Cesarean birth definition

Cesarean Section | Johns Hopkins Medicine

What is a Cesarean section?

Cesarean section, C-section, or Cesarean birth is the surgical delivery of a baby through a cut (incision) made in the mother's abdomen and uterus. Health care providers use it when they believe it is safer for the mother, the baby, or both.

The incision made in the skin may be:

• Up-and-down (vertical). This incision extends from the belly button to the pubic hairline.

or

• Across from side-to-side (horizontal). This incision extends across the pubic hairline. It is used most often, because it heals well and there is less bleeding.

The type of incision used depends on the health of the mother and the fetus. The incision in the uterus may also be either vertical or horizontal.

Why might I need a C-section?

If you can't deliver vaginally, C-section allows the fetus to be delivered surgically. You may be able to plan and schedule your Cesarean. Or, you may have it done because of problems during labor.

Several conditions make a Cesarean delivery more likely. These include:

• Abnormal fetal heart rate. The fetal heart rate during labor is a good sign of how well the fetus is doing. Your provider will monitor the fetal heart rate during labor. The normal rate varies between 120 to 160 beats per minute. If the fetal heart rate shows there may be a problem, your provider will take immediate action. This may be giving the mother oxygen, increasing fluids, and changing the mother's position. If the heart rate doesn’t improve, he or she may do a Cesarean delivery.
• Abnormal position of the fetus during birth. The normal position for the fetus during birth is head-down, facing the mother's back. Sometimes a fetus is not in the right position. This makes delivery more difficult through the birth canal.
• Problems with labor. Labor that fails to progress or does not progress the way it should.
• Size of the fetus. The baby is too large for your provider to deliver vaginally.
• Placenta problems. This includes placenta previa, in which the placenta blocks the cervix. (Premature detachment from the fetus is known as abruption.)
• Certain conditions in the mother, such as diabetes, high blood pressure, or HIV infection
• Active herpes sores in the mother’s vagina or cervix
• Twins or other multiples
• Previous C-section

Your healthcare provider may have other reasons to recommend a Cesarean delivery.

What are the risks of a C-section?

Some possible complications of a C-section may include:

• Reactions to the medicines used during surgery
• Bleeding
• Abnormal separation of the placenta, especially in women with previous Cesarean delivery
• Injury to the bladder or bowel
• Infection in the uterus
• Wound infection
• Trouble urinating or urinary tract infection
• Delayed return of bowel function
• Blood clots

After a C-section, a woman may not be able to have a vaginal birth in a future pregnancy. It will depend on the type of uterine incision used. Vertical scars are not strong enough to hold together during labor contractions, so a repeat C-section is necessary.

You may have other risks that are unique to you. Be sure to discuss any concerns with your healthcare provider before the procedure, if possible.

How do I get ready for a C-section?

• Your healthcare provider will explain the procedure to you and you can ask question.
• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is unclear.
• You will be asked when you last had anything to eat or drink. If your C-section is planned and requires general, spinal, or epidural anesthesia, you will be asked to not eat or drink anything for 8 hours before the procedure.
• Tell your healthcare provider if you are sensitive to or are allergic to any medicine, latex, iodine, tape, or anesthesia.
• Tell your healthcare provider of all medicine (prescription and over-the-counter), vitamins, herbs, and supplements that you are taking.
• Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. You may be told to stop these medicines before the procedure.
• You may be given medicine to decrease the acid in your stomach. These also help dry the secretions in your mouth and breathing passages.
• Plan to have someone stay with you after a C-section. You may have pain in the first few days and will need help with the baby.
• Follow any other instructions your provider gives you to get ready.

What happens during a C-section?

A C-section will be done in an operating room or a special delivery room. Procedures may vary depending on your condition and your healthcare provider's practices.

In most cases, you will be awake for a C-section. Only in rare cases will a mother need medicine that puts you into a deep sleep (general anesthesia). Most C-sections are done with a regional anesthesia such as an epidural or spinal. With these, you will have no feeling from your waist down, but you will be awake and able to hear and see your baby as soon as he or she is born.

