A caesarean section is an abdominal operation in which the baby is delivered through an incision made in the pregnant mother's abdomen and uterus (womb). A caesarean becomes necessary when the baby cannot be born through the vagina, or when a normal birth would carry a high risk for the mother and baby.
The most common reasons for a caesarean
- Prolonged labour: if labour lasts more than 20 hours in a first pregnancy, or more than 14 hours in second and later pregnancies, this is called failure to progress or delayed labour, and it is one of the main reasons for a caesarean.
- Abnormal position of the baby (the baby lying crosswise or feet first)
- Fetal distress (the baby is not getting enough oxygen)
- Birth defects (such as excess fluid collecting in the brain, or congenital heart disease)
- Repeat caesarean
- Chronic illness in the mother (high blood pressure, gestational diabetes, heart disease…). In diseases such as AIDS, genital herpes or any other infection that could be passed to the baby during a normal birth, a caesarean is preferable.
- Cord prolapse (the umbilical cord lies in front of the baby's head and comes out through the cervix before the baby, which disrupts and reduces the blood supply to the baby and puts the baby's health at risk).
- Mismatch between the baby's head and the mother's pelvis (when the mother's pelvis is too small for a normal birth and the baby's head is too large for the birth canal)
- Placental problems: (placenta praevia, meaning the placenta completely or partly covers the cervix) or (part of the placenta separating from the uterus before the baby is born (placental abruption))
- Multiple pregnancy
- Fear of normal birth. Steps needed before a caesarean: if your operation is not an emergency, do not eat or drink anything (not even water) for 8 hours before the operation. In emergencies, however, the operation is done much sooner than this.
After you are admitted to hospital, the following will be done for you:
- Your blood pressure, pulse and temperature are checked.
- A cannula (IV line) is placed in one of your veins so that fluids and medicines can be given through it.
- Unwanted hair around the site of the abdominal incision is shaved.
- Your abdomen is washed with antiseptic solution.
- A Foley catheter is inserted in the operating theatre to empty your bladder and reduce the risk of injuring it during the operation.
- If necessary, an antibiotic is injected before the operation.
- Before the operation, the obstetrician and the anaesthetist need to be fully aware of your medical history, so you must tell your doctor about any illness or physical problem. It is essential to tell the obstetrician and anaesthetist about the following:
- Any allergy to antibiotics, anaesthetic drugs or other medicines
- Long-term treatment such as blood thinners, insulin and anti-inflammatory drugs
- Recent or long-standing illness, or previous surgery
- Anaemia caused by heavy and prolonged bleeding
- Any herbal or chemical medicines you have taken recently.
Stages of a caesarean: after regional anaesthesia (spinal or epidural) or general anaesthesia has been given, the doctor makes a horizontal or vertical incision 10 to 20 centimetres long in the skin of the lower abdomen and reaches the uterus by cutting through the layers underneath. When the doctor reaches the abdominal muscles, they are moved aside to reach the uterus itself.
The incision in the uterus is usually horizontal and made in its lower part, but in special circumstances it may be vertical.
After the incision, the doctor lifts the baby out and, once the umbilical cord has been cut, the mother can see her baby for a few moments. Various checks are then carried out on the baby, but first the baby is wrapped in a warm towel so that it does not get cold. After the placenta has been delivered, the doctor begins stitching the uterus and abdomen; stitching the layers of the uterus and abdominal wall takes between 15 and 40 minutes. Types of anaesthesia for a caesarean: a caesarean can be done under general anaesthesia or under regional anaesthesia through the spine (spinal or epidural). General anaesthesia is usually used in emergencies or when spinal or epidural anaesthesia is not allowed.
Spinal or epidural anaesthesia is usually preferred, especially when the operation is not urgent. The obstetrician and anaesthetist will usually explain which method is best for you. If you have a general anaesthetic, you will be asleep during the operation. With spinal or epidural anaesthesia you will feel some pulling during the operation, but no pain. If you do feel pain, tell the doctor.
Sometimes spinal anaesthesia does not work completely, and in these cases a general anaesthetic is needed. The people at your bedside during the operation are: the surgeon, the anaesthetist, the anaesthetic technician, the surgical assistant, the neonatologist (newborn specialist), the nurse/person responsible for the baby, and the circulating nurse, who helps with preparing the surgical instruments in the operating theatre, preparing you before the operation and similar tasks.
Prepared by: Homa Yektapour – Education Unit
Source: Williams Obstetrics
Document code: NO-BR-16