when their first child is born —; To avoid labor or the potential complications of a vaginal birth, or take advantage of the convenience of a planned birth. However, this is not recommended if you are planning to have more children. Women who have multiple C-sections are more likely to have placental problems, as well as heavy bleeding that may require a hysterectomy. If you’re planning a C-section for your first birth, work with your health care provider to make the best decision for you and your baby.
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Risks
As with other types of major surgery, a cesarean delivery carries some risks.
Risks to your child include:
breathing problems Babies born by scheduled C-section are more likely to develop transient tachypnea — a breathing problem marked by abnormally rapid breathing in the first few days of birth.
Surgical injury. Accidental abrasions to the child’s skin may occur during surgery, but this is rare.
Your risks include:
infection. After a C-section, you may be at risk of infection of the lining of the uterus (endometriosis).
Postpartum bleeding. A cesarean delivery can cause heavy bleeding during and after delivery.
Reactions to the drug. Adverse reactions can occur with any type of drug.
blood clots; A C-section may increase the risk of deep vein thrombosis, especially in the legs or pelvic organs (deep vein thrombosis). If a blood clot travels to the lungs and blocks the bloodstream (pulmonary embolism), this damage can be life-threatening.
Wound infection. Depending on your risk factors and whether you need an emergency C-section, you may be at high risk of developing a surgical site infection.
Surgical injury. Surgical injuries, although rare, can occur to the bladder or intestines during a C-section. If you sustain a surgical injury during a C-section, you may need additional surgery.
Increased risk during future pregnancy. After a cesarean delivery, you may have a higher risk of serious complications in a subsequent pregnancy than you would after a vaginal delivery. The more you have a C-section, the more likely you are to have placenta previa and to develop a condition in which the placenta attaches abnormally to the uterine wall (placenta accreta). You’re also more likely to have a uterine rupture along the line of the residual scar from a previous C-section (uterine rupture) if you try to have a VBAC.
how to prepare
If you’ve scheduled a C-section in advance, your follow-up health care provider might suggest that you consult an anesthesiologist about any potential medical conditions that may increase your risk of complications with anesthesia.
Your health care provider might also recommend some blood tests before a C-section. These tests will provide information about your blood type and level of hemoglobin, the main component of red blood cells. These details will be useful to your health care team in the unlikely event that you need a blood transfusion during a C-section.
Also, if you’re planning a vaginal birth, it’s important to be prepared for the unexpected. Discuss the possibility of a C-section with your health care provider well before your due date. Ask your questions, express your concerns, and review the circumstances that might make a cesarean delivery the best option. In an emergency situation, your health care provider may not have time to explain the procedure or answer your questions in detail.
After your C-section, you’ll need time to rest and recover. Before your due date, consider seeking help in the weeks after delivery.
If you’re not planning to have more children, you may talk to your health care provider about long-term reversible birth control or permanent birth control.
What you can expect
Before performing the medical procedure
While the process can vary depending on the reason for the procedure, most cesarean deliveries include the following steps:
at home. Your health care provider may ask you to shower with antiseptic soap the night before and in the morning of your C-section. Do not shave your pubic hair within 24 hours before a caesarean section. This may increase the risk of infection at the surgical site. If you need to remove pubic hair, the surgical staff will trim it for you right before surgery.
in the hospital. Your stomach will be cleansed. A tube (catheter) will likely be placed in your bladder to collect urine. An intravenous (IV) lead will be placed in a vein in your hand or arm to give you fluids and medications through.
Anesthesia. Most C-sections are performed under local anesthesia, which numbs only the lower part of your body, allowing you to remain awake during the procedure. Common options include a spinal block and an epidural block. Sometimes general anesthesia is needed in emergency situations. With general anesthesia, you won’t be able to see, feel or hear anything during delivery.
during the procedure
While C-sections can vary depending on the reason for the procedure, most of these procedures involve the following steps:
at home. Your health care provider may ask you to shower with antiseptic soap the night before and in the morning of your C-section. Do not shave your pubic hair within 24 hours before a caesarean section. This may increase the risk of infection at the surgical site. If you need to remove pubic hair, the surgical staff will trim it for you right before surgery.
in the hospital. Your stomach will be cleansed. A tube (catheter) will likely be placed in your bladder to collect urine. An intravenous (IV) lead will be placed in a vein in your hand or arm to give you fluids and medications through.
Anesthesia. Most C-sections are performed under local anesthesia, which numbs only the lower part of your body, allowing you to remain awake during the procedure. Common options include a spinal block and an epidural block. Sometimes general anesthesia is needed in emergency situations. With general anaesthesia, you won’t be able to see, feel or hear anything during delivery.
After the operation
You’ll likely stay in the hospital for a few days after your C-section. Your health care provider will discuss pain relief options with you.
Once the effects of the anesthesia begin to wear off, the medical team will encourage you to drink plenty of fluids and to walk. This helps prevent constipation and deep venous thrombosis. Your health care team will monitor the wound for any signs of infection. If you’re using a bladder catheter, it will likely be removed as soon as possible.
You will be able to start breastfeeding as soon as you feel up to it. Ask your nurse or lactation consultant to teach you the position to breastfeed and support your baby until you feel comfortable. Your health care team will choose the medications you’ll take to relieve postoperative pain with breastfeeding in mind.
Before you leave the hospital, talk to your doctor about any preventive care you might need. Making sure that the vaccines you’ve had haven’t finished working can help protect your health and your baby’s health.
When you come home
Discomfort and fatigue are common things that you may feel during the recovery process from a C-section. To speed up recovery:
Do not be upset. Rest whenever possible. Try to keep everything you and your baby may need within easy reach. For the first few weeks, avoid lifting anything heavier than your baby. Also, avoid getting up from a squatting position.
Take care of the pain. To soothe wound pain, your health care provider might recommend a heating pad or medications such as ibuprofen (Advil, Motrin, others), acetaminophen (Tylenol, others) or other pain medications. Most pain medications are safe for women who are breast-feeding their babies.
Avoid having sex. To avoid infection, avoid sex for six weeks after a caesarean section.
You should also consider not driving until you can brake and turn around to check your blind spots effortlessly, without taking painkillers. This may take anywhere from one to two weeks.
Examine the caesarean section incision to make sure there are no signs of infection. Pay attention to any signs or symptoms you’re experiencing. Contact your health care provider if:
The incision is red, swollen, or draining
have a fever
The bleeding was profuse
Pain exacerbation
If you experience extreme mood swings, loss of appetite, extreme fatigue, and a lack of happiness in life shortly after giving birth, you may have postpartum depression. Contact your health care provider if you think you may be depressed, especially if your signs and symptoms don’t go away on their own, you have difficulty caring for your baby or completing daily tasks, or you have thoughts about harming yourself or your baby.
The American College of Obstetricians and Gynecologists recommends that postpartum care be an ongoing process rather than a one-time visit after delivery. Contact your health care provider during the first three weeks after birth. And be sure to see your health care provider within the 12 weeks after delivery for a comprehensive postpartum evaluation. During this appointment, your health care provider will check your mood and mental state, discuss contraceptive options and separate births with you, review information about infant care and feeding, talk about your sleep habits and issues with fatigue, and perform a physical exam. This exam may include an examination of your abdomen, vagina, uterus and cervix, to make sure you are recovering well. In some cases, you may be tested early so that your health care provider can perform a C-section incision. You can use this visit to ask questions about your improvement and your baby’s care.
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12/06/2020
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