Cesarean section . A type of delivery in which a surgical incision is made in the mother’s abdomen and uterus to remove one or more fetuses. It is usually performed when a vaginal delivery could lead to medical complications.
Summary
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- 1 Story
- 1 Types of Cesarean Section
- 2 Indications
- 2 Risks
- 1 Risks to the baby
- 2 Risks to the mother
- 3 Anesthesia
- 4 vaginal deliveries after cesarean section
- 1 Planned cesarean deliveries
- 5 Cesarean Delivery
- 1 Fetal indications
- 2 Maternal indications
- 6 Recovery from caesarean section
- 7 Consequences of a caesarean section
- 8 Source
- 9 References
History
Cesarean sections were already known and practiced in ancient Rome, and the Roman dictator and politician Julius Caesar is said to have been born by this method. The first data that is had of a woman who survived a caesarean section was in Germany in 1500: It is believed that Jacob Nufer, a castrator of pigs, performed this operation on his wife after prolonged labor. Most of the time, the procedure had a high mortality. In Great Britain and Ireland mortality in 1865 was 85%. The key measures in reducing mortality were:
- Acceptance of the principles of asepsis .
- The introduction of uterine suturing by Max Sänger in 1882.
- Extraperitoneal caesarean section and then move to the lower transverse incision (Krönig, 1912).
- Advances in anesthesia.
- Blood transfusion.
European travelers in the Great Lakes region of Africa observed cesarean sections during the 19th century that were carried out on a regular basis. The expectant mother was normally anesthetized with alcohol and a mixture of herbs was used to improve recovery. Given the well-developed nature of the procedures used, European observers concluded that they had been used for some time.
On March 5, 2000, Inés Ramírez performed the cesarean section on herself and survived, as did her son, Orlando Ruiz Ramírez. She is believed to have been the only woman to have caesarean section herself and to have survived.
Caesarean Types
- The classic incision is longitudinal in the midline, allowing more space for delivery. It is rarely used, as it is more susceptible to complications.
- The most common today is the lower segment, in which a cross section is made just above the edge of the bladder. Blood loss is less and repair easier.
- A cesarean section hysterectomy is delivery by cesarean section and subsequent removal of the uterus, which can be performed in cases of intractable bleeding or when the placenta cannot be separated from the uterus.
- Sometimes other types have been practiced, such as extraperitoneal or Porro’s.
Sometimes the father is asked to witness the operation in order to support and share the experience with his partner. The anesthesiologist usually temporarily discovers the field when the baby is coming out so that the parents can see it.
Indications
Gynecologists recommend cesarean section when vaginal delivery can be risky for the child or mother. Some possible reasons are:
- Prolonged complicated labor or dystocia: abnormal pelvis, maternal exhaustion, uterine malformations , abnormal fetal position, asynclitism, hydrocephalus , too narrow pelvis.
- Apparent fetal distress
- Apparent maternal distress
- Complications like pre-eclampsia or eclampsia
- Multiple births
- Bad positioning of the baby, (head up instead of towards the pelvis)
- Abnormal presentation
- Failed induction of labor
- Failed instrumental delivery
- Very large baby (macrosomia)
- Very low placenta or placenta previa
- Contract pelvis
- Evidence of intrauterine infection
- Sometimes prior cesarean section
- Perineum healing problems, derived from childbirth or Crohn’s disease.
Risks
Most women and babies are fine after a cesarean section. But cesarean section is a major operation with risks related to the surgery itself and anesthesia. According to the National Center for Health Statistics, 1 in 3 babies in the US . born by caesarean section. In recent years, the rate of cesarean births has increased rapidly. Some health professionals think that there are no medical reasons for many cesarean deliveries. When a woman has a cesarean section, the benefits of the surgery must outweigh the risks. The risk of preterm delivery almost to term. Cesarean deliveries contribute to the growing number of babies who are born “almost full term premature”, between the 34th and 36th weeks of pregnancy. While these babies are generally considered healthy, they are at higher risk for health problems than full-term babies. A baby’s lungs and brain mature late in pregnancy . Compared to a full-term baby, a baby born between 34 and 36 weeks gestation is more likely to have problems with:
- The breathing
- Eating
- Control the temperature
- Jaundice
It can be difficult to determine your baby’s conception date. Failure for a week or two can result in premature birth. This can affect your baby’s health. Keep this in mind when making an appointment for a C-section.
