by Pregnancy.org Staff
Approximately 20 percent of births in the United States are done by cesarean section. Every woman, no matter how simple her pregnancy, faces the possibility that her labor could end in a C-section.
It's smart for every pregnant woman to read up on and understand the procedure so that in the unlikely event that it happens to her, she will have some idea of what to expect.
Reasons for Cesarean
There is a great deal of debate in the medical community about what constitutes a necessary cesarean-section. Some common reasons are:
- Failure to progress: The risk of infection increases the longer a mother goes without delivering after her water has broken. Risk to the baby also increases and at some point, some women really can't deliver vaginally and must go to surgery to have the baby.
- Fetal distress: A baby who is in need of medical care or may not be able to withstand the stress of a vaginal delivery can be delivered quickly by C-section.
- Abnormal position of the baby: Transverse lie and breech presentation are usually delivered by C-section.
- Abnormalities of the placenta and umbilical cord: Included are Placenta Abrubtia and Placenta Previa.
- Genital herpes: If the mother is experiencing an outbreak, a cesarean is necessary to prevent the baby from contracting the disease.
- Mother's preference: Many practices and hospitals will allow elective cesarean sections at the mother's preference; although, the practice is hotly debated.
Pre-Op: Preparing for Surgery
Depending upon the circumstances of your cesarean, doctors will have between a couple of hours and a couple of minutes to prepare you for surgery. They may ask you to drink a syrup that will help to coat your stomach to fight nausea from the anesthetic. You will lift your legs to your stomach while a nurse inserts a tube through your urethra and into your bladder. This is not a painful procedure, and if you have an epidural in you won't feel it at all. You also will probably be shaved to ensure that pubic hair does not enter into the incision. Most cesarean incisions are done just above the pubic bone and can be hidden under regular underwear or a bikini.
At some point, you probably will be given a sedative in your I.V. The sedative may have a mild effect on your memory of events, but more importantly will help calm you so that you can focus on the birth of your baby instead of on the worries of surgery.
Your doctor will go over the risks for you and talk to you about the procedure and you probably will sign a release acknowledging the risks. This is standard procedure for any surgery. Your spouse or partner will be offered the opportunity to scrub in and be with you.
Next, you will be wheeled down to the operating room where surgical staff will lift you from your hospital bed to the operating table. Don't help. They know how to lift even very-pregnant-you and they know where they want you.
Your obstetrician will probably meet you in the operating room where an anesthesiologist will be ready. The anesthesiologist will be responsible for your spinal block. If you already have an epidural, you may still need an additional needle stick to accommodate the spinal. The spinal block is a much heavier dose of medicine and will ensure that you are completely numb from the waist down.
A curtain will be raised over your mid section and you arms will be outstretched in order for the anesthesiologist and nurse to have access to your I.V. Your doctor will probably talk you through the surgery as he conducts it, if you ask him to. Otherwise, you can just talk to your partner and wait to hear the sounds of your baby's first cries!
Many hospitals require a pediatrician to examine a C-section baby just to be sure everything is okay. Your baby will be cleaned and weighed and brought to you. You won't be able to hold the baby for a little while as you will still be in surgery and your arms will have I.V. lines in them.
After the surgeon closes, you will be wheeled into recovery where you will be observed as the anesthetic wears off. Depending upon the nature of your surgery and your doctor's assessment of your pain, you probably will be given a morphine self-medicator for the first few hours to address the pain. You will remain on the catheter for a while, as well.
You can breast feed any time you like, and may just want to ask a nurse or lactation consultant to help you. If you are concerned about medications and breastfeeding, be sure to talk to your doctor.
Most cesarean patients remain in the hospital for several days. About six-ten hours after surgery, nurses will arrive to help you get on your feet. Your catheter will be removed (painless) and you will be disconnected from the morphine and helped to undress for a shower. Your incision is stapled, so as long as you keep soap off it, showering is fine. Vaginal bleeding will be the same as if you had delivered vaginally.
You will still continue to receive pain medications at your doctor's discretion in order to help you through those first days. It is major abdominal surgery so it is important to rest and not to strain your stitches.
Most patients who have been catheterized experience difficulty urinating afterward. Urinary tract infections are also common after catheters. Both problems are mild and will pass in time. Give yourself lots of time in the bathroom and relax -- your body has just been through a major trauma and needs a little time to recover. Be sure to keep drinking water and eating whatever the doctors and nurses suggest. Report any itching or burning sensations to your nurses so they can check for infection.
Most women experience some anxiety over their first bowel movements following delivery. It is wise to eat lots of high-fiber dried fruits and keep hydrated. The first bowel movement may be painful, even for cesarean patients, but it will vastly improve after that.
How Will I Feel?
FIRST DAY: Usually not the most painful because most women are on epidural or IV anesthesia and non-functional intestinal track. Some common discomforts are:
- Sore shoulders
- Itching/skin eruptions if sensitive to the pain killer
- Sore throat (if you had oxygen or were intubated for general anesthesia.)
FORTY EIGHT HOURS POST-OP: This is usually the time the patient experiences the most soreness. Keep taking your pain medications on the schedule prescribed and report pain to your doctor for more help. By the third day, the pain should be significantly diminished.
If you anticipate a C-section, it is good to plan and prepare your bed room for it. It is very hard to sit up and get out of bed for several weeks post-op. The best alternative is to have something to pull up on so that the arms and not the stomach muscles are strained. Even just a strap wrapped around the foot board that you can pull up on will make a tremendous difference.
C-section patients cannot carry infant carriers up and down stairs for a few weeks. If you anticipate a C-section, figure out where you and the baby will spend your day so that you don't have to go up and down stairs. Bring diapers down stairs to the living room so you don't even have to get off the couch. Or bring everything the baby needs into your bed room with you so that you and baby can sleep and recover together.
Lifting the baby in and our of the car also is a very bad idea for C-section patients. Be sure that someone helps you with this task so you are not threatening to pull out stitches.
Taking Care of the Incision
Your C-section scar will look initially like something Frankenstein wore on his head. But the staples closing the skin are only part of the story. There are layers of muscle and fat, and a uterus, which all have been cut during surgery, and there are layers of stitches inside you. It is very important that you do not strain your incisions by lifting heavy objects or exercising until your doctor approves.
The scar will start to itch in the first week, a good sign of healing. Don't scratch the scar or pick at it. The itch is a sign of health but the scar must be left alone to heal.
Eventually, the staples may start to fall out on their own as the skin heals. Your doctor will have you come in about a week post-op to look at the incision and to remove the exterior stitches or staples. This procedure does not hurt, just tickles a bit if you are ticklish.
Many cesarean patients experience numbness around the incision and even in the abdomen for quite some time after surgery. The nerves and muscles were cut and it takes time for them to regrow and feeling to be restored. It will happen eventually. Aching and soreness at the site of incision is a common experience and may continue for weeks or months. It is not severe, just a reminder of the trauma your body underwent as you gave birth to your baby.
Never in history have cesarean sections been safer, less painful, or more efficient. Should you be facing the prospect of a C-section, remember that your doctor has performed a lot of them and that recovery is typically prompt and complete with the patient's prospects for more children unharmed.
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