Caesarean section: Indications and Complications

Caesarean section delivery is the surgical procedure for the delivery of a child. Over 1.2 million cesarean deliveries are performed in the US annually, i.e. one in every three mothers deliver a baby by a cesarean section.

The procedure

Caesarean section is a major surgical procedure. To make sure you are fit enough to go through this surgery a set of basic blood tests will be done.

• A cannula will be placed in your arm to have continuous access to your vein to give you fluids and drugs during the surgery.
• A small tube will be placed through your urethra to keep your bladder empty as this minimizes the chances of injury to the bladder during the surgery.
• Anesthesia: This procedure can be done under general anesthesia or an epidural block or a spinal block; you may decide which form of anesthesia you wish to have after having a discussion with your obstetrician. For an epidural or a spinal block, your anesthetist will give you an injection in your spine which will numb your pelvis and your lower extremity while keeping you awake. Under general anesthesia, you will be completely unconscious. Before the surgery starts your abdomen will be cleaned and your pubic hair may be trimmed.
• During the surgery, your obstetrician will put an incision on your abdomen, either vertical or horizontal depending upon the indications for the procedure. The obstetrician will then separate or cut through the muscles in your abdomen to reach your uterus which another incision will be put to open it.
• The baby is delivered through this incision and the cord is clamped after some time. After the delivery of the placenta, the uterus is closed with the help of sutures which will dissolve on their own. The abdomen muscles and the skin are closed with the help of sutures or staples.

Indications

Caesarean section will be suggested as an option to you if:

• The labour is progressing slowly
• There are signs of fetal distress
• The cord is wrapped around the neck of the baby or is getting compressed, hence compromising the blood flow to your baby
• The baby is in a breech position, i.e. your baby is placed in the uterus in such a way that the first part to come out could be the buttock or the limbs; this leads to a difficult delivery and the chances of trauma to the baby during a normal vaginal delivery increases.
• The head of the baby is too big or you have a narrow pelvis which might lead to trauma to the baby if you choose to go with a normal vaginal delivery
• You have a condition, like congenital heart disease or hypertension; which may aggravate with a normal vaginal delivery
• The placenta is near the opening of the uterus
• More than one baby is in the uterus i.e. a twin pregnancy
• You have an infection like HIV or genital herpes, to reduce the chances of transmission to your baby
• You have had a previous cesarean section and there are chances of a rupture of the uterus if you go through with normal vaginal delivery.

Cesarean section can also be an elective procedure where you choose to have a c-section in the absence of any indications after having a discussion with your obstetrician.

Complications

Caesarean section being a major surgical procedure comes with various complications like:

• Infection at the site of the incision
• Blood loss and hemorrhage during the surgery
• Endometritis
• Some women who deliver by a cesarean section report to have less satisfaction with their birth experience. Some women also express strong feelings of failure, anger, and loss.
• Birth trauma to the baby
• Significant increase in risk for abnormal placenta for future pregnancies
• Increase risk in rupture of the uterus during a future pregnancy

Recovery

After the procedure, you will be taken to the recovery room. If you were under general anesthesia you might feel a little groggy and disoriented on waking up. Women who opt for an epidural or a spinal block may hold their baby as soon as the baby is born. You may start breastfeeding as soon as you wish to.

The incision may be sore for a few days and you will be required to keep it clean to prevent infections. You will be advised to avoid lifting heavy weights and exert yourself to make sure the wound heals properly. After a 2-3 day stays at the hospital you will be allowed to go home. You might experience bleeding with clots from your vagina for a few days accompanied by discomfort. If the pain and bleeding are extreme you should immediately contact your obstetrician.

Prognosis

Some studies have shown that children born from a cesarean section have a greater chance of developing allergic diseases compared to babies born by normal vaginal delivery.

Sources

CDC. births-method of delivery, 2015.

Cesarean childbirth and psychosocial outcomes: A meta-analysis. DiMatteo MR, Morton SC, Lepper HS, Damush TM, Carney MF, Pearson M, Kahn KL