Cesarean Section

A cesarean section, commonly known as a c-section, is a surgical procedure where a baby is delivered through an incision in the uterus. While the incidence of cesarean sections varies regionally, approximately 1 in 4 babies are delivered this way globally.

Reasons for C-section

• Failure of the cervix to continue to dilate.
• Abnormal fetal heart rate during labor.
• Twin pregnancies, particularly if the first baby is too large or not head down.
• Abnormal placenta location, such as placenta previa, where the placenta covers the cervix.
• Concerns that the baby is too large for a safe vaginal delivery.
• Breech baby (not head down).
• Active herpes infection.
• History of anal sphincter trauma with a previous vaginal delivery.
• Patient requests a c-section.

Anesthesia

Before entering the operating room, the patient meets the anesthesia clinician and the rest of the OR team, which includes OB nurses, the circulating nurse, and the doctor. A spinal anesthetic is administered in the operating room. This process is explained beforehand and usually takes a few minutes. After the spinal anesthetic is in place, the patient lies down as the anesthetic starts to work rapidly, causing numbness from the upper abdomen to the toes. A catheter is placed in the bladder once the patient is numb from the spinal anesthetic and is later removed after the spinal wears off.

Most patients choose to have their significant other or a family member present during the c-section. Family members are brought to the operating room after the spinal anesthetic is in place and before the cesarean section begins. At CRMC, every effort is made to ensure a family-friendly delivery, including the use of a clear drape if the patient wishes to watch the delivery. Some patients also have music requests.

A test is performed on the skin to ensure numbness before starting the surgery. An incision is made about 2 centimeters above the pubic bone in a horizontal fashion. It typically takes several minutes from the time of the skin incision to the delivery of the baby. The baby is shown to the parents immediately, and every effort is made to provide some degree of skin contact while the doctor finishes the surgery. Pictures of the baby are often taken in the operating room. Barring any unexpected circumstances, the baby can stay in the operating room or be escorted back to the OB nursery accompanied by an obstetric nurse. The significant other or support person is encouraged to join. Once in the nursery, the baby’s weight and measurements are taken. The baby is kept warm and comfortable until the mother returns to the OB unit and can be reunited with the baby. Upon the mother’s arrival, skin-to-skin contact is encouraged, and rooming-in is promoted to support bonding and breastfeeding. All assessments and interventions can be done in the room in the presence of family if desired.

Post-Operative Care

After the c-section, a TAP block can be performed before leaving the operating room to provide longer pain control for the first few days of recovery. This is done by the anesthesia clinician using an ultrasound to block the nerves along the sides of the abdomen, helping to reduce the need for narcotics after the c-section. The Foley catheter is typically removed about 12 hours after surgery. Patients can usually eat within a couple of hours post-surgery. Breastfeeding is encouraged right away, and lactation-certified nurses are available to help. The IV is usually left in place overnight in case medications are needed. A blood draw is obtained the day after the c-section, and if the results are normal, the IV is removed. Walking is encouraged at least a few times a day. Patients typically stay for 2-3 nights in the hospital.