Cesarean Sections
A cesarean section is performed by making a surgical incision through the lower abdomen and uterus to deliver the baby. Care is taken to place the incision low on the abdomen and to repairing the incision for the best cosmetic result.
There are many reasons for a woman to have a cesarean section.
Some of these reasons are not encountered until labor while others are known well in advance of your due date.
Breech Baby
A breech baby has the buttocks rather the head in the mother’s pelvis. There are multiple risks to the baby during a breech birth. The safest choice for delivery of a breech baby is a cesarean section.
No Progress in Labor
Labor usually progresses about a centimeter an hour, especially if your water is broken. Sometimes women have dilated all the way to 10 centimeters but then pushing doesn’t bring the baby down into the birth canal. Your labor progress may slow or stop if your pelvis is too small to allow passage of the baby or the baby is too big to deliver. When labor doesn’t progress despite good contractions and adequate pain relief your doctor will recommend a cesarean section.
Fetal Intolerance of Labor
A fetal monitor will be used during labor to monitor your baby’s heart rate and response to the stresses of contractions. If the heart rate tracing indicates that your baby is not getting enough oxygen then your labor nurse and doctor will try multiple treatments to improve the baby’s condition. Sometimes oxygen on the mother, more IV fluids or changing the position of the mother will help the baby. If these treatments do not improve the blood and oxygen flow to the baby then the doctor will recommend a cesarean section.
Infections
If your bag of water has been broken for many hours you can develop a uterine infection that can affect your baby’s health. If delivery is not anticipated in a short time after an infection is diagnosed, your doctor may recommend a cesarean section.
If you have a herpes infection at the time of labor your doctor will offer a cesarean section to reduce the risk of infection in the newborn. Medication can be taken in the last 6 weeks of pregnancy which will reduce the chance that the herpes virus will be active at the time of labor. Ask your doctor about this.
HIV positive mothers may be offered a cesarean section in an effort to decrease the risk of HIV infection in the newborn.
Placenta Previa
A placenta which covers the cervix either partially or completely is called a placenta previa. The placenta is attached to the uterus and cervix with blood vessels that can bleed if they become detached. Sometimes a cesarean section is performed because of bleeding from the placenta. Usually you and your doctor will schedule a surgery date 2-5 weeks before your due date.
Twins
Twins are often delivered by cesarean section because one or both babies are not head down.
A Large Baby
As you near your due date your doctor expects your baby’s head to settle into the pelvis and onto the cervix. If your baby is overly large or your pelvis is small, he or she may not engage in the pelvis in those last three weeks. Your doctor may recommend planning a cesarean section before the onset of labor if he believes the baby will not be able to deliver vaginally.
Another Cesarean Section
If you had a cesarean section for your first baby then you may choose to have another cesarean section. Your doctor will provide you with information about the risks and benefits of another cesarean section versus attempting labor for a vaginal delivery.
If you have had more than one cesarean section is the past then your doctor will help you schedule another cesarean 7-10 days before your due date.
Preoperative Instructions
You need to arrive at least two hours prior to your surgical time.
Bring a nice pair of thick socks for your feet. Leave your jewelry at home. Remove nail polish from your fingers. Remove piercings from your tongue, nipples, belly button and clitoris. You may wear your contacts or glasses.
You must have an empty stomach for your surgery. Please do not eat or drink anything in the eight hours before your surgery. You may rinse and spit, brush your teeth or chew sugar free gum. Take important daily medications with a sip of water.
Getting Ready for Surgery
Your surgery nurse will attach the fetal monitor to your uterus while she starts your IV, draws your blood and helps you sign consents for surgery and anesthesia.
Your coach will be given clothing or a cover for his clothes.
In about two hours you will be taken to the surgery suite.
In Surgery
The anesthesiologist will place a spinal anesthetic which will give you excellent anesthesia for surgery.
Your back will be washed and numbed with a local anesthetic. Next you will feel the doctor pushing to find the place for the spinal needle. In a matter of moments your feet will be numb and then your abdomen.
The nurse will help you to lie back on the table. She will put a catheter in your bladder and then wash off your abdomen for surgery.
While lying on the table you may feel a little short of breath even though you are getting enough oxygen. This is a common side effect of spinal anesthesia. The doctor will monitor you constantly throughout your surgery.
Soon the pediatric team from the nursery will arrive to receive your baby. The pediatric team will dry off your baby and help him start breathing. Once your baby is stable he or she will be taken to the nursery for continued care and observation. Your coach can go with the baby if you like.
After delivery you will be taken to the recovery room for up to 2 hours. When you are stable and moving your legs the nurse will take you to the nursery and then to your room on the maternity ward.
Recovering at the Hospital
In your room you nurse will check on you every 2-4 hours. Pain medication will be available if needed.
The catheter will be removed when you are ready to go to the bathroom. Food will be available when you are ready to eat.
After surgery the staff will help you to get out of bed and walk every 6 hours.
Your stable newborn will be in your room with you continuously.
Visitors may see you and your newborn two at a time between 10am and 8pm.
Most women stay in the hospital 3 to 4 days after a cesarean section.
Recovering at Home
You will be discharged with a prescription for pain medicine.
During the first week at home we advise you to attend to your baby and your needs by spending most of your time in bed or on the sofa. You should shower daily and change your sanitary pad every 4 hours. You may not have much of an appetite during the first week at home, but drink plenty of water and stay hydrated.
Within three days of surgery you should have a bowel movement. Unfortuntely narcotic pain medication (such as codeine, vicodin or percocet) cause the bowels to slow down leading to an uncomfortable constipation. If your bowels are not working well you can use a stool softener, laxative, Fleets enema or suppository. To decrease narcotic use women will take ibuprofen (motrin, advil, nuprin, alleve) between their narcotic medication. This will give you more even pain relief and improve your bowel function. Both motrin and narcotics can upset an empty stomach.
- Stool softener: Colace or Pericolace
- Laxative:Ex-lax or Correctal or Miralax
- Enema:Fleets
- SuppostitoryDulcolax
Your incision will be tender and swollen for 2-6 weeks. As the pain subsides you can do more physical activity, but do not lift more than 15 pounds in the first six weeks. Do not drive the car for the first two weeks or at any time that you are taking narcotic pain medication.
You can use a heating pad on your incision if you like.
Your incision may have some drainage in the first two weeks. If this drainage is associated with a fever or excess pain, please call the office for a check-up.
During your 6 week recovery you should not soak in the bathtub, swim in the pool or jacuzzi, use tampons or have sex. These activities will increase your risk for uterine infection. Important reasons to call and return to the office:
- fever over 100 degrees
- unusual or uncontrolled pain
- heavy or excessive bleeding that soaks more than a pad an hour
- urinary pain such as burning, cramping, blood in the urine
- hard, red, painful knots in the breasts
- yellow drainage (pus) from the incision
Please come back to the office 6 weeks after delivery for your final check up.
