Cesarean Section

Cesarean section is necessary when a normal birth would endanger either the mother or the baby. This can be due to the size and position of the baby, the presence of bacteria, or because of multiple births. There are two types of cesaren section, but modern medicine has made both of them extremely safe procedures.

Cesarean section is the delivery of a baby by cutting through the abdominal wall and uterus and removing the baby through these incisions. Almost 30 percent of all births in the United States are by cesarean section.

Reasons

Cesarean section is performed when delivery of the baby is necessary and when a vaginal delivery would cause injury to either the mother or the baby. Some of the specific reasons for a cesarean section include the following:

  • To save the baby's life when problems with the placenta or the umbilical cord cut off the blood supply to the baby (This event is often detected when abnormal heart rate patterns appear on a fetal monitor.)
  • To deliver the baby if the mother is unable to give birth after a long labor, in most cases because the baby is too large to pass through the pelvis
  • To prevent infection of the baby from dangerous bacteria in the surrounding amniotic fluid or a dangerous vaginal or cervical infection
  • To prevent injury to the baby during a breech birth, when the baby would emerge buttocks or feet first through the vagina rather than head first (Many obstetricians believe that all breech births in first-time mothers and all premature breech births require cesarean delivery.)
  • To treat disease of the mother or the baby that can be treated better if birth occurs as soon as possible
  • To prevent the chance of rupture of the uterus during labor if the mother has had a previous cesarean section, especially of the classical type
  • To deliver multiple pregnancies involving three or more fetuses

Types

Two types of cesarean section are performed:

  • In the classical cesarean section, a vertical cut is made directly down the center of the uterus in its thick upper section. The incision on the skin may be horizontal or vertical. This operation is generally performed only if the baby is lying in an abnormal position or if the placenta is in an abnormally low position in the cavity of the uterus. With this type of cesarean section, more bleeding occurs than with other methods, the incision is more difficult to repair, and the uterus is more likely to rupture during a future pregnancy. For these reasons, the classical cesarean section is seldom used today unless there are specific reasons for its use.
  • The lower-segment cesarean section is the more commonly performed operation. Here, a horizontal incision is made in the lower, thinner portion of the uterus. The incision made on the skin may be smile-shaped (the "bikini" incision) near the lower part of the abdomen.

Risks

To minimize risks associated with a cesarean section, the operation should be performed only by a skilled obstetrician, accompanied by an anesthesiologist to administer anesthesia to the mother. In some cases, a pediatrician may also participate to take care of the baby after birth.

Risks associated with cesarean section include possible infection, excessive bleeding, and dangerous blood clots that may enter the blood circulation.

Further, the operation may be inconvenient for the mother, requiring her to stay in the hospital at least two or three days instead of going home with the baby soon after a vaginal delivery. And although the use of general anesthesia is now uncommon with cesarean section, if it was used, a woman may not be able to see the baby for a number of hours after delivery. (Breast-feeding following cesarean section should not present a problem if adequate pain relief is provided and maintained for the mother.)

She will have pain from the operative incision, and once she arrives home, she will need to restrict her activity for a while. It takes up to six weeks for complete healing of the incision.

Of course, all these inconveniences are small if the result is a healthy mother and a healthy baby. And today, fortunately, cesarean section is an extremely safe operation because of improved antibiotics and better anesthesia.

Effects on Parents

In the past, women undergoing cesarean section have been separated from their husbands during surgery, and as a result have often expressed negative feelings of isolation and inadequacy for having failed to accomplish a vaginal delivery. To assist these parents and prevent this from happening to others, many childbirth instructors provide couples with more information about cesarean section.

In many hospitals, husbands are allowed to remain with their wives during the operation. Generally, allowing fathers in the operating room has not caused problems, and women who have undergone cesarean section with their husbands at their sides have shared and enjoyed the birth experience in a far more positive way.

Vaginal Birth After Cesarean Section

In the past, a firm rule in obstetrics was "once a section, always a section." More recently, obstetricians have found that many women with a previous cesarean section can have a safe vaginal delivery in a subsequent pregnancy. To minimize the risks of rupture of the uterine scar during labor, certain criteria must be met: The previous cesarean must have been only the lower-segment type; the mother's pelvis must be of normal size; and the indication for the previous cesarean should not exist with the present pregnancy.

While cesarean sections do not typically affect a baby long-term, birth defects can be lifelong conditions. On the next page you'll learn what some of the more common birth defects are.