Generally, a C-section follows this process:

1. You will be asked to undress and put on a hospital gown.
2. You will be positioned on an operating or exam table.
3. A urinary catheter may be put in if it was not done before coming to the operating room.
4. An intravenous (IV) line will be started in your arm or hand.
5. For safety reasons, straps will be placed over your legs to hold you on the table.
6. Hair around the surgical site may be shaved. The skin will be cleaned with an antiseptic solution.
7. Your abdomen (belly) will be draped with sterile material. A drape will also be placed above your chest to screen the surgical site.
8. The anesthesiologist will continuously watch your heart rate, blood pressure, breathing, and blood oxygen level during the procedure.
9. Once the anesthesia has taken effect, your provider will make an incision above the pubic bone, either transverse or vertical. You may hear the sounds of an electrocautery machine that seals off bleeding.
10. Your provider will make deeper incisions through the tissues and separate the muscles until the uterine wall is reached. He or she will make a final incision in the uterus. This incision is also either horizontal or vertical.
11. Your provider will open the amniotic sac, and deliver the baby through the opening. You may feel some pressure or a pulling sensation.
12. He or she will cut the umbilical cord.
13. You will get medicine to help the uterus contract and expel the placenta in your IV.
14. Your provider will remove your placenta and examine the uterus for tears or pieces of placenta.
15. He or she will use sutures to close the incision in the uterine muscle and reposition the uterus in the pelvic cavity.
16. Your provider will close the muscle and tissue layers with sutures. He or she will close the skin incision with sutures or surgical staples.
17. Finally, your provider will apply a sterile bandage.

What happens after a C-section?

In the recovery room, nurses will watch your blood pressure, breathing, pulse, bleeding, and the firmness of your uterus.

Usually, you can be with your baby while you are in the recovery area. In some cases, babies born by Cesarean will first need to be monitored in the nursery for a short time. Breastfeeding can start in the recovery area, just as with a vaginal delivery.

After an hour or 2 in the recovery area, you will be moved to your room for the rest of your hospital stay.

As the anesthesia wears off, you may get pain medicine as needed. This can be either from the nurse or through a device connected to your intravenous (IV) line called a PCA (Patient Controlled Analgesia) pump. In some cases, pain medicine may be given through the epidural catheter until it is removed.

You may have gas pains as the intestinal tract starts working again after surgery. You will be encouraged to get out of bed. Moving around and walking helps ease gas pains. Your healthcare provider may also give you medicine for this. You may feel some uterine contractions called after-pains for a few days. The uterus continues to contract and get smaller over several weeks.

The urinary catheter is usually removed the day after surgery.

You may be given liquids to drink a few hours after surgery. You can gradually add more solid foods as you can handle them.

You may be given antibiotics in your IV while in the hospital and a prescription to keep taking the antibiotics at home.

You will need to wear a sanitary pad for bleeding. It is normal to have cramps and vaginal bleeding for several days after birth. You may have discharge that changes from dark red or brown to a lighter color over several weeks.

Do not douche, use tampons, or have sex until your healthcare provider tells you it’s OK. You may also have other limits on your activity, including no strenuous activity, driving, or heavy lifting.

Take a pain reliever as recommended by your healthcare provider. Aspirin or certain other pain medicines may increase bleeding. So, be sure to take only recommended medicines.

Arrange for a follow-up visit with your healthcare provider. This is usually 2 to 3 weeks after the surgery.

Call your healthcare provider right away if any of these occur:

• Heavy vaginal bleeding
• Foul-smelling drainage from your vagina
• Fever or chills
• Severe abdominal (belly) pain
• Increased pain, redness, swelling, or bleeding or other drainage from the incision
• Leg pain
• Trouble breathing, chest pain, or heart palpitations

Your healthcare provider may give you other instructions, depending on your situation.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure
• The reason you are having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• What the possible side effects or complications are
• When and where you are to have the test or procedure
• Who will do the test or procedure and what that person’s qualifications are
• What would happen if you did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how will you get the results
• Who to call after the test or procedure if you have questions or problems
• How much will you have to pay for the test or procedure

C-section - Mayo Clinic

Overview

Cesarean delivery (C-section) is used to deliver a baby through surgical incisions made in the abdomen and uterus.

