Caesarean section
What is a caesarean section?
A caesarean section, also known simply as a caesarean or C-section, is a surgical procedure used to deliver a baby. This can be a planned procedure, or performed as an emergency if there are complications during labor. There are various advantages and disadvantages of a caesarean section.
Reasons for a caesarean section
Planned caesarean section
A planned caesarean section may be recommended if there are perceived risks to a vaginal delivery. Some circumstances where this may occur include the following:
- A physical obstruction that complicates vaginal delivery, such as a pelvic fracture, uterine fibroids, or the placenta covering the cervix;
- The baby is too large or the pelvis is too small for a vaginal delivery;
- There are multiple babies to be delivered, for example, twins or triplets;
- You have an infection that can be transferred to the baby during vaginal delivery (e.g. HIV or genital herpes), or;
- You have cervical cancer.
A planned caesarean section can have advantages, including knowing exactly when your baby will be born, as well as avoiding some potential risks to your baby. It also minimizes injuries to pelvic floor muscles that can occur during vaginal delivery. This can help to prevent urinary incontinence associated with childbirth.
It is possible to request a caesarean section. This means you choose to have a caesarean section even when there are no specific medical risks identified by your obstetrician. This is termed 'caesarean delivery on request' and you will need to understand the risks and benefits of this decision.
Unplanned or emergency caesarean section
In some cases, women who plan to have a vaginal delivery may unexpectedly require a delivery by caesarean section. A caesarean section may be required if:
- Your labor is not progressing as planned - for example, if the contractions are too weak or your baby's heart rate is abnormal;
- Your baby is in a breech (bottom or feet-first) or transverse (sideways) position when the labor begins;
- There is placental abruption, which occurs when the placenta separates from the uterus before the baby is born. This can cause heavy vaginal bleeding;
- The umbilical cord has fallen through (prolapsed) the cervix and into the vagina. This can be dangerous, as the umbilical cord carries oxygenated blood to your baby, which can be compromised during a prolapse, and;
- There is a medical emergency - for example, a car accident involving trauma, which forces a caesarean delivery to be performed.
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Cervix
The lower part of the uterus, leading out into the vagina.
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HIV
A virus transmitted mainly by sexual or blood-to-blood contact, that infects cells of the immune system. It is the causative agent of acquired immune deficiency syndrome (AIDS).
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Infection
Entry into the body of microorganisms that can reproduce and cause disease.
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Placenta
The organ that forms within the uterus of a pregnant woman to provide the fetus with nourishment from the blood supply of the mother.
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Umbilical cord
Also called the birth cord. A tube connecting the blood supply of the uterus of the mother to the circulatory system of the developing baby.
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Uterine fibroids
Abnormal growths that develop from the muscle in the walls of the uterus. They are not cancerous, however, they can cause a range of symptoms including pain, pressure in the pelvis and heavy menstrual bleeding.
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Uterus
The hollow organ of the female reproductive system that is responsible for the development of the embryo and fetus during pregnancy. Also known as the womb.
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Pelvic
Relating to the pelvis, which is the bony structure in the lower part of the trunk. The pelvis connects the base of the spine to the legs, anchors the thigh and abdominal muscles and protects important organs such as the bladder and bowel (and in women, the uterus).
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Cervical cancer
Cancer of the cervix, the lower part of the uterus that leads out into the vagina.
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Pelvic floor muscles
A group of deep muscles and ligaments at the bottom of the pelvis that support the organs that lie on it and control the anal, vaginal and urinary openings.
What happens during the procedure?
After admission to the hospital, before the procedure begins, you will have monitoring equipment placed on you, to observe your blood pressure, heart rate and blood oxygen levels during the surgery. You will also be given an intravenous (IV) line into your arm or hand for the infusion of fluids. After the procedure, pain medication can also be infused using the IV line. A catheter will also be inserted into your bladder to collect urine.
Anesthesia
There are two main types of anesthesia that can be used for caesarean section - regional anesthesia and general anesthesia. Regional anesthesia involves an injection near the spine, causing numbing of the abdomen and legs for the duration of the procedure. The main types of regional anesthesia include spinal and epidural anesthesia. You will remain awake during the procedure and although you may feel some pushing and pulling, you will generally be pain-free. General anesthesia involves medications to induce unconsciousness during the procedure. Therefore, you will not be awake during the delivery of your baby. This may be performed if the caesarean is urgent and there is not enough time to perform regional anesthesia. There is the possibility that some of the general anesthetic may cross the placenta and temporarily affect the newborn. For these reasons, regional anesthesia is generally preferred.
