Cesarean Section

Caesarean Section Meaning- A classical cesarean section is nothing but an alternative for a vaginal birth or vaginal delivery.  Cesarean delivery that is also referred to as C-section is a surgical technique that involves incisions in the abdomen and uterus to deliver a baby. If you have pregnancy difficulties or have had a previous C-section and aren't interested in having a vaginal delivery after your caesarean (VBAC), a C-section may be scheduled ahead of time.  A vaginal delivery also allows mothers to return home sooner and recuperate faster. C-sections, on the other hand, can save lives in an emergency and enable women who are at risk of difficulties to escape perilous delivery-room conditions. Obstetricians are the doctors who care for pregnant women before, during, and after birth and some family physicians usually perform the C-sections. Despite the fact that more women are choosing midwives to deliver their infants, midwives with any level of licensure are not permitted to perform C-sections. Let us now explore further the reasons leading up to the cesarean birth, the types of cesarean section, the procedure, symptoms and how to care for post the c section operation. 

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Reasons or Causes to Initiate a Cesarean Birth

1. The labour isn't moving forward and stalled labour is one of the leading causes.

2. There have been cases of multiple gestations, such as twins or triplets.

3. The foetus is in danger or has a serious health problem.

4. Hydrocephalus, or an excess of fluid on the brain, affects the foetus.

5. The foetus is in the transverse or breech position.

6. Because the baby is too big to fit through the cervix, it cannot be delivered.

7. The mother has a communicable illness, such as herpes or HIV (Human Immunodeficiency Virus), which would be transmitted to the baby if she gave birth vaginally.

8. The mother has a number of health issues, including diabetes and high blood pressure.

9. The mother is suffering from a uterine disorder or a fibroid that is restricting the cervix.

10. Anomalies exist in the placental or umbilical cord.

11. The mother has had a previous C-section birth.

12. In the womb, the baby is breech (feet- or bottom-first) or transverse (sideways).

13. There are several birth malformations in the newborn (such as severe hydrocephalus).

14. The mother's placenta is causing her complications, such as placenta previa (when the placenta sits too low in the uterus and covers the cervix).

A caesarean section may also be requested by the mother and this kind of elective cesarean section can be due to various reasons, which are as follows. 

1. Because of dread of pain during childbirth or apprehension about vaginal delivery especially for new mothers.

2. Following a series of contacts with healthcare specialists, mothers feel confident in going ahead.

3. The media, friends, and family are all examples of social influences which can help the mothers to change their opinion about the choice of method of delivery.

4. A sense of being in charge of the birthing process.

Cesarean Section Procedure

Stage 1- Preparation For The Cesarean Birth Procedure

• Heart rate, respiration, and blood pressure are all monitored using various devices.

• An oxygen mask or a tube inserted into your nostrils to provide oxygen.

• A catheter (a tiny tube) inserted into your bladder through your urethra an IV in the mother’s arm or hand.

•  The belly is cleaned and any hair between the belly button and pubic bone is shaved.

• A privacy screen is placed around the belly.

Stage 2- Inducing anaesthesia for the mother to be ready and for numbing any kind of pain. Three different types of anaesthesia are given based on the circumstances specific to the mother. 

• A spinal block is a type of anaesthetic that is injected directly into the sac that surrounds your spinal cord, numbing your lower body.

• Epidural anaesthetic is injected into your lower back outside the sac of the spinal cord and is used for both vaginal and caesarean deliveries.

• General anaesthesia is a type of anaesthetic that puts you to sleep without feeling pain. It is frequently used in emergency situations.

Stage 3- Cesarean section procedure- The doctor makes an incision on the skin of the abdomen, usually horizontally (1–2 inches above the pubic hairline, often known as "the bikini cut"), after administering anaesthetic. The doctor will then split the abdominal muscles gently to provide access to the uterus, where he or she will make a second incision in the uterus itself. This incision might be horizontal or vertical. Doctors frequently make a horizontal incision in the uterus, also known as a transverse incision, because it heals faster and allows for more options. The baby is carefully pulled out once the uterine incision is created. The umbilical cord is clamped and severed after the doctor suctions the baby's mouth and nose. You should be able to see your kid right away, just like with a vaginal birth. The baby is then passed off to a nurse or doctor, who will look after your infant for a few minutes and longer if any concerns arise. 

