The Cesarean Section:
description, risks, benefits, complications, and alternatives( RBCA)
Your C-section would be a lot prettier than the one in the Medieval woodcut. First of all, it would be done under an anesthetic block. In case you are wondering, we believe that an anesthesia block such as a spinal block or epidural are safer for mom and baby then general anesthesia, or going to sleep. Is also important to us that the mom be able to be present at the birth to share the immediate joy of discovering the baby.
For those of you interested in a step-by-step description:
The patient is laying down on a table in an operating room full of staff. The anesthesiologist is at the head of the bed and the obstetrician and her assistants are below. We "prep" the abdomen which is to sterilize the skin, and then we dress you in surgical drapes so that only the area of work is exposed. We then test to make sure you are numb. It is important for you to know that you can still feel the pressure and swishing sensations. This is normal. Even though you can feel these things you should not feel anything painful. We test you to make sure.
Normally we make the so-called "bikini cut". We go down carefully through the layers of skin, fat and fascia. Observers should note that there is always a little bleeding and we take care of it as we go. We usually use a cautery tool which makes sound and a little smoke. We then part the muscles like curtains and generally do not have to cut them. We then enter the abdomen and evaluate the uterus.
At that point, the bladder, which is next to the lower uterine segment, sometimes needs to be loosened and dropped down out of the way. The incision is made in the stretchy part of the lower uterine segment instead of this stiff upper part. ( This lower area heals much more strongly. When this lower uterine segment area is used for the incision for delivery, the uterus heals strongly enough for the patient to have a trial of labor in the future.) At this point, a great deal of fluid issues forth. This includes amniotic fluid, blood, and sometimes meconium, which is baby poo. The procedure becomes quite physical. The primary surgeon reaches her had in and fishes around for a good grasp on the baby's head ( or bum) and brings it up to the incision. Oftentimes, a suction cup device is placed on the baby's head since it makes the delivery easier. Not uncommonly the head alone will be out and we will begin to suction. ( see above photo ! ) If the shoulders are snug, an arm may be worked out separately. Then the rest of the baby is usually born with some gentle pressure on mom's abdomen.
At this point, the baby's mouth is suctioned. The cord is allowed to pulsate, or, in the interests of getting the bleeding uterus repaired , it is expressed toward the baby and then clamped and cut. Baby is taken off the field to the warmer and the pediatrics team. Meanwhile back on the surgical field, cord blood is taken for testing. The uterus is massaged and the placenta removed. The uterus is then lifted out through the incision so that the incision can be easily seen and closed. Care is taken that no fragments of membrane or placenta remain. Medicine may be given to hasten its involution (shrinking).
Closure is multilayered, with one or two rows of stitches on the uterus itself. After that, peritoneum, fascia, subcutaneous fat and the skin are sewn. Incisions are dressed with either bandages or glue.
Afterwards the patient is taken to the recovery room. She will probably be wearing oxygen, have a foley urinary catheter and compression stockings. If both mother and baby are stable, she is presented with baby and encouraged to get the baby to breast ASAP.