Risks to the baby
Anesthesia: Some babies are affected by medications given to the mother for anesthesia during surgery. These medications numb the woman so that she does not feel pain. But they can also cause drowsiness or inactivity in the baby.
Breathing problems: Even though they are born full-term, babies born by cesarean section are more likely to have difficulty breathing than babies born through the vagina.
Risks to the mother
Some women may experience one or more of the following complications after a cesarean section:
- Infection in the incision, uterus, or other nearby pelvic organs
- Heavy bleeding that can lead to a blood transfusion
- Injury to the bladder or intestines
- Clots in the legs, pelvic organs, or lungs
- Reactions to medications or anesthesia (medications that numb you so you don’t feel pain)
A small number of women who have cesarean deliveries die. Death, although mother death is not common, is more likely to occur in a cesarean delivery than in a vaginal delivery. A woman who has had a cesarean delivery and wants to become pregnant again is at increased risk of:
Placenta previa: A low placenta that covers part or all of the inside of the opening of the cervix. Placenta accreta: A placenta that attaches too deeply and firmly to the wall of the uterus.
Both conditions can cause severe bleeding during labor and delivery, endangering the health of the mother and baby. The risk increases with the number of pregnancies.
Anesthesia
The mother generally receives regional (spinal) or epidural anesthesia, allowing her to be awake during labor and avoiding sedation of the infant. In modern practice, general anesthesia for caesarean section is increasingly rare as the benefit of regional anesthesia for both mother and baby has been scientifically established .
Vaginal deliveries after cesarean section
Vaginal deliveries after cesarean section are not uncommon today. In the past, a vertical incision was used for caesarean section that cut the muscle fibers of the uterus . Modern caesarean sections are generally performed with a horizontal incision following the path of the muscle fibers. The uterus then maintains its integrity better and can tolerate strong contractions of future delivery. For cosmetic reasons, the scar from modern caesarean sections is below the (bikini line). It should be noted that this type of incision is not recommended for health, since it takes much longer to heal because naturally, our skin follows a kind of vertical sequence, so it never even heals completely.
Currently the old aphorism of after caesarean, always caesarean is not admitted. Unless the cause of the first cesarean section remains, for example, the placenta praevia or narrow pelvis, the accepted behavior is to allow labor to proceed and to act according to evolution. Another point in which an intense controversy has been unleashed is on the right of the pregnant woman to choose the way of childbirth, that is, the pregnant woman that she wishes, without objectionable causes for a cesarean section.
Planned cesarean deliveries
Cesarean deliveries are planned when a medical problem is known that will make the labor dangerous for the mother or baby. Some of the medical reasons for the planned caesarean section may be: A fetus in any position other than the head-down position (including the breech position). Decreased blood supply to the placenta before birth, which could lead to the baby being born very small. The medical urgency for the baby to be born when labor is not successful. When the baby’s measurement is estimated to be less than 9 to 10 pounds or more. A maternal disease or condition that could condition labor, such as heart disease for example. In cases of placenta previa, that is, when the placenta is blocking the cervix. Diseases like [[genital herpes ]] that could pass to the baby if it passes through the vagina during delivery.
In cases where the mother holds the virus of immunodeficiency human ( HIV ), which can be transmitted to the fetus if it is born through the vagina. Multiple pregnancies. The direction and size of the incisions in these cases will depend on the position of the fetuses. In particular, cesarean delivery could be done due to multiple causes:
- Twins who share the same amniotic sac .
- More than three fetuses.
- In cases of Siamese twins.
A uterus that does not contract properly during labor, causing labor to be prolonged and complicated. When fetuses are too big.
Cesarean birth
Cesarean delivery is a type of delivery that is often planned in time, while others are performed when the baby needs to be born immediately to ensure that the mother and the baby on the way are in good condition. Sometimes the pregnancy does not end as the mother would have liked. Under certain circumstances, natural childbirth is not possible and a cesarean section must be used. In it, the pregnant woman is surgically intervened to remove the baby. An incision is made in the abdomen (laparotomy) and another in the uterus, the amniotic fluid is removed and then the baby. The newborn’s mouth and nose are cleaned of fluids, the umbilical cord is cut and tied, and the baby is transferred to a pediatrician or nurse who will monitor his breathing. The baby and placenta are removed through the incision within minutes after the start of surgery. These incisions are closed and this entire process takes about an hour.