Skin incision
Your abdominal skin will be washed with an antibacterial solution to help prevent infection and partial shaving of your pubic hair may be required. The operation involves a 10-15cm incision (cut), usually horizontally in the lower part of the abdomen ('bikini-line'). This provides access to the uterus. Less commonly, a vertical incision may be made, particularly if it is performed in more urgent situations.
Uterine incision
After reaching the uterus through the skin incision, the uterus is then opened with another incision. It is commonly horizontal, but a vertical incision may be required if your baby is in a breech or sideways position, or the placenta is in the lower front area of the uterus.
Your baby will be lifted out of your uterus by hand or with forceps. The umbilical cord is clamped and cut, freeing your baby from the placenta. The placenta is then delivered by hand, before the uterus and wound are stitched up and a dressing put in place. Your baby will be evaluated by a pediatrician, before being given to you to hold.
A caesarean section typically involves a horizontal cut in the abdomen.
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Catheter
A thin, flexible tube inserted through a narrow opening into a body cavity for removing fluid.
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Epidural
An anesthetic injected into the epidural space of the spinal cord, especially used in childbirth.
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General anesthetic
An anesthetic given to a person to put them to sleep while having an operation or medical procedure. Afterwards, the person regains consciousness and usually has no memory of the procedure. A general anesthetic is given in hospital by a specialist called an anesthetist.
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Infection
Entry into the body of microorganisms that can reproduce and cause disease.
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Pediatrician
A doctor who specializes in the diagnosis and treatment of health conditions in children and babies.
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Placenta
The organ that forms within the uterus of a pregnant woman to provide the fetus with nourishment from the blood supply of the mother.
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Umbilical cord
Also called the birth cord. A tube connecting the blood supply of the uterus of the mother to the circulatory system of the developing baby.
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Uterus
The hollow organ of the female reproductive system that is responsible for the development of the embryo and fetus during pregnancy. Also known as the womb.
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Antibacterial
Preventing the growth or reproduction of bacteria.
What happens after the procedure?
Once your surgery is complete, you will be monitored and given pain medication. After your anesthesia has worn off, which usually takes one to three hours, you will be able to move around, drink fluids and eat food. You will generally be kept in hospital for 3-5 days, for staff to closely assess your recovery and assist you in caring for your baby.
Recovery time after a caesarean section can be up to six weeks. During this time you will be unable to lift anything heavier than your baby and will need to get as much rest as possible. Getting help from partners, relatives and friends can help with rest and recovery. It is usually advisable to not drive a car during the recovery time. It is common to feel numbness around the incision and aches and pains for up to three months after the procedure.
Potential complications
As a caesarean section involves anesthesia and major surgery, there are potential risks associated with the procedure. These must be considered when comparing the procedure against a vaginal delivery.
Some potential risks to the mother include:
- A risk of injury to abdominal organs, including the bladder and bowel;
- A risk of infections to the wound site, uterus or urinary tract;
- A risk of developing blood clots in the legs (deep vein thrombosis);
- Hemorrhage, which may require blood transfusions;
- Anesthetic complications, including allergic reactions, medication side effects, even death, and;
- Increased recovery time.
Risks to the newborn include:
- Temporary breathing issues;
- Injury or death, and;
- The need for additional care in a neonatal intensive care unit.
Risks to future pregnancies include:
- The placenta abnormally attaching to or growing into the uterus wall, due to scar tissue;
- The uterus rupturing, and;
- An increased likelihood for a caesarean section in future pregnancies.
It is important to discuss the risks versus the benefits with your doctor that are specific to your own circumstances. Generally, a caesarean section will be recommended by your doctor if the potential risks to you or your baby will be greater with a vaginal delivery than with a caesarean section. If you choose to have a caesarean for reasons other than a specific medical reason, discuss the risks and benefits with your doctor so that you can make as informed a decision as possible.
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Hemorrhage
Excessive bleeding that is difficult to stop.
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Placenta
The organ that forms within the uterus of a pregnant woman to provide the fetus with nourishment from the blood supply of the mother.
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Transfusions
The process of receiving blood or blood components from an external source directly into the bloodstream.
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Urinary tract
The organs and tubes involved in transporting urine within the body and out of it.
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Uterus
The hollow organ of the female reproductive system that is responsible for the development of the embryo and fetus during pregnancy. Also known as the womb.
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Neonatal
Relating to newborn babies.
