What you need to know about Cesarean Birth (for talula_fairie ;o)
Cesarean section (c-section) is the surgical delivery of a baby through an incision (a cut) in the abdomen and the uterus. It can be a lifesaving operation when either you or your baby experience certain problems before or during labor and delivery. There is a chance you might deliver your baby surgically, but you probably won't know for sure until the last minute.
If you're like most women, you probably won't give cesarean section much thought unless your pregnancy is high risk. But did you know that more than 1 in 4 babies in the United States are delivered by c-section? Also, most women who have c-sections do not know they'll deliver this way ahead of time.
Taking the time now to learn what c-sections are, why they are performed and what recovery involves can make the whole process easier to cope with if you are one of the mothers who deliver by c-section.
C-sections are performed when the health of the baby or mother is at risk. Some of the situations that could put you or your baby at risk include:
* Problems with the umbilical cord. Sometimes the umbilical cord falls into the vagina or is pinched or compressed.
* Bleeding from the placenta.
* Abnormal pelvic structure in the mother. For instance, some women have had a serious injury to the pelvis, or they were born with a pelvic defect.
* Serious maternal health problems (such as heart disease or an active herpes infection) when labor would not be safe for either mother or baby.
* Delivery is advised but the mother is not in labor. Reasons include infection or severe preeclampsia.
* Failure of labor to progress. About one-third of c-sections are done because labor progresses too slowly or stops. (*1*)
* Shoulder or breech (*2*) presentation. The baby's buttocks or feet enter the birth canal first, instead of the head.
* More than one baby. Many women having twins are able to deliver vaginally, but the risk increases with the number of babies.
* Fetal distress. The baby may show signs of distress such as slowing of heart rate or acid in the blood before vaginal delivery can be completed quickly.
* Fetal illness. Babies diagnosed prenatally with certain medical conditions, such as spina bifida (a birth defect that affects the backbone and sometimes the spinal cord), may need to be delivered by c-section.
But keep in mind that having any of these conditions does not necessarily mean you will have to have a c-section-it just increases the chance that you will have one.
C-sections usually are performed in an operating room set aside for these special surgeries. Either general or regional anesthesia (epidural or spinal) is used. If your c-section is an emergency procedure, general anesthesia may be needed and you will be asleep during the delivery. If spinal or epidural anesthesia is used, you will be awake for the birth of your baby, but numb from pain from below your breasts to your toes.
A thin tube called a catheter is placed into your bladder to drain urine during surgery, and a needle is inserted in a vein in your hand or arm to give you fluids during the operation and medications if needed. After your abdomen is shaved and washed, and you are numb or asleep, the doctor makes the first incision. This is usually a horizontal or "bikini" cut just above your pubic bone, although sometimes a vertical incision is needed (depending upon the position of the baby or the placenta). The second incision is made in the wall of the uterus. The doctor can then open the amniotic sac and remove the baby. You may feel some tugging, pulling and some pressure. Next the doctor detaches and removes the placenta. Then the incisions in the uterus and abdomen are closed.
The procedure usually takes about 45 minutes to an hour. The baby is born in the first 5 to 10 minutes. Then the incision is repaired. If you're feeling up to it, you may be able to hold your baby in the delivery room, once the baby's nose and mouth have been suctioned and he or she has been checked.
Physical and emotional recovery from a cesarean delivery takes more time than recovery from a vaginal delivery. You can expect to spend two to four days in the hospital, and four to six weeks at home before feeling back to normal. You'll need to take things slowly and get as much help as possible until you are back on your feet again.
Cesarean birth carries greater risk for both the mother and the baby than a vaginal delivery. Some of the increased risks for the mother include possible infection of the uterus and nearby pelvic organs; increased bleeding; blood clots in the legs, pelvic organs and sometimes the lungs; and, in very rare situations, death. For babies, there is the risk of being born prematurely if the due date is not accurately calculated. This can mean difficulty breathing (respiratory distress) and low birthweight. The baby also may be sluggish as a result of the anesthesia. A cesarean birth also is more painful, is more expensive, and takes longer to recover from than a vaginal birth.
Some health care experts believe that half of all c-sections performed in the U.S. are unnecessary, and you may have heard publicity about the high c-section rate in the U.S. So why are they so common? Many people suspect doctors' motives, including fear of malpractice suits and convenience. Others dispute these accusations, point to the lifesaving aspects of c-sections, and argue it is better to be safe than sorry.
Unless there are serious medical risks, fewer than half of women who have previously had c-sections need them again. If you've had a c-section before, and you want to try to deliver your next baby vaginally, be sure to discuss VBAC (vaginal birth after cesarean) with your health care provider.
It is important to keep in mind that a cesarean section delivery is major surgery and should be done only when the health of the mother or baby is at risk. It should not be considered an option for the convenience of the doctor or the parents, or for any other nonmedical reason.