Planning for a C-section might be necessary if there are certain pregnancy complications. Women who have had a C-section might have another C-section. Often, however, the need for a first-time C-section isn' clear until after labor starts.

If you're pregnant, knowing what to expect during and after a C-section can help you prepare.

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Why it's done

Health care providers might recommend a C-section if:

• Labor isn't progressing normally. Labor that isn't progressing (labor dystocia) is one of the most common reasons for a C-section. Issues with labor progression include prolonged first stage (prolonged dilation or opening of the cervix) or prolonged second stage (prolonged time of pushing after complete cervical dilation).
• The baby is in distress. Concern about changes in a baby's heartbeat might make a C-section the safest option.
• The baby or babies are in an unusual position. A C-section is the safest way to deliver babies whose feet or buttocks enter the birth canal first (breech) or babies whose sides or shoulders come first (transverse).
• You're carrying more than one baby. A C-section might be needed for women carrying twins, triplets or more. This is especially true if labor starts too early or the babies are not in a head-down position.
• There's a problem with the placenta. If the placenta covers the opening of the cervix (placenta previa), a C-section is recommended for delivery.
• Prolapsed umbilical cord. A C-section might be recommended if a loop of umbilical cord slips through the cervix in front of the baby.
• There's a health concern. A C-section might be recommended for women with certain health issues, such as a heart or brain condition.
• There's a blockage. A large fibroid blocking the birth canal, a pelvic fracture or a baby who has a condition that can cause the head to be unusually large (severe hydrocephalus) might be reasons for a C-section.
• You've had a previous C-section or other surgery on the uterus. Although it's often possible to have a vaginal birth after a C-section, a health care provider might recommend a repeat C-section.

Some women request C-sections with their first babies. They might want to avoid labor or the possible complications of vaginal birth. Or they might want to plan the time of delivery. However, according to the American College of Obstetricians and Gynecologists, this might not be a good option for women who plan to have several children. The more C-sections a woman has, the greater the risk of problems with future pregnancies.

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Risks

Like other types of major surgery, C-sections carry risks.

Risks to babies include:

• Breathing problems. Babies born by scheduled C-section are more likely to develop a breathing issue that causes them to breathe too fast for a few days after birth (transient tachypnea).
• Surgical injury. Although rare, accidental nicks to the baby's skin can occur during surgery.

Risks to mothers include:

• Infection. After a C-section, there might be a risk of developing an infection of the lining of the uterus (endometritis), in the urinary tract or at the site of the incision.
• Blood loss. A C-section might cause heavy bleeding during and after delivery.
• Reactions to anesthesia. Reactions to any type of anesthesia are possible.
• Blood clots. A C-section might increase the risk of developing a blood clot inside a deep vein, especially in the legs or pelvis (deep vein thrombosis). If a blood clot travels to the lungs and blocks blood flow (pulmonary embolism), the damage can be life-threatening.
• Surgical injury. Although rare, surgical injuries to the bladder or bowel can occur during a C-section.

• Increased risks during future pregnancies. Having a C-section increases the risk of complications in a later pregnancy and in other surgeries. The more C-sections, the higher the risks of placenta previa and a condition in which the placenta becomes attached to the wall of the uterus (placenta accreta).

  A C-section also increases the risk of the uterus tearing along the scar line (uterine rupture) for women who attempt a vaginal delivery in a later pregnancy.

How you prepare

For a planned C-section, a health care provider might suggest talking with an anesthesiologist if there are medical conditions that might increase the risk of anesthesia complications.

A health care provider might also recommend certain blood tests before a C-section. These tests provide information about blood type and the level of the main component of red blood cells (hemoglobin). The test results can be helpful in case you need a blood transfusion during the C-section.