This procedure is generally performed under spinal or epidural anesthesia, allowing the mother to be awake during labor, but anesthetized from the chest to the legs. This anesthesia does not sedate the baby, and the mother can hear and see her baby. General anesthesia is used but very rarely. The caesarean section incision is usually made above the pubis, above the edge of the bladder, below the “bikini line”. Another type of longitudinal incision can be made, but it is rarely used because it can generate more complications than the previous incision. Cesarean sections should only be performed when vaginal delivery presents with some complications. Some of these reasons may be:
Fetal indications
- Acute fetal distress (OSS) due to decreased oxygen supply to the fetus.
- Fetal tachycardia or bradycardia (the heart beats too fast or too fast).
Maternal indications
Relating to the uterus
- Uterus too small, scarred, or misshapen.
- Multiple gestation, can be due to natural causes or IVF.
Relating to the cervix (cervix)
- Cervix too relaxed (cervical incompetence).
- Presence of active genital herpes infection in the mother.
- Evidence of intrauterine infection
Relating to the placenta and umbilical cord
- Placenta that occludes the cervix (placenta previa), or low insertion.
- Premature placental abruption (placenta abruptio).
- Cord prolapse (exit of the cord through the vaginal canal).
Danger to the mother (maternal distress)
- The fetus’ head is too large to pass through the mother’s pelvis (pelvic cephalo disproportion).
- Very long labor and little dilation
- Failed induction of labor (by synthetic oxytocin, which is applied to speed up the dilation process of the cervix)
- Failed instrumental delivery ( forceps , spatulas, and obstetric suction cup)
- Baby’s abnormal position.
- Breech and primiparous (breech presentation).
- Transverse presentation.
- Face presentation.
- Elderly mother (aged), over 40 years
- Presence of a major associated disease (toxemia, preeclampsia, eclampsia, hypertension)
- Sometimes prior cesarean section
- Problems of healing of the perineum, derived from childbirth or Crohn’s disease, for example.
Cesarean section must be seriously justified as it is a major intervention. The probability of death of the mother in a caesarean section is three times greater than in a vaginal delivery. Babies born by caesarean section are very likely to have initial trouble breathing. It should also be borne in mind that although a vaginal delivery may occur after a cesarean section, the possibilities are less, since the uterus is usually felt, finer in the area of the incision, so perhaps not can withstand future contractions. Cesarean section is a major surgery, with all the risks this may have:
- The risks of any intervention under anesthesia.
- Reactions to medication.
- Respiratory problems.
- Additional risks include:
- Infection of the uterus
Other drawbacks:
- Increases the risk of infection 5 to 20 times (endometritis)
- Increases the risk of hospitalization of the baby in neonatology
- Increased risk of neonatal respiratory distress
- Maternal hospitalization time increases
- Postpartum pain increases
C-section recovery
Surely you feel very sore and you will need painkillers. The healing can take several weeks. While recovering you may feel: Mild cramps Discharge or bleeding for about 4 to 6 weeks Bleeding with clots and cramps Incision pain It will take 4 to 6 weeks before you can return to your regular activities
Consequences of a caesarean section
It should not be forgotten that caesarean section is a surgical operation and that, therefore, it has the same risks as any other intervention (infections, blood loss, etc.), in addition to those of anesthesia. Another aspect to keep in mind is that the postoperative period of a cesarean section is almost always more bothersome than recovery after a vaginal delivery. It is also more difficult the formation of breast milk (the “milk rise”), and may be delayed for several days more than usual after a vaginal delivery. The caesarean section scar is another sequel of great importance, since it increases the risk that the uterus ruptures in a subsequent delivery. However, vaginal delivery is possible in a woman who has previously had a cesarean, only increased vigilance during delivery is required.
Finally, caesarean section somewhat limits the number of pregnancies, since the risks increase with each new birth. Although there are women who have had four caesarean sections, the most common is that after the third caesarean section, a tubal ligation is performed if the mother agrees. Although always trying to avoid if possible, in the case of mothers giving birth for the first time, they look for alternatives to caesarean section with greater effort. If there has been a previous cesarean section, there are situations in which it is impossible to attempt a vaginal delivery and the only option is a new cesarean section. Some of these possible situations are: The uterus ruptured in the previous delivery. The mother has already had two or more caesarean sections, or her uterus has some other scar from a previous intervention.
The cause that required a cesarean section last time is repeated. The previous caesarean section was corporal (not segmental). She has only had a cesarean section, but there are more added risks, and the final forecast is very negative for attempting a vaginal delivery (breech presentation, twin pregnancy, diabetes, loss of fetal well-being
