Lower section Caesarean Delivery

A cesarean section is the procedure of the delivering of a baby through a surgical incision. The incision is made in the mother’s abdomen and uterus. Cesarean section, in short, is called C-section. Doctors recommend the Caesarean section to mothers who can have some unforeseen complications. At times, during the normal delivery, there can be some complications pertaining to the danger to the baby then the doctor will rely on a C-section. If the danger to the mother or the baby is foreseen, then the doctor will rely on a
C-section.

When do the mothers get a C-section?

Doctors do not usually recommend a C-section, but in some cases, they may consider Caesarean. But how does the doctor decide? What are the reasons that make the doctor opt for a lower section, cesarean baby?

1.    Mothers who have had a C-section in the past are not recommended to undergo vaginal delivery. The risk of a uterus rupture is a possibility. The risk of this happening increases if the mother had more than one cesarean surgery in the past. Mothers who have had a C-section but with a horizontal uterine incision then you are still a good candidate for a vaginal delivery.
2.    If the mother had any invasive uterine surgery in the past, then the doctor may suggest a C-section. Surgeries like myomectomy increase the risk of a ruptured uterus during vaginal delivery.
3.    One of the reasons for a C-section is multiple babies. If the mother is carrying more than a single baby then the doctor may recommend an open delivery. For delivering twins, both vaginal delivery and cesarean delivery is fine. But in case of unwanted complications, the doctor may opt for a C-section. This decision majorly depends on the position of the twins, the term of the pregnancy and so on. In the case of triplets and quadruplets, the doctor will strongly recommend a lower section cesarean surgery.
4.    If the baby is too big, the doctors recommend a cesarean surgery. The condition in which the baby is larger than usual is called macrosomia. In such cases, if the mother is diabetic then a C-section is strongly recommended. In the case of macrosomia, the mother undergoes an abdominal and uterine incision in order to avoid any trauma to the baby during vaginal birth.
5.    If your baby in a transverse position then the probability of the doctor suggesting a C-section is high. This happens more often in the case of twins. In such cases, it may happen that the first baby is in a head down position but the second baby is breech. In this case, the breech baby can be delivered vaginally.
6.    There are cases where the mother has a placenta Previa. In this condition, the placenta is so low in the uterus that it almost covers the cervix.
7.    Another common reason is hindrances like fibroids. Mothers with fibroids make the vaginal delivery almost impossible and thereby adhering to a C-section.
8.    When the baby has a known abnormality of malformation, a vaginal delivery is avoided to avoid any harm to trauma to both the mother and the child. Such a possibility is seen in cases like open neural tube defects.
9.    In the case of HIV positive mothers, C-section is the choice. In such cases, a blood test is done near the end of the pregnancy term to check the blood for the viral load.

How does an unplanned C-section happen?

1.    This is done to mothers who have a genital herpes outbreak. This generally happens when the mother goes into labor or when the water breaks. In this case, vaginal delivery can cause infection.
2.    There are cases when the cervix of the mother stops dilating. Another situation is when the baby stops moving down the birth canal; even the pushing and attempts to stimulate the contraction is a failure; the doctor will opt for an unplanned C-section.

When does the doctor have to opt for an emergency C-section?

1.    There are situations where prolonged labor can be harmful to both the mother and the baby. In such situations, the doctor suggests an emergency C-section.
2.    In case the baby’s heart rate is a concern then the doctors will again recommend a C-section. In such cases, the baby cannot withstand the continued labor.
3.    In some cases, the umbilical cord slips through the cervix of the mother. In such a situation the baby is cut off from oxygen supply and an immediate C-section is done.
4.    In some mothers, the placenta gets separated from the uterine wall. Such a condition is called placental abruption; in this condition, the oxygen supply for the baby is cut off and hence the C-section is opted.
5.    If the doctor feels that there is a probability of a uterine rupture then C-section is your best option.

In the case of a C-section, the doctor explains the reasons and scenarios which have compelled him to opt for a C-section to the mother. A consent form is to be signed by the mother.

How is the procedure done?

For this procedure, anesthesia is administered to ease the pain.  After the anesthesia kicks in, the belly is swabbed with an antiseptic; the doctor next makes a small and horizontal incision right above the pubic bone. After this, the doctor will cut through the underlying tissue, and then to the uterus. The abdominal muscles are separated manually to expose the uterus. Once the doctor reaches the uterus, she will make another horizontal cut in the lower section, this cut is called a low-transverse uterine incision.

Only under rare circumstances, the doctor can make a vertical uterine incision. This happens usually when the baby is premature and the lower part of the uterus is not thin enough to cut. After this, the next step is pulling the baby out. The cord is cut carefully, and the baby is then checked by the pediatrician, and the placenta is delivered by the doctor and then the mother is closed up.

After the C-section eventually the stitches will dissolve. The recovery is crucial and during this time not much of moving around is advisable. The hospital stay post the surgery may be for about three days. The doctor will administer some pain medications to ease out the pain.

What are the risk factors?

A C-section is major surgery. Hence it is riskier than a vaginal delivery. This is a reason why the doctor’s first option is vaginal delivery. C-sections can leave the mother with infections, there can be excessive bleeding. Blood clots, post-surgery pain is given and inevitable. The recovery period is undoubtedly longer. Every time you get a C-section done the possibility of conditions like placenta Previa and placenta accrete in the future, increases.

The surgery is not sought after like a vaginal delivery. But in case of risks and unforeseen conditions, a lower section cesarean delivery is the only option.