Even for a planned vaginal birth, it's important to prepare for the unexpected. Discuss the possibility of a C-section with your health care provider well before your due date.

If you don't plan to have more children, you might talk to your health care provider about long-acting reversible birth control or permanent birth control. A permanent birth control procedure might be performed at the time of the C-section.

What you can expect

Before the procedure

Abdominal incisions used during C-sections

Abdominal incisions used during C-sections

A C-section includes an abdominal incision and a uterine incision. The abdominal incision is made first. It's either a vertical incision between your navel and pubic hair (left) or, more commonly, a horizontal incision lower on your abdomen (right).

Uterine incisions used during C-sections

Uterine incisions used during C-sections

A C-section includes an abdominal incision and a uterine incision. After the abdominal incision, the health care provider will make an incision in the uterus. Low transverse incisions are the most common (top left).

A C-section can be done in various ways. But most C-sections involve these steps:

• At home. Your health care provider might ask you to shower at home with an antiseptic soap the night before and the morning of your C-section. Don't shave your pubic hair within 24 hours of your C-section. This can increase the risk of a surgical site infection. If your pubic hair needs to be removed, it will be trimmed by the surgical staff just before surgery.
• At the hospital. Your abdomen will be cleansed. A thin tube (catheter) will likely be placed into your bladder to collect urine. An intravenous line will be placed in a vein in your hand or arm to provide fluid and drugs, including antibiotics to prevent infection.

• Anesthesia. Most C-sections are done under regional anesthesia, which numbs only the lower part of your body. This allows you to be awake during the procedure. Common choices include a spinal block and an epidural block.

  Some C-sections might require general anesthesia. With general anesthesia, you won't be awake during the birth.

During the procedure

A doctor makes surgical incisions in the abdomen and the uterus to deliver the baby.

• Abdominal incision. The doctor makes an incision in the abdominal wall. It's usually done horizontally near the pubic hairline. Or the doctor might make a vertical incision from just below the navel to just above the pubic bone.
• Uterine incision. The uterine incision is then made — usually horizontally across the lower part of the uterus (low transverse incision). Other types of uterine incisions might be used depending on the baby's position within the uterus and whether there are complications, such as placenta previa or preterm delivery.
• Delivery. The baby will be delivered through the incisions. The doctor clears the baby's mouth and nose of fluids, then clamps and cuts the umbilical cord. The placenta is then removed from the uterus, and the incisions are closed with sutures.

If you have regional anesthesia, you're likely to be able to hold the baby shortly after delivery.

After the procedure

A C-section usually requires a hospital stay for 2 to 3 days. Your health care provider will discuss pain relief options with you.

Once the anesthesia begins to wear off, you'll be encouraged to drink fluids and walk. This helps prevent constipation and deep vein thrombosis. Your health care team will monitor your incision for signs of infection. The bladder catheter will likely be removed as soon as possible.

You can start breastfeeding as soon as you're ready, even in the delivery room. Ask your nurse or a lactation consultant to teach you how to position yourself and support your baby so that you're comfortable. Your health care team will select medications for your post-surgical pain with breastfeeding in mind.

When you go home

During the C-section recovery process, discomfort and fatigue are common. To promote healing:

• Take it easy. Rest when possible. Try to keep everything that you and your baby need within reach. For the first few weeks, don't lift more than 25 pounds.
• Use recommended pain relief. To soothe incision soreness, your health care provider might recommend a heating pad and pain medications that are safe for breastfeeding women and their babies. These include ibuprofen (Advil, Motrin IB, others) and acetaminophen (Tylenol, others).
• Wait to have sex. To prevent infection, wait at least six weeks to have sex and don't put anything in your vagina after your C-section.
• Wait to drive. If you're taking narcotics for pain relief, it might take 1 to 2 weeks before you can comfortably apply brakes and twist to check blind spots.

