Wednesday, March 4, 2015

Cesarean (C-section) Birth

Some women will have to opt for a cesarean section (c-section) as an alternative for childbirth.  There are numerous reasons, the most common being that a vaginal birth is less safe or impossible for the mother to do.  Fortunately, we have modern medicine now and a c-section is fairly routine, typically a 30 minute surgery with about 1-2 hours of recovery post surgery.

I will be honest, I do not have any experience with a cesarean section- I was really close to having one with my son, but then other means were used to get him out.  However, I would still like to go over basic information regarding c-sections so that you can get a general idea of what to expect.

C-sections can go two ways: scheduled and unplanned. Your doctor will weigh the risks and advantages of both a c-section and vaginal delivery and determine what is safest for you. Side note: I know that there's always some documentary or news article about the alarming increasing rates of c-sections, but let me just say- don't judge.  We may not know why someone chose to have an elective c-section but it's none of our business to begin with.  Most doctors will make an informed decision about your health- after all, it's their job to provide care.

Once decided that you are going the c-section route (let's say this is a planned procedure and not emergent), your day will go something like this: fasting 8-12 hours before surgery, arriving at the hospital at your scheduled time, and then receiving anesthesia.  I believe a spinal block is preferred over an epidural and is more common (just a quick note- epidurals are like an IV in that a small tube is left in your spine and spinal blocks are one-time shots into the spinal fluid. We will discuss this in more detail in an upcoming post). You will also have a urinary catheter placed so that your bladder can have relief while you have little control as well as an IV to receive medications and fluids through. After all prepped, it's surgery time! The operating room (OR) looks like any OR and your doctor, an anesthesiologist, and a team of nurses and scrub techs will be there.  Everyone has a purpose, so don't worry, you're not on display for any reason.  Most providers put up a privacy curtain to block your view and your partner will typically be allowed to be present at your side.  They will provide him/her with a pair of surgical scrubs too.

Now from your perspective, you may just feel a little pressure (or nothing) and then hear a baby cry after a few minutes. You may become a little nauseous- this is normal. But so much more is going on! There is a lot of precision and care when performing a c-section.

At this point in medicine, c-sections will typically have a curved transverse (horizontal) incision, sometimes called a "bikini cut" made in the low abdomen instead of a vertical incision. Studies have shown that there is less abdominal pain and a faster recovery with the transverse cut and it is also less noticeable in the long run.  Vertical incisions are more common in emergent situations, but even so, many doctors are able to do a transverse incision emergently too.  Here's a visual aid:

thanks for being realistic, Baby Center, by including the stretch marks! Moms can appreciate this.

A scalpel is used and after the incision to the skin, the doctor will cut through the adipose (fat) tissue, then the fascia, which covers the abdominal muscles, and then the abdominal muscles midline (which runs vertically) can be pulled apart and held open. The peritoneum is what lines everyone's abdomens and "encases" your innards.  This thin layer is then cut as well, exposing the bladder and uterus.  The bladder is kind of in front of the uterus, so the team will pull it downward and out of the way, giving a clear picture of the uterus.  Once the uterine incision is made, the delivery is much like a vaginal delivery in that the head will come out gently as the rest of the baby is guided out.  The umbilical cord will be clamped and cut, parents get to say hi to baby, and then baby is whisked away to get cleaned up and assessed.  The doctor will gently pull the placenta out and begin to close you up.  Closing the incisions will be much like the initial procedure in reverse, but of course much slower.  First the uterus is sutured and then the peritoneum suturing is actually commonly skipped as studies have shown that this step is not necessary and can prevent complications of the uterus or bladder adhering to it.  The abdominal muscles can be left alone or have 2-3 sutures to help it "remember" where to heal, and then the fascia is carefully closed.  The fascia is like the glue in the abdoment, holding it all together.  The fat can also be skipped when suturing, and then the skin will be carefully stitched, stapled, or glued.  All internal sutures will dissolve on their own.  Did you note that there are seven layers to get through? 


Watch an animated c-section here and skip to 2:09 to visualize the procedure:


I'm not sure why, but this baby is not delivered head first- maybe just the positioning...

Following the end of the procedure, you will be wheeled to a post-op recovery room where a nurse can monitor your vital signs as anesthesia wears off. Once decided that you are stable, 1-2 hours later, you can be wheeled back to your postpartum recovery room to join your new addition and family! Expect to stay for at least 3 days in the hospital.  This obviously varies between patients- I have heard of some women staying for only 2 days too because they were recovering really well and their hospital protocol was more flexible.  If I were you and I just had abdominal surgery, I'd be happy to stay for three days in the hospital with my baby and not have to fret about everyday things like laundry and dishes. Just sayin'.

The recovery of a c-section is much like a vaginal birth recovery- we will go more in depth in an upcoming post- but some things you can expect are vaginal bleeding still and a particularly sore abdomen.  Remember, as routine as a c-section is, it is still abdominal surgery! Many women stay in bed for at least the first half of the day post c-section, if not the whole day.  Your urine catheter and IV will be removed within 24 hours and you will likely need to be supervised when first getting in and out of bed.  Passing gas is normal and a good thing as it shows your bowels are "waking up" from the anesthesia.  You may want a postpartum abdominal binder/support (Belly Bandit is the only one I can think of, but there are many brands)- this is somewhat of a hype in that you probably won't get that celebrity beach body from this alone, but it acts as a good splint/brace for everyday things like getting out of bed, sneezing, light lifting, etc.  I have also heard of women using these with vaginal childbirth too.  Pain medications you will receive will be much like vaginal childbirth- narcotics, tylenol, ibuprofen. 

Almost like a smile with those starry eyes.... courtesy to Google Image search for "real c-section scar."

Having a baby should be an empowering experience whatever the route they arrive.  You should feel accomplished about your pregnancy more than anything else and embrace the fact that you are a mama to a snuggly newborn! 

*information courtesy of Dr. Dileo and Lalaena Gonzalez from Babble.com and also Mayo Clinc.

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