Cesarean Birth in Southern New England

A cesarean section, also called a C-section, is a surgical procedure performed when a vaginal delivery is not possible or safe, or when the health of the mother or the baby is at risk. During this procedure, the baby is delivered through surgical incisions made in the abdomen and the uterus.

A cesarean delivery might be planned in advance if a medical reason calls for it, or it might be unplanned and take place during your labor if certain problems arise.

You might need to have a planned cesarean delivery if any of the following conditions exist:

• Cephalopelvic disproportion: CPD is a term that means that the baby’s head or body is too large to pass safely through the mother’s pelvis, or the mother’s pelvis is too small to deliver a normal-sized baby.
• Previous cesarean birth: Although it is possible to have a vaginal birth after a previous cesarean, it is not an option for all women. Factors that can affect whether a cesarean is needed include the type of uterine incision used in the previous cesarean and the risk of rupturing the uterus with a vaginal birth.
• Multiple pregnancy: Although twins can often be delivered vaginally, two or more babies might require a cesarean delivery.
• Placenta Previa: In this condition, the placenta is attached too low in the uterine wall and blocks the baby’s exit through the cervix.
• Transverse lie: The baby is in a horizontal, or sideways, position in the uterus. In this condition, a cesarean delivery is always used.
• Breech presentation: In a breech presentation, or breech birth, the baby is positioned to deliver feet or bottom first. If your doctor determines that the baby cannot be turned through abdominal manipulation, you will need to have a cesarean delivery.

An unplanned cesarean delivery might be needed if any of the following conditions arise during your labor:

• Failure of labor to progress: In this condition, the cervix begins to dilate and stops before the woman is fully dilated, or the baby stops moving down the birth canal.
• Cord compression: The umbilical cord is looped around the baby’s neck or body, or caught between the baby’s head and the mother’s pelvis.
• Prolapsed cord: The umbilical cord comes out of the cervix before the baby does.
• Abruptio placentae: The placenta separates from the wall of the uterus before the baby is born.
• Fetal distress: During labor, the baby might begin to develop problems that cause an irregular heart rate. Your doctor might decide that the baby can no longer tolerate labor and that a cesarean delivery is necessary.

If the cesarean delivery is not an emergency, the following procedures will take place:

• You will be asked if you consent to the procedure.
• The anesthesiologist will discuss the type of anesthesia to be used.
• Your blood pressure, pulse and temperature will be taken.
• A shave will be done around the incision area.
• A catheter will be inserted to keep your bladder empty.
• Medicine will be put directly into your vein.
• You will have heart and blood pressure monitors applied

At the start of the procedure, the anesthesia will be administered. Your abdomen will be cleaned with an antiseptic, and a sterile drape will be used to prevent you from watching the surgery.

The doctor will then make an incision through your skin and into the wall of the abdomen. The doctor might use either a vertical or transverse incision (A horizontal incision is also called a bikini incision because it is beneath the belly button). Next, a three- to four-inch incision is then made in the wall of the uterus, and the doctor removes the baby through the incisions. The umbilical cord is then cut, the placenta is removed and the incisions are closed.

If the cesarean is an emergency, the time from incision to delivery takes about two minutes. In a non-emergency, a cesarean birth can take 10 to 15 minutes, with an additional 45 minutes for the delivery of the placenta and suturing of the incisions.

Because the cesarean is major surgery, it will take you longer to recover from this type of delivery than it would from a vaginal delivery. Depending on your condition, you will probably stay in the hospital from three to four days.

Once the anesthesia wears off, you will begin to feel the pain from the incisions, so be sure to ask for pain medicine. You might also experience gas pains and have trouble taking deep breaths. You will also have a vaginal discharge after the surgery due to the shedding of the uterine wall. The discharge will be red at first and then gradually changes to yellow. Be sure to call your health care provider if you experience heavy bleeding or a foul odor from the vaginal discharge.

Like any surgery, a cesarean section involves some risks. These might include:

• A ruptured or cut blood vessel
• Infection or bleeding
• A blood clot (DVT or PE)
• Loss of blood
• Injury of the bowel or bladder
• A cut that might weaken the uterine wall

The majority of women who have had a cesarean delivery might be able to delivery vaginally in a subsequent pregnancy. If you meet the following criteria, your chances of vaginal birth after cesarean (VBAC) are greatly increased:

• A low transverse incision was made into your uterus during your cesarean.
• Your pelvis is not too small to accommodate a normal-sized baby.
• You are not having a multiple pregnancy.
• Your first cesarean was performed for breech presentation of your baby.