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Cesarean
Section
What is a cesarean
section
A cesarean section (or 'C-section')
is a surgical procedure for delivering a baby. It is usually performed
when a normal vaginal delivery may be risky or impossible. The operation
involves an abdominal and uterine incision. The abdominal incision may
be horizontal, just above the pubic hairline, or vertical extending down
from the bellybutton. The incision in the uterus runs horizontally across
the lower part of the uterus (low transverse or low segment incision).
Cesarean sections are usually done under general anaesthesia. The whole
procedure takes between 35 to 40 minutes.
What are the complications
linked to a c-section?
Cesarean sections are more painful,
more disabling, requires a longer hospital stay, and is four times more
risky than a normal vaginal delivery. Uterine infection is one of the common
complications associated with cesarean sections and it occurs ten times
more frequently than in vaginal deliveries. Other complications arising
from are thrombophlebitis, urinary tract infection, respiratory problems
in the newborn
and complications of anaesthesia.
However, doctors are constantly making improvements in surgical technique.
This, accompanied by the swift pace of medical advancement, serves to reduce
the risk of this procedure.
"Once a section,
always a section." - Is this true?
It was a widely accepted belief that
most women, whose earlier childbirth was done through a cesarean section,
had to have a repeat cesarean section for subsequent childbirth. Initially,
the 'classical' method of doing a cesarean was to make a vertical incision
in the upper part of the uterus. Incisions like this are more likely to
rupture when labour begins leading to bleeding that could put the lives
of both the mother and baby at risk. However, a woman who has had a low
transverse incision (as opposed to the classical vertical incision) in
the uterus is a better candidate for a vaginal birth after cesarean (VBAC).
This is because this incision cuts through the lower part of the uterus
that has fewer muscles and is less full of blood vessels lowering the chances
of bleeding due to uterine rupture. The present practice for women who
have had previous cesarean sections with a low transverse incision in the
uterus is to give them a trial of labour and vaginal birth. However, the
doctors should be prepared to perform an emergency cesarean should the
need arise.
Breech babies
Doctors often perform a cesarean
as a matter of course when the baby is in a breech position. A breech is
when the baby's feet or bottom enter the birth canal first instead of the
head. This makes a vaginal delivery particularly risky because there are
more chances of a prolapsed cord or fetal injury. If the doctor and his
team have some experience in doing vaginal breech deliveries, they can
attempt to do the procedure in the following conditions: the baby is expected
to weigh less than eight pounds; the woman has a normal pelvis; and the
baby is in a frank breech with legs extended and head flexed.
Failure of labour
Dystocia is the medical term for
failure to progress in labour. Some women have ineffective uterine contractions
that lead to prolonged labour. The woman may be unable to push the baby
out under her own steam. If the contractions are weak and irregular, doctors
usually administer oxytocin to stimulate contractions. However, if this
has no effect, the doctors may have no choice but to perform a cesarean.
Fetal distress
Fetal distress is also often a reason
why doctors decide to do a cesarean section. In cases of prolonged labour
and fetal distress, some doctors would prefer to do a cesarean section
as the safer option to performing a mid-forceps or low-forceps delivery.
They are of the opinion that a cesarean is less risky for the baby in these
situations.
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