Check your C-section incision for signs of infection. Pay attention to any symptoms. Contact your health care provider if:

• Your incision is red, swollen or leaking discharge
• You have a fever
• You have heavy bleeding
• You have worsening pain

If you have severe mood swings, loss of appetite, overwhelming fatigue and lack of joy in life shortly after childbirth, you might have postpartum depression. Contact your health care provider if you think you might be depressed, especially if your symptoms don't go away, you have trouble caring for your baby or completing daily tasks, or you have thoughts of harming yourself or your baby.

The American College of Obstetricians and Gynecologists recommends that postpartum care be ongoing. Have contact with your health care provider within three weeks after delivery. Within 12 weeks after delivery, see your health care provider for a postpartum evaluation.

During this appointment your health care provider likely will check your mood and emotional well-being, discuss contraception and birth spacing, review information about infant care and feeding, talk about your sleep habits and issues related to fatigue and do a physical exam, including a pap smear if it's due. This might include a check of your abdomen, vagina, cervix and uterus to make sure you're healing well.

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Natural birth or caesarean section?

16/03/2018 - 13:35

Expectant mothers often face a dilemma: what will be better for her and the baby - natural childbirth or caesarean section. Both methods of obstetrics have their pros and cons, their indications and contraindications.

Aleksey Sherstobitov, head of the obstetric department of the Chelyabinsk Regional Perinatal Center, obstetrician-gynecologist of the highest category, helped the Ural-press-inform agency to dispel the fears and unnecessary fears of women. nine0005

- Alexey Vasilyevich, in your opinion, as a professional, what choice should I make (natural birth or caesarean section), based on the benefits for mother and child?

- Until about the 1980s, the percentage of caesarean sections was about 2-4 percent of the total volume of deliveries. And we are all alive and well. And everything is fine with our grandmothers and mothers.

- What are the advantages of natural childbirth?

- In case of childbirth through natural birth canal, there is no pain syndrome in the postoperative period. The recovery process for the female body as a result of natural childbirth is much faster than after a cesarean section. There are fewer complications. Accordingly, the time of stay of a woman in labor in a hospital is reduced. The woman goes home on the third or fourth day. After caesarean section - only for 4-5 days. In addition, during natural childbirth, the baby is immediately brought to the mother's breast, which is good for the health of the newborn and for the mother's lactation. nine0005

- When is natural childbirth contraindicated?

- For certain medical conditions in a woman (eg, somatic, eye, cardiovascular disease), vaginal delivery is more of a risk than a benefit. For some women, a caesarean section is performed according to indications that occur during childbirth (acute fetal hypoxia and others). There are also relative indications - breech or foot presentation, large fetus.

- Is the woman's age an indication for caesarean section?

- Now women are increasingly giving birth at a late reproductive age. Previously, a woman aged 33 years and older was written late. And that was an indication for a caesarean section. Now there is no such term, and women at this age also give birth through the natural birth canal. We have several women who are 44-47 years old sometimes pass through us in a week.

- How old was your oldest woman in labor?

- 51 years old (her first daughter was already 31 years old). There was also a woman who had her first pregnancy at the age of 49.

- Can a woman in labor be an indication for a caesarean section?

- There are several countries in the world where the indication of a woman's desire to have a caesarean section is legislated. The Russian Federation is not included in this list of countries. Therefore, we do not perform cesarean at the request of a woman without medical indications. Indications for a caesarean section are clearly regulated by the order of the Ministry of Health of the Russian Federation. They are divided into a number of groups: planned and emergency indications during pregnancy, as well as emergency during childbirth. And there is no such indication as the desire of a woman. nine0005

- The number of births by caesarean section has increased dramatically. Why did this happen?

- Perinatal focus of medicine has expanded the range of indications for operative delivery. For example, earlier women with heart defects were strictly forbidden to give birth. At the moment, these defects are being corrected. For a woman, therapy is selected, and she becomes pregnant. Subject to certain rules, a favorable outcome is guaranteed. The method of delivery is chosen in each case individually, depending on the degree of compensation of the defect by the time of delivery. nine0005

- Have caesarean sections become more advanced today?

