Cesarean Section
If a normal vaginal delivery could be dangerous or even impossible for you, your baby will be delivered by cesarean section. Small horizontal incisions are made in your abdomen and uterus, and your baby is delivered through them.The vertical cut is no longer used because there’s a risk it may tear again if you have another child. The number of babies delivered by cesarean section has increased rapidly and is currently about one in four in the United States. One reason for this increase is that doctors are worried about being sued if a difficult birth causes complications that could have been avoided by a cesarean section. Another is that the operation is now so safe that it can be less risky than some other forms of delivery.
The need for a cesarean section may be apparent well before labor begins, so you, your partner, and your obstetrician have time to talk through what will happen-this is an elective cesarean. In emergencies, the need only becomes evident once labor is under way.
Elective Cesarean Section
The most common reasons for choosing to have a cesarean include failure to progress in labor or dystocia (abnormally slow progress of labor), your baby being in a breech position or lying across your pelvis; placenta previa; and certain medical conditions such as active herpes type II infection. A cesarean may also be necessary if you’ve had one for a previous baby-the worry used to be that the scar would open up again. Experience has shown that this does not happen with the horizontal or “bikini” cut, now generally used instead of the vertical cut, and so hospitals often allow a vaginal delivery to begin, and if there are no problems, labor goes on as normal- a “trial of labor.”
Elective cesareans are often carried out under a spinal anesthetic. This has several advantages over a general anesthetic: it’s safer for your baby; you have no postoperative nausea or vomiting; and because you are conscious, you can hold your baby as soon as he’s born. It’s usually possible for your partner to be with you during the operation, just as he can be at a vaginal delivery.
When you’ve had a cesarean, you may feel deeply disappointed that you didn’t have a vaginal delivery. It’s natural to feel this way, and the best thing you can do is talk to your partner about it. If he describes the birth to you in detail it may help you to visualize and accept it. Also, remember that the way your child comes into the world isn’t nearly as important as having a healthy baby.
It also helps, of course, to prepare yourself in advance for this type of birth. Go and see the obstetrician with your partner and find out what the operation involves, what procedures will be used, and whether your partner is allowed to be there. Ask if you can see a video so you’ll know what’s going to happen to you. If you can, talk to other women who’ve had cesarean sections. They’ll be able to give you useful advice and reassurance.
Emergency Cesarean Section
An emergency C-section may be needed when something goes wrong during labor, such as a prolapsed umbilical cord, placental hemorrhage, fetal distress, or serious failure to progress in labor. Emergency cesarean sections may be carried out under epidural and the hospital may not allow your partner to be present at the operation.
After a Cesarean Section
As is the case with any major surgery, it takes time to recover from a cesarean, but even so you’ll be encouraged to get up and walk around a few hours afterward to stimulate your circulation. You’ll be given painkillers if you need them, and the dressings will be removed after three or four days. Your internal stitches will be made with absorbable sutures, which will dissolve away naturally. Skin stitches may also be absorbable, but if staples are used they should be removed within about a week.
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