Step-by-step cesarean section

Any pregnancy can end in a cesarean section, so it doesn't hurt to know how the intervention is performed and what we can ask for it to be respectful of the mother and the baby. Nowadays it is a very safe intervention that should not be feared.

In a few decades, cesarean section has gone from being an almost exceptional intervention to the way in which one in four children come into the world. Regardless of how worrying this tendency to medicalize childbirth is, the truth is that it doesn't hurt to know all the details:

Preparations for cesarean section

They usually last 15 to 30 minutes. Before starting the intervention, a dropper is placed on the woman to balance blood pressure, the upper area of ​​the pubic hair is shaved, the skin of the abdomen is cleaned, anesthesia is administered (if it has not been used until now) and, when has taken effect, a catheter is placed in the bladder to keep it empty of urine.

The epidural allows the mother to see the birth of her child, and sometimes even share it with her partner (not all doctors are in favor of the father entering the operating room). The baby does not suffer the effects of anesthesia because the drug acts directly on the nerves and does not pass into the maternal blood, nor therefore into the child. When injecting anesthesia, the doctor usually asks the woman to get into the fetal position, that is, with her knees at chest level, to encourage the extension of the spine.

There are two types of epidural anesthesia:

Cut

Once the anesthesia has taken effect, surgery begins. Usually, a transverse (horizontal) skin cut is made at the upper edge of the pubic hair (this is what is called a ' Pfannenstiel incision ').

After cutting the skin, the fat is separated and the aponeurosis, which is a strong layer that supports the abdominal muscles and intestines, is cut transversely. The abdominal muscles are separated, not cut. The peritoneum, a thin bag where the abdominal organs accumulate, is gently torn with the fingers. This is how you access the uterus. This is opened with a transverse cut through an area called the segment, which is between the cervix and the body of the uterus, to remove the baby.

Once the child is out, the umbilical cord is cut and the placenta is manually removed.

It is desirable that professionals show the child to the mother as soon as possible (even without having cut the cord) and that after the first medical examinations, they leave him in the care of the father while they finish the cesarean section.

Clothes

The uterus is sewn with a thread that is reabsorbed in 40 days. The peritoneum grows back on its own, so it is best not to sew it up. Then the layer that holds the abdominal muscles is sutured with a similar thread, and they return to their place.

The skin wound can be closed with staples or with a nylon thread under the skin, which leaves the scar thinner and more homogeneous. They both leave in a few days.

From the beginning of cutting the belly to the final suture, about 40-60 minutes pass if there are no incidents. In most cesarean sections, the mother and newborn could go together from the operating room to the room and begin breastfeeding in the first hour of the baby's life, just as in vaginal delivery.

The effect of the anesthesia wears off in one or two hours. Then painkillers (painkillers) are put into the serum periodically. Most of these drugs are perfectly compatible with breastfeeding.

The IV drip can be removed between 8 and 12 hours later, as can the bladder catheter, thus avoiding urinary infections. The mother can drink liquids four hours after the intervention.

When is it indicated?

Cesarean sections are becoming safer thanks to advances in medicine, but like all surgical interventions, only those that are strictly necessary should be done, when the benefits outweigh the risks. That is, when continuing the pregnancy or allowing labor to continue is more risky for the baby or its mother than performing the intervention. It is essential in the case of...

Cord prolapse. The umbilical cord comes out into the vagina before the baby and the head puts pressure on it, enough that blood stops passing through the cord and the baby does not receive oxygen.

Placental abruption before or during labor. Bleeding occurs and the baby may stop receiving oxygen if action is not taken quickly. The mother usually feels intense abdominal pain and the baby's life is in serious danger if a cesarean section is not performed in the shortest possible time.

Total placenta previa is placed at the exit of the uterus so that it obstructs the passage of the baby. It is common for the mother to have bleeding that warns of the problem. It is only diagnosed at the end of pregnancy.

Poor fetal positioning. Sometimes babies are positioned in a way that makes it impossible for them to get out and they can no longer change their position. For example, if labor begins and the child is in a transverse position.

The mother suffers from decompensated heart disease or other serious illnesses. These complications are fortunately very rare, and in total occur in less than 5 percent of births.

It is likely in the case of…...

Narrow pelvis. It is rare, but it can occur in mothers who have rickets in childhood or other malformations. In addition, the birthing position influences the baby's gait. Numerous studies have shown that giving birth lying down or with your legs up, in addition to being absurd, is dangerous, because it causes the child to get stuck and not come down. However, when squatting, the opening of the pelvis increases by 30%. Artificially breaking the water or giving oxytocin while the mother is lying down also makes it difficult for babies to come down.

Breech presentation. In recent years, cesarean sections have been promoted for breech births, especially in primiparous women. But medical studies show that a vaginal birth is viable in a breech presentation with a flexed fetal head, balanced fetal weight, and a normal maternal pelvis.

Tumors that hinder the baby's passage. They are usually uterine fibroids. It is best to wait for labor to begin and see how it progresses.

Do not dilate. Fear, environmental tension, feeling alone or observed by healthcare personnel... all of this causes the body to block and dilation to stagnate. In these circumstances, if the woman is left alone for a while, without observers, she can almost always dilate easily.

Loss of fetal well-being. The baby, during labor, shows alterations in its heartbeat that are maintained and accentuated over time, and in which a progressive loss of its recovery capacity is assessed. But sometimes this discomfort is due to improper use of oxytocin or the mother remaining lying down.

Previous cesarean section. It is no longer advisable to perform a cesarean section because there is a previous cesarean section. More than 70 percent of women can achieve a vaginal birth after a cesarean section.

Multiple pregnancies. It depends on fetal maturity and the position of the babies. In Holland, only 14 percent of twins are born by cesarean section, in Spain 50 percent.

Certain maternal diseases such as preeclampsia, genital herpes (if the mother has an active outbreak), or HIV infection.

To consider

Even if it is expected to end in a cesarean section.

During childbirth, with the first contractions, the lower area of ​​the uterus stretches and the area called the segment is formed (the uterus at the end of pregnancy is balloon-shaped, and the segment is the area that is closest to the closure of the balloon, what stretches during childbirth).

However, the segment is not formed if the uterus does not have labor contractions for some time. As it is a very thin area, because the tissue is very stretched, performing a cesarean section in the uterine segment ensures less bleeding during the cesarean section and facilitates a vaginal delivery in the future.

The technique is practically identical. The cut in the skin is made in the same place and the existing scar is removed by stitching.

In the uterus, sometimes the scar from the previous cesarean section is practically invisible. Depending on the number of previous cesarean sections, there may be adhesions (fibrous cords) between the uterus and the organs that surround it, which make the intervention last a little longer than usual.

The cesarean section can be made respectful for the mother and child, allowing the presence of the father or another companion, using epidural anesthesia, treating the woman with affection, and explaining everything that is happening. May the first thing the child hears be the voice of his mother and may the first skin he touches be that of her mother. In most cesarean sections, breastfeeding can be started within the first hour, and mother and child should not be systematically separated.