- Yes. The technique of performing caesarean section operations is being improved, more modern suture material is used, when sutured, the lower uterine segment is better restored, less scar tissue is formed.

- Previously, if a woman had a caesarean section during her first birth, then only a caesarean section during her second and subsequent births ...

- Absolutely right. But for the fourth year in our perinatal center, women with a scar on the uterus give birth through the natural birth canal.

- And now, after the first caesarean, a woman, having become pregnant for the second time, can choose - to give birth through the birth canal or she will have a caesarean section?

- Yes. If a woman with a scar on the uterus wants to give birth through the birth canal, she must sign up for a planned hospitalization with us. She will need to submit the protocol of the previous operation - a caesarean section. We will see how it was performed, we will find out from the woman if there were any complications in the postoperative period. Doctors working in the ultrasound department will assess the condition of the lower uterine segment, the obstetrician - the viability of the scar. nine0005

Then the woman in labor enters the department of pathology of pregnant women, where a consultation is held with the participation of the chief physician, the head of the department, and employees of the department of the Chelyabinsk State Medical Academy. And we determine whether a woman can give birth through the natural birth canal or not.

- Does a pregnant woman with a scar on the uterus need early hospitalization in a maternity hospital?

- Each time the issue is resolved individually. It depends on many factors: parity (what kind of child a woman should give birth to), how far she lives from the perinatal center. Residents of remote areas, we try to hospitalize in advance. For women living in Chelyabinsk or at a distance of 30-40 kilometers from the regional center, there are no indications for early hospitalization. nine0005

- Only residents of the region or Chelyabinsk can apply to the regional maternity hospital?

- A woman, regardless of where she lives, can choose the maternity hospital where she wants to give birth. But for this, she must come to the maternity hospital in advance, sign a dispensary book, and discuss the terms of hospitalization.

indications, how they do it, for how long the planned one is done and how it differs from the emergency

In 2016, I had an emergency caesarean section.

Veronika Vysotina

went through a caesarean section

All five days before the discharge, the doctors called me and other women who needed surgery "cesareans", and our babies - "cesareans".

I was not at all ready for the operation: the pregnancy was going well. For almost half a year after the cesarean, I struggled with various thoughts, went through the stages of "I'm not a real mother" and "I'm ashamed in front of the child", I envied my friends who gave birth themselves. Fortunately, now all this is behind us. nine0005

In this article I will talk about what a caesarean section is, how it is done and how the recovery goes.

What is a caesarean section

What is it. Caesarean section is also childbirth, only operational. And efficiency here is not about time, but about surgical intervention. Unlike natural childbirth, when a woman gives birth to a child herself through attempts, during a cesarean, the doctor makes an incision in the abdomen with a scalpel and takes the child out of the uterus through it.

Caesarean section - Medscape

Initially, a caesarean section was performed to save the baby if the mother died in childbirth. This operation is mentioned even in Greek and Roman myths - even the name itself came, according to one version, from the Roman law, according to which a pregnant woman could be buried only after the child was taken out of her stomach.

Caesarean section - Britannica

In the 17th century, caesarean sections were performed on living women, but almost always the patient died due to blood loss or infection. mid 19For centuries, doctors came up with the idea of ​​removing the uterus, and a little later they began to put stitches on it, leaving a chance for the next pregnancy.

Methodical letter of the Ministry of Health of the Russian Federation on the classification of caesarean sectionPDF, 2.98 MB

Nowadays, caesarean section has become a fairly common situation: in Russia, about every third birth ends like this.

Which is better: caesarean or natural childbirth. The term "natural birth" is a little outdated: childbirth cannot be unnatural. A caesarean section is carried out according to indications from the mother or fetus - often otherwise the woman cannot give birth or there is a risk to the health and even the life of the child.

It cannot be said that some way to give birth is definitely better: doctors recommend the method of delivery that will be the safest in a particular situation.

What week is the caesarean section. nine0004 If a caesarean section was planned in advance, then it is usually done starting from the 39th week of pregnancy.