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.

Baby’s First Hours

Once your baby is delivered, all the attention will be given to her, not to you, and rightly so. She may cry first when delivered and will be bawling robustly a few seconds after birth. She’ll probably be a bluish-white color at first and may be covered with vernix-a white, cheesy substance that protects her skin in the womb. She’ll have streaks of blood on her and, depending on your delivery, her head may look slightly pointed after her journey down the birth canal.

Her First Moments

If her breathing is normal, there’s absolutely no reason why you shouldn’t hold her immediately. If there’s a danger of her being cold, you can be covered with a towel or blanket. Your gentle stroking movements and the sound of your heartbeat and voice will reassure your baby. Her eyes will almost certainly fasten on your face and she may scrabble as if trying to swim toward you.

Cutting the cord The first procedure after the delivery is the clamping of the cord. At the appropriate time, two clamps are applied to the cord, one a short distance from the navel, the other about an inch away. These clamps prevent the cord from bleeding, the one closest to your baby being the most important. At this point, your partner may be invited to cut the cord between the clamps. Some practitioners prefer to wait, however, until the placenta is delivered or the cord has stopped pulsating before cutting the cord. The cord may also be clamped and cut during delivery if it is looped tightly around your baby’s neck.

Her general condition The doctor or labor nurse will check your baby’s general condition. She’ll remove any fluid remaining in your baby’s mouth, nose, or air passages by sucking it out with disposable plastic tubing or a bulb syringe. If your baby doesn’t start to breathe immediately, the doctor will take her and give her oxygen, and the neonatologists will be called to the room.

Welcoming Your Baby

Once the nursing and medical staff have checked that both you and your baby are well, by all means ask them to leave if you want to be left alone in the warmth of your birthing room with your partner and your baby.

If you’ve had an episiotomy, you may have to wait until after you’ve been stitched; your doctor will be able to make a much neater repair if you’re stitched as soon as possible after the birth before the tissues swell. Once this is done, you can relax after your hard work and enjoy this amazing new experience together. It’s a good idea to put your baby to your breast immediately because it stimulates delivery of the placenta, even if your baby isn’t hungry at first.

Spend these first few moments concentrating on your baby, getting to know her, learning to recognize her face and cooing at her so that she can hear the sound of your voice. Ideally, hold her about 8-10 inches (20-25 centimeters) away from your face-at this distance she can make out your face quite clearly. Smile and talk gently in a sing-song voice, because newborn babies are attuned to high vocal pitches.

Let your partner hold his baby for the first time within half an hour of the birth. Men can bond as deeply and as quickly with their newborn children as women do.

After this initial bonding process, you’ll be washed down and asked to pass urine to make sure that everything’s in working order. You can then change, and the nurses will check your baby more thoroughly.

A More Thorough Check

Shortly after birth the doctor or nurse will make some specific checks on your baby. The doctor will check that her facial features and her body proportions are normal. She’ll be turned over to make sure that her back is normal and there are no indications of spina bifida. Her anus is checked, as are her fingers and toes. The number of blood vessels in the umbilical cord is recorded-there are usually two arteries and one vein. Your baby will then be weighed and her head circumference and possibly her body length measured. All this takes only a few seconds in the hands of an experienced doctor or mildwife.