Since no one can plan for a "perfect" delivery, and most c-sections are unexpected, it is unlikely there is anything special you can do to avoid a c-section. You can, however, take good care of yourself during your pregnancy so that you have the best chance of delivering a healthy baby. Some of these things may help you avoid the need for a cesarean:
* Get early prenatal care. When you choose a hospital or health care provider, ask about their cesarean rate. Look for rates around 15 percent. If you've already had a c-section, ask how many of the provider's patients try to deliver vaginally with later babies.
* Stay fit and maintain a healthy lifestyle during your pregnancy. Watch your weight-too much weight gain can increase the baby's size, making vaginal delivery difficult.
* Watch for any signs of trouble during pregnancy and alert your provider immediately.
* During early labor, drink plenty of fluids, and suck on ice chips during active labor. Remember to urinate, too! Walk around as much as possible or change positions frequently during labor to see what is most comfortable for you.
Remember, by learning all you can about cesarean birth, you'll know when it is appropriate and what to expect. And if you do need one, try not to feel disappointed. While most mothers would prefer a vaginal birth, virtually all would agree that having a healthy baby and being a healthy mom are much more important than the method of delivery.
(*1*): There are cases when labor doesn't prgress properly. In most cases though, "failure to progress" is deemed by the clock. Natural labor, when not induced, can last anywhere from 2 hours to days. Does this mean your body isn't progressing? No. In most cases, this is the body's way of progressing naturally. Pushing can take minutes to hours. Remember, your body cannot be put on a time limit. Only your body knows what it is doing.
(*2*)A variation of normal presentation of the baby in the uterus in which the buttocks, or breech, of the baby is presenting first. One baby in four will present breech at some stage in pregnancy, but by the 34th week most of these babies have turned. Acupuncture, chiropractic and external version are options for turning a breech baby. For vaginal breech delivery, an epidural is not recommended and the Burns-Marshall maneuver or Mauriceau-Smellie-Veit maneuver may be utilized, providing a normal vaginal delivery. AKA frank breech, footling breech, knee breech, or full breech.
# During a normal vaginal birth, the baby's chest is pressed by the birth canal, pushing amniotic fluids and other secretions out of its lungs, but this action becomes weak in surgery. If the baby is parturient and healthy, problems rarely occur; if the baby is weak, it will have trouble spitting and develop dyspnea.
# After the birth, she may experience severe gas pains from having her abdomen opened up.
# Uterine contractions after the birth will be more severely painful as a result of the surgery.
# The mother should expect a longer recovery period after a c-section and more weariness/tiredness as a result of the anesthesia and operation.
# The incision on the uterus may heal well, but there will be a scar on the uterine muscle and the uterus may not recover to its original state. Most scarred areas are weak and occasionally become paper thin, which can rupture during the next pregnancy or labor.
# The danger for rupture increases when the uterus has been cut vertically because of placenta previa and cross birth (transverse presentation). Mothers who have received vertically cut cesarean sections should remember this and remind their physician, in the event of subsequent births.
# Your insides will feel like they are falling out the following day after surgery, but they are held in place by several layers of stitches and staples.
# Chances are high that the next pregnancy will occur where the uterine incision was made, thereby increasing the possibility of placenta previa.
# If an embryonic sack grows on the outside of the incision region, there is a danger of hysterorrhexis (metrorrhexis) early in the pregnancy. Appropriate measures should be taken to avoid an extrauterine pregnancy (ectopic pregnancy).
# Women often receive abdominal incisions (celiotomy, laparotomy) because of uterine and ovarian abnormalities or extrauterine pregnancies. A cesarean section adds to the overall number of surgeries. Most women who undergo a cesarean section receive another with each additional pregnancy, continuously burdening the body. Therefore, it is recommended that a natural birth be attempted with the first pregnancy.
# Women run 5 to 7 times the risk of death with c-section compared with vaginal birth.
# Complications during and after the surgery include surgical injury to the bladder, uterus and blood vessels (2 per 100), hemorrhage (1 to 6 women per 100 require a blood transfusion), anesthesia accidents, blood clots in the legs (6 to 20 per 1000), pulmonary embolism (1 to 2 per 1000), paralyzed bowel (10 to 20 per 100 mild cases, 1 in 100 severe), and infection (up to 50 times more common).
# One in ten women report difficulties with normal activities two months after the birth, and one in four report pain at the incision site as a major problem.9 One in fourteen still report incisional pain six months or more after delivery.
# Twice as many women require rehospitalization as women having normal vaginal birth.
# Especially with unplanned cesarean section, women are more likely to experience negative emotions, including lower self-esteem, a sense of failure, loss of control, and disappointment. They may develop postpartum depression or post-traumatic stress syndrome. Some mothers express dominant feelings of fear and anxiety about their cesarean as long as five years later.
# After the surgery, women may experience numbness and itching around and at the incision site.
# Women having cesarean sections are less likely to decide to become pregnant again.
Video of a C-section