References
- Anaesthesia for Lower-Segment Caesarean Section: Changing Perspectives. Accessed September 2 2014. link here
- Caesarean Section | Better Health Channel. Accessed September 2 2014. link here
- C-Section (cesarean Delivery). Accessed September 2 2014. link here
- C-Section Risks - Tests and Procedures - Mayo Clinic. Accessed September 2 2014. link here
- The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Accessed September 2 2014. link here
- Spinal Anaesthesia for Caesarean Section: An Ultrasound Comparison of Two Different Landmark Techniques - International Journal of Obstetric Anesthesia. Accessed September 2 2014. link here
- Spinal Anaesthesia for Emergency Caesarean Section in a Part...?: European Journal of Anaesthesiology (EJA). Accessed September 2 2014. link here
10 Most frequently asked questions (FAQs)
What is a caesarean section? A caesarean section, also known simply as a caesarean or C-section, is a surgical procedure used to deliver a baby via the abdomen. What is a planned caesarean section? A planned caesarean section delivery may be recommended by your obstetrician if they believe there are increased risks to you or to your baby if a vaginal delivery is performed. Some circumstances when this may occur include: a physical obstruction that complicates a vaginal delivery, including a pelvic fracture, uterine fibroids, or the placenta is covering the cervix; the baby is too large or your pelvis is too small for a vaginal delivery; there are multiple babies to be delivered, for example, twins or triplets; you have an infection that can be transferred to the baby during vaginal delivery (e.g., HIV or genital herpes), or; you have cervical cancer. What is an unplanned or emergency caesarean section? A caesarean section may be required if: your labor is not progressing as planned - for example, if the contractions are too weak or your baby's heart rate is abnormal and indicating a problem; your baby is in a breech (bottom or feet-first) or transverse (sideways) position when the labor begins; there is placental abruption, which occurs when the placenta separates from the uterus before the baby is born. This can cause heavy vaginal bleeding; the umbilical cord has fallen through (prolapsed) the cervix and into the vagina. This can be dangerous as the umbilical cord carries oxygenated blood to your baby which can be restricted during a prolapse, and; there is a medical emergency, for example, a car accident involving trauma, which forces a caesarean delivery to be performed. Is it possible to request a caesarean section? Yes, it is possible to request a caesarean section. This means you choose to have a caesarean section even when there are no specific medical risks identified by your obstetrician. You will need to understand the risks and benefits of this decision. What are the risks of a caesarean section? As a caesarean section involves anesthesia and major surgery, there are risks and complications associated with the procedure. Some potential risks include: a risk of injury to abdominal organs including the bladder and bowel; a risk of infections to the wound site, uterus or urinary tract; a risk of developing blood clots in the legs (deep vein thrombosis); hemorrhage (blood loss), which can sometimes require blood transfusions; anesthetic complications, including allergic reactions, medication side effects and maternal death; complications to the uterus from the caesarean incision. (this can include the placenta abnormally attaching to the uterus wall in future pregnancies, as well as the risk of the uterus rupturing in future pregnancies); temporary respiratory complications in your newborn, and; increased recovery time. What are the benefits of a planned caesarean section? A planned caesarean section can have advantages, including knowing exactly when your baby will be born, as well as avoiding some potential risks to your baby depending on your circumstances. It also minimizes injuries to pelvic floor muscles that can occur from vaginal delivery. This can help to prevent urinary incontinence associated with childbirth. How is a caesarean performed? A caesarean operation involves a 10-15cm incision (cut) made either laterally ('bikini line') or vertically through the layers of skin, fat and muscle of the abdomen to reach your uterus. Before the operation, you will be given a regional anesthetic (usually an epidural), which will numb the abdomen and legs. This allows you to be awake during the procedure, but not feel any pain. Your baby and placenta will be gently lifted out of the uterus by hand or with forceps. The umbilical cord will be clamped and cut and your wound will then be stitched up and dressed. How long does it take to recover from a caesarean section? Recovery time after a caesarean section can be up to six weeks. During this time you will be unable to lift anything heavier than your baby and will need to get as much rest as possible. Getting help from partners, relatives and friends can help with rest and recovery. It is usually advised not to drive a car during the recovery time. It is common to feel numbness around the incision and aches and pains for up to three months after the operation. Can I still breastfeed after a caesarean section? Yes, it is possible to breastfeed after a caesarean section. You will be encouraged to breastfeed by your obstetrician as your breast milk is the best source of nutrients for your baby at this time.
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