Generality
Caesarean section is a surgical procedure that allows the birth of a child in situations where it is not possible, or not advisable, to proceed spontaneously and naturally.
Indications for cesarean section include all conditions in which a vaginal delivery is impossible or presents risks for the mother or child. For example, recourse to surgery to give birth may depend on fetal problems ( fetal distress, breech presentation, etc.) and / or maternal problems (one or more previous caesarean sections, gestosis, gestational diabetes, etc.).
A caesarean section can be elective (ie planned at the end of gestation, before labor) or emergency (when the health of the mother and child are in immediate danger). The operation is performed after the administration of anesthesia which may be spinal, epidural or general.
Cesarean delivery is a risk-free surgical procedure, so it should only be performed if the gynecologist believes that vaginal delivery is not safe. Major complications of the method include bleeding, uterine infections and bladder injuries.
What is caesarean section?
Caesarean section is a surgical operation in which a child is born through an incision made in the wall of both the abdomen and the maternal uterus. This operation must be performed only when it is considered safer - for the future mother or for the fetus - than the natural birth through the vagina.
The incision to facilitate birth is practiced in the lower abdomen and can extend in the longitudinal direction (in correspondence with the central line of the abdomen) or transversely, above the pubis.
Why is it called "cesarean"?
The expression "caesarean section" seems to derive from the name of Julius Caesar, who, according to a legend, would have come to light with this method. Another theory argues, instead, that the term derives from the "Lex Caesarea" (from the Latin "caedo", ie "cut"), a provision of Roman emperors that ordered that any woman who died during pregnancy should be cut caesarean, to try to save the child or be able to baptize him.
Indications for caesarean section
Caesarean section is a measure that is adopted taking into account multiple factors, which differ from case to case. The need to resort to this procedure can be found from the first visit to which the woman is subjected to at the beginning of pregnancy, or it can become evident only when labor is already in progress.
Caesarean section is necessary mainly in the following cases:
- The fetus is too large compared to the maternal pelvis to allow a natural development of the birth;
- Labor is prolonged, dilation is not adequate or the contractions are too weak, so it is unlikely that the expulsion of the fetus can occur normally through the vagina in an acceptable time frame;
- The placenta is previously (therefore completely or partially covers the birth canal, hindering the passage of the fetus) or undergoes untimely detachment from the uterine wall, for which it is feared to have hemorrhage, which could be dangerous both for the mother and for the child;
- Abnormal presentation of the child, especially when it is breech. In such an eventuality, vaginal delivery would necessarily involve considerable dangers for the mother and child;
- Twin pregnancy with the first breech baby: in the case of a vaginal birth, there would in fact be the risk of possible fetal damage;
- Prolapse of the umbilical cord, when the birth is not yet to be considered imminent;
- Pre-eclampsia or eclampsia: if the blood pressure of the future mother suffers a sudden increase and other specific symptoms appear, associated or not with convulsive attacks, a timely cesarean delivery can be the only useful measure to save the life of the woman and the child;
- Risk of laceration of the cervix or vaginal wall during natural birth, for example in cases where the mother has previously undergone other surgical procedures (caesarean sections or excision of uterine myomas);
- Presence of uterine myomas, ovarian cysts, fibroids or other formations that, by restricting the birth canal, do not allow the normal passage of the newborn;
- In all cases where there is a severe fetal distress, such as worrying heart rate abnormalities, such as to require rapid delivery.
In addition to these indications (which are the most frequent), there may be other conditions that make a caesarean section necessary, including: maternal infections, premature babies, cardiovascular diseases, nephropathies and gestational diabetes.
Procedure
The caesarean section can be practiced with multiple techniques, but in almost all consists of a laparatomia, followed by the extraction of the child through an incision made in the uterine wall .
This surgery is generally performed in the last weeks of pregnancy, after the administration of an anesthetic (general, spinal or epidural). More and more frequently, the birth is performed under spinal anesthesia: the patient, remaining awake and conscious during surgery, can consciously participate in the birth of her baby.
The caesarean section lasts from 45 minutes to about an hour and takes place in the operating room.
First, the patient's pubic hair is shaved, so a urinary probe is placed to empty the bladder and avoid a risk of perforation during the procedure.
After disinfecting the skin, the surgeon cuts into the abdominal and uterine walls, then introduces the hand through the opening made and carefully extracts the child.
The umbilical cord is severed and tied according to the usual technique. Then, the surgeon withdraws the placenta and sutures the incision made in the uterus and abdominal wall with thread or staples, which will be removed in the next 5-7 days.
Usually, a woman can be referred to approximately three or four caesarean sections; a greater number of parts with this method is feasible, but involves greater risks.
Techniques
- Classic type : the incision is made vertically on the anterior wall of the uterus, going up towards the upper segment. This method causes a greater blood loss compared to the incision of the inferior uterine segment and, generally, it is performed only in the case of placenta previa, fetal transverse position, breech presentation or preterm child.
- Incision