Stage 4- Post Operation Care- The placenta is then removed from the uterus, the uterus is closed with dissolvable stitches, and the abdominal incision is closed with sutures which are the surgical staples that are normally removed a few days later post-surgery and this is a painless procedure. After a C-section, one should expect to spend a few days in the hospital. The pain management choices will be discussed with the health care professional. When the anaesthetic wears off, the mother is encouraged to drink plenty of water and walkabout. This aids in the prevention of constipation and DVT (deep vein thrombosis). The medical staff will keep an eye on the wound for signs of infection. If a bladder catheter is present, it will almost certainly be removed as quickly as possible. The mother can hold and start nursing the newborn in the recovery room if the infant is doing well. If the mother has to continue lying down flat, it is advised to gain the required assistance in holding the baby on the breast.

Types of Cesarean Section

The orientation of the incision on the abdomen differs between the two types of caesarean sections. The bikini cut and the classical cut and the hysterectomy are the different options. 

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1. Traditional or Classical Cesarean Section- A long, vertical incision is created in the midline of the abdomen during a traditional Cesarean section or C-section. The uterus is also incised vertically after the skin is incised, and the baby is born. This type of C-section allows for a considerable amount of space for the baby to be delivered due to the size of the incision. The treatment, however, is associated with post-surgical problems and is no longer widely performed. For years following surgery, the large incision weakens the abdominal muscles and raises the risk of hernia. Furthermore, vaginal birth is not safe for future pregnancies once this sort of C-section has been performed. 

2. The Bikini Cut or The Lower Uterine Segment Cesarean Section (LUCS)- It is increasingly popular since it heals and looks better after surgery, as well as causing less pain. The doctor makes an incision from one side of the belly to the other, just above the pubic hairline, in a bikini cut caesarean section. On the uterus itself, there are two sorts of incisions that can be done. If a bikini cut was utilised on the abdomen, the surgeon may perform a low transverse uterine incision or lower segment caesarean section on the uterus (LSCS). If the classic cut was used on the abdomen, the doctor may make a bikini cut on the uterus or, more rarely, a classic uterine incision, which is a vertical cut on the uterus. Inserting a hand into the uterus and pulling the baby out is how the baby is delivered. This is one of the most used C-section delivery procedures nowadays. The danger of bleeding and other complications such as hernia after the surgery is small, and the surgical wound heals more quickly than the wound left following a typical C-section. Furthermore, a woman might choose vaginal delivery for future pregnancies. 

3. Hysterectomy by Caesarean Section- The uterus is removed during the same process as the C-section delivery in a Cesarean hysterectomy. This may be necessary if the placenta is bleeding profusely after delivery or if the placenta cannot be detached from the uterus walls.

Symptoms Following a C-Section Operation 

• Fever is one of the most common ways of the body to respond to a caesarean operation.

• Vaginal bleeding has increased.

• An increase in the amount of redness around the incision site.

• The surgical incision may be drained or swollen.

• Breast pain is accompanied by redness or a fever.

• Vaginal discharge with a terrible odour.

• Urination causes pain.

Risks of Cesarean Section Procedure 

The risks a mother experience depends on the types of c section performed and the obstetrician performing it. Often even if the types of cesarean section becomes complicated the risks can be lower if the doctor is an experienced expert. The following are some of the issues that a mother could face- 

1. Blood loss from a wound infection.

2. Infection in the operated area may increase. 

3. Blood clots injury to an organ, such as the intestines or bladder bad responses to medicines or anaesthesia future pregnancy issues.

