Everything You Need to Know about C-section

Commonly known as caesarean delivery, this is a surgical procedure used to deliver a baby through two incisions – one in the mother's abdomen and another in the mother's uterus. If you have any complications with your pregnancy or if you have already had a C-section with your previous pregnancy and are not considering vaginal birth after caesarean, then a C-section can be planned ahead of time. However, many a time until labour is under way, the need to perform a C-section is not obvious.

When will you have a C-section

• You're carrying twins, triplets or other multiples
• Your baby has a health concern such as developmental conditions
• You've had a previous C-section
• Your baby is in an abnormal position
• There's a problem with the umbilical cord or placenta
• Your baby isn't getting enough oxygen
• Your labour isn't progressing
• You have a health concern such as unstable heart disease, high blood pressure or infections such as genital herpes or HIV

C section is also performed at your request.

How a C-section is performed

Anaesthesia:  C-sections mostly require just local anaesthesia which numbs only the lower part of your body allowing you to stay awake during the procedure. The most common anaesthesia choice is a spinal block in which the anaesthesia is given directly into the sac surrounding your spinal cord. Sometimes, an epidural may be given to your lower back just outside the sac that surrounds your spinal cord. General anaesthesia can be used if you are over anxious about the procedure or some other conditions. Abdominal incision: Once the anaesthesia is adequate, an incision will be made through your abdominal wall, usually horizontally, near the pubic hairline (bikini incision). In some cases, a vertical incision will be made from just below the navel to just above the pubic bone when a large incision is needed or when your baby needs to be delivered very quickly. Uterine incision: A second incision, called the uterine incision, is made in the uterus after the abdominal incision. In the absence of any pregnancy complications, an incision will be made horizontally across the lower part of the uterus (low transverse incision). Delivery: Even while under anaesthesia, you might feel some movement as the doctor gently removes the baby from your uterus, but you shouldn't feel any pain. Your baby's mouth and nose is cleared off all fluids, then clamped and the umbilical cord is cut. The placenta is removed from your uterus, and the incisions are sutured. If you’ve had a C-section, you and your baby will stay in the hospital for about three days. You'll be encouraged to get up and walk as moving around can hasten your recovery and help prevent constipation and the risk of blood clots. Your healthcare team will instruct you on movement, fluid intake and other post-delivery complications. Meanwhile, your incision will be monitored for any possible signs of infection, and you will be given medicines for postsurgical pain. You should start breastfeeding soon after the surgery, this might be a little uncomfortable due to pain at the incision site. Don’t worry though, your healthcare team and the lactation consultant will help you with this.

FAQs from our Readers

What is an emergency caesarean and why is it performed? Most of the time, an emergency C-section means that it was not scheduled or is a 'non-elective' caesarean. But there are times when it is performed for urgent reasons like the following:

• Arrested labour, which means the labour is not progressing and is causing foetal distress or maternal exhaustion
• There is a risk of heavy bleeding or haemorrhage caused by the placenta separating from the uterine wall
• The baby is in a complicated position, i.e., transverse or difficult breech despite manipulation
• The pelvis is too narrow for the baby's head to pass through

What is an elective caesarean? Elective caesarean means it was planned and scheduled in advance, generally in the 39th week. Here, both you and your doctor make the decision to deliver surgically. Sometimes, your OB advises you to have a C-section due to the following circumstances:

• You have cephalopelvic disproportion where your baby's head is too big to pass through the birth canal.
• You have had a previous C-section.
• You have Placenta Previa or other placental complications that can be life-threatening
• Your previous pregnancy and labour situation was difficult
• You have pre-eclampsia that is affecting your well-being or your baby
• You have a multiple pregnancy
• Your baby's position cannot be manipulated for vaginal delivery

What are the advantages of having a planned caesarean? Since you have plenty to time to plan, a caesarean can be an advantage. You can choose the date of delivery (unless your baby arrives early). You don’t have to endure labour pains. You don’t have to go through vaginal interrogation done routinely for women in labour to measure dilation. With a planned C-section, your partner can be with you during the operation. Is the C-section surgery painful? What are you likely to feel while in the operation theatre? With a planned C-section, you are most likely to be on an epidural which means you will be awake. You could feel some odd sensations like tugging, pulling, pressure and some rummaging as your doctor disengages your baby's head from the pelvis and pulls the rest of the body out. You should not feel any pain since the anaesthetic effect is adequate to numb the affected region before your doctor proceeds with the incisions. You may sometimes experience uncontrollable shivering and chills. Will I be able to deliver normally after having a C-section? The biggest risk of a vaginal birth after a C-section is the tearing of the uterus. But these days, vertical scars from incisions are much stronger, and VBAC (vaginal birth after C-section) has a much lower risk. It basically depends on why you had a C-section previously and the number of operations you have had before and the type of incision made. What are the possible complications after having a C-section? Uterine infections, severe bleeding requiring blood transfusion, possible damage to the bladder or other organs, scarring of internal organs, blood clots in the leg veins or lungs are some possibilities. Issues like adhesions or opening of the skin incision can occur post-delivery. There seems to be an increase in repeat caesareans, what are the reasons for this? Many women opt for a repeat C-section due to the slight risk of uterine tear. Caesareans are preferred over difficult forceps vaginal deliveries and breech deliveries and also larger babies seem to be norm these days which requires surgery. Due to effective technologies, high-risk women can become mothers; however, problems such as high blood pressure, diabetes, obesity and advanced maternal age contribute to the increase of surgical births. Some women choose caesarean over normal delivery because of fear of labour pain or convenience even though they have no medical reasons with contraindicates a vaginal birth.