Caesarean section, also known as C-section, or caesarean delivery, is the use of surgery to deliver babies. A caesarean section is often necessary when a vaginal delivery would put the baby or mother at risk.
Sometime patients have some questions and myths in their mind so we tries to answer some of them below.
Caesarean section (C-section) is the delivery of a baby through a cut in the mother's lower abdomen and the uterus. Caesarean births are more common than most surgeries (such as gallbladder removal, hysterectomy or tonsillectomy) because a caesarean section may be life saving for the baby, or mother (or both). Caesarean birth is also much safer today than it was a few decades ago. Hence 'caesarean'; is not something that should scare you, as the ultimate goal is a healthy mother and healthy baby, regardless of the method of delivery. It is important to know a few things about caesarean section in order to be prepared for a caesarean birth if it does happen to you. The following section will help you to understand caesarean births better. Caesarean section may be an emergency procedure or an elective and hence planned procedure. Peparation for the surgery may be done in the labour room or in the theatre itself. This includes putting a catheter into your bladder to drain urine, and an intravenous line (needle) into a vein in your hand or arm to give your body fluids and medications as required. Suitable anaesthesia is given to you so that you are pain-free during the procedure. The doctor makes the skin incision first. This is either a vertical incision in the middle from below the navel up to the pubic bone. A transverse or bikinicut incision (called pfannesteil incision) from side to side just above your pubic hairline. This incision is most common as it heals better and has a shorter recovery time, besides being more cosmetically acceptable. The complete procedure takes about 45 minutes to one hour in an uncomplicated case. From the initial incision to delivery of the baby takes about 5 minutes, and the remaining time is taken for repairing your uterus and abdominal wall.
Common indications for emergency caesarean sections are Foetal distress. Dystocia or non-progress of labour. Bleeding from your placenta. An emergency surgery is always more risky than a planned procedure. This may be because you are not on empty stomach, or there are life threatening problems like severe bleeding or rise in your blood pressure, or complete facilities like experienced anaesthetist / neonatologist / operative team / blood may not be immediately available.
This is one reason why your doctor may suggest a planned or elective caesarean section to you. If there are certain pre-existing conditions, which make it nearly certain that you will not be able to deliver safely vaginally, it may be better to do a planned procedure. This could be for reasons like
- Previous two or more caesareans.
- Placenta praevia.
- Mal-presentations of your baby etc.
A stenosed cervix.
- A thickly cervix which does not open up.
- Previous pelvic repair of a urinary or rectal fistula.
- Active herpes lesions of the genital tract
These may be the reasons for your doctor suggesting caesarean section.
- Maternal medical conditions may also call for a C-section. The conditions include
- Pre-eclampsia or Pregnancy Induced Hypertension (PIH) is a leading cause of maternal and foetal problem, even today. Due to uncontrolled blood pressure or impending complication likes eclampsia, HELP syndrome it may be necessary to opt for caesarean birth.
- Maternal diabetes in pregnancy is also associated with problems, which may make caesarean birth a safer option.
- Other medical illness like severe asthma, certain types of cardiac diseases, etc. may also preclude labour as mother, baby or both may not be able to tolerate labour well.
This is now becoming a very common indication for repeat caesarean section. Most patients with one prior caesarean delivery may deliver safely vaginally in the later pregnancies. This is more likely if the prior caesarean section was for a non-recurrent or temporary condition of that pregnancy, such as:
The options should be discussed by you and your doctor prior to onset of labour. If a vaginal birth trial is opted for certain guidelines need to be followed discussed later in this section. In some cases, you and your doctor may opt for an elective or planned repeat caesarean. This is more commonly done if you have had:
- More than one caesarean previously
- Your baby is now larger
- Not in a favorable presentation
The type of prior caesarean is also important, as with an incision, the risks of attempting VBAC are more.Other uterine surgeries done in the past such as myomectomy or septum resection may also influence the decision for type of delivery.
Caesarean births are much safer now than they were a few decades ago, In fact, hardly a century ago, having a caesarean was like a death sentence for the mothers. Today, the procedure carries a 'risk' of less than 1 in 2500. Yet, this risk is 4 times more than the risk of death after a normal vaginal delivery. However, when talking about risks, one must keep in mind that statistics show that most people die at home or in bed. That doesn't mean that by not staying home or not sleeping you can escape the inevitable! While talking of risks what needs to be seen in the risk-benefit ratio. The ultimate aim is to have a healthy mother and healthy baby. In a given situation, if the benefits offered by caesarean birth to the mother, the baby or both are more than the risks; the procedure needs to be done regardless. Individual medical conditions like uncontrolled blood pressure or profuse bleeding from the placenta may make a vaginal birth more dangerous for the mother.