4. Endometritis, an infection of the uterine lining, can also affect some women.

5. Child breathing issues, especially if done before 39 weeks of pregnancy.

6. Future pregnancies are at a higher risk.

7. Abdominal surgical issues such as adhesions, hernias, and other difficulties.

Emergency Care Post Cesarean Section

Even after the surgery, the mother may experience some painful symptoms but not all of them need emergency and immediate attention. If there is a severe case like the following cases then call the doctor and seek advice and treatment if need be. 

1. You may be experiencing depression, despair, or hopelessness, or you may be having worrisome thoughts. Postpartum depression is more common than one may think which can affect the baby too along with the mother. So seeking professional help will be beneficial. 

2. Pain, pus, swelling, redness, swollen lymph nodes, or fever are all signs of infection.

3. A temperature of over 100.4 degrees Fahrenheit.

4. Breathing problems.

5. Every 2 hours, bright crimson vaginal bleeding soaks through more than one pad (or less).

6. More than 4 days after giving birth, your vaginal bleeding has worsened or is still vivid red.

7. Pain in your thigh, groyne, back of the knee, or calf are all signs of a blood clot.

8. Your incision is about to open up.

9. Vomiting or nausea.

10. A golf ball-sized clot in the vaginal canal.

11. It's difficult to pass urine or faeces.

Caring Post the Cesarean Section Procedure

A caesarean section is a more invasive surgery that takes longer to recover from than vaginal childbirth. One may experience the following symptoms in the first few days or even weeks like feeling fatigued and uncomfortable around the incision and the doctor can prescribe pain killers that are safe to take during breastfeeding which will help the new mother.  One may also be gassy and constipated and even when one sneezes, coughs, or laughs, it is important to support the abdomen near the incision. Some Dos and Don’ts post-surgery are as follows. 

Dos- 

• Take some time to sit with your kid and bond with him or her.

• When you're exhausted, take a break.

• Every day, go for a walk. Constipation and blood clots can both be avoided by walking.

• When you need to cough or laugh, place a cushion over your incision.

• If you're having problems nursing, talk to a lactation expert.

• Take it all in slowly and do not panic if you think you have made a mistake.

• Take care of the wound and be cautious of applying anything other than the doctor-recommended products.

• After cleansing, carefully wipe the incision dry. If your doctor applied incision tape to your wound, don't remove it; instead, let it come off naturally. Do not apply any products to your wound without first consulting your doctor.

• Drinking plenty of water and eating a balanced diet is anyhow a step towards self-care and more so when caring for another life.

• Maintaining regular hydration and eating correctly will provide your body with all of the macronutrients and micronutrients it requires to return to normal.

• It's also crucial not to dismiss your doctor's advice. Don't do anything you're not sure about without first consulting your doctor, and always follow their instructions.

Don’ts- 

• Lifting anything heavier than your kid is not a good idea.

• Do not use tampons or douche unless your doctor has given you permission.

• Bathe only after your incision has healed and your postpartum bleeding has subsided.

• Do not engage in strenuous activity or perform core muscle workouts unless your doctor has cleared you to do so.

• Do not engage in sexual activity unless your doctor has given you permission.

• Do not use the stairwell on a regular basis.

• Soak in public pools or hot tubs at your own risk. 

• Do not be embarrassed about asking any queries and clarify all your concerns and talk to experts and professionals as much as possible. 

Conclusion

Because pregnancy and childbirth can be unpredictable, expectant mothers should be prepared in case a caesarean section is required. Giving birth is a wonderful and remarkable experience, and it's better to be as prepared as possible for the unexpected. Caring for a new baby is both magical and challenging. It's considerably more difficult to do so while recovering from a c-section. Don't be hesitant to tell someone you're having trouble, whether it's your partner, friends, family, or a professional. Getting help with your baby, grocery shopping, or other household activities can assist to relieve your stress and give you more time to rest. Take proper care of yourself so you can care for the baby. And the family along with the partner of the woman or the father of the baby should be supportive and caring for the mother and the baby.