COMMON REASONS FOR CESAREAN SECTIONcephalopelvic disproportion ECLAMPSIA
erratic fetal heartbeat GENITAL HERPESoutbreak
higher order multiples known serious BIRTH DEFECTS
(triplets or more) known SPINA BIFIDA
macrosomia (very large baby) maternal CARDIOVASCULAR
maternal HIV/AIDS DISEASE(CVD)
maternal DIABETES nonprogressive labor
PLACENTAabruptio placenta previa
PREECLAMPSIA previous CESAREAN SECTION
previous uterine surgery prolapsed UMBILICAL CORD
Most hospitals allow the woman’s partner to be
present in the operating room during nonemer-
gency cesarean delivery. The partner must change
into sterile clothing (scrubs) and remain outside
the sterile field, usually seated beside the woman’s
head; the delivery team will provide clear and spe-
cific instruction for the partner. A draped sheet
provides a screen to block the woman’s view of
the OPERATIONas it is taking place. Except in emer-
gency situations when time is crucial, ANESTHESIA
is nearly always epidural (injection of the anes-
thetic DRUG into the space around the SPINAL
CORD) or spinal. These forms of anesthesia provide
complete PAINrelief for the mother but do not
affect the infant. General anesthesia, because the
drugs enter the mother’s BLOODcirculation, affects
the infant and may suppress BREATHINGand HEART
RATE.
Surgical ProcedureAfter the anesthesia takes effect, the obstetrician
makes an incision through the SKINand abdominal
muscles to expose the uterus, then makes an inci-
sion through the wall of the uterus to deliver the
baby. The most common incision is the low trans-
verse (also called the bikini cut), running horizon-
tally across the lower abdomen just above the
pubic BONEabout at the pubic hair line. An alter-
native incision for rapid delivery is the vertical
incision, which extends from the umbilicus (belly
button) to just above the pubic bone.
The obstetrician first delivers the baby’s head
and thoroughly suctions the secretions from the
NOSE, MOUTH, and upper THROAT. The pressures and
forces of a vaginal delivery would squeeze these
secretions from the infant as it passed through the
birth canal. Removing the secretions is essential to
prepare the airways for breathing. The obstetrician
then delivers the rest of the baby and clamps the
umbilical cord. The pediatrician examines the
baby to assess its breathing and overall health.
Often the obstetrician allows the woman’s partner
to cut the cord and show the baby to the mother.
To this point, the cesarean section takes about 10
minutes.
The rest of the cesarean section takes about 40
minutes and consists of delivering the placenta,
repairing the incision into the uterus, and repair-
ing the incision through the abdominal muscles
and the skin. The anesthesiologist may administer
a sedative to help the mother relax and sleep dur-
ing this part, after which she goes to the recovery
unit until the epidural anesthesia wears off and
sensation returns.Risks and Complications
The risk for serious complications is very low with
cesarean section. Among them are unusual bleed-
ing, blood clots, and INFECTION in the immediate
postoperative period, injury to the BLADDER or
ureters, and URINARY TRACT INFECTION(UTI). There is
also risk, comparable to that of vaginal birth, of
injury to the infant.
The path of recovery is substantially longer for
cesarean section than for vaginal birth. Most
women spend three to five days in the hospital for
initial recovery. The doctor will prescribe ANAL-
GESIC MEDICATIONSto relieve pain that are safe for
the woman to take while she is BREASTFEEDING.
During the first two weeks at home the woman
needs to take care of her incision as the doctor
instructs. Full recuperation takes six to eight
weeks, during which the woman needs help lift-
ing and caring for the baby. However, walking and
other physical activities are necessary and impor-
tant for HEALINGas well as to keep the LUNGSclear
and to help prevent blood clots.
Long-term complications are rare and are most
likely to occur when the cesarean section was an
emergency and the obstetrician made a vertical
incision. This incision creates weakness in the
abdominal wall, the muscles of which have
already stretched as a consequence of the preg-
nancy. Proper care is essential for optimal healing.
The risk of incisional HERNIAis higher with the ver-
tical incision than the transverse incision.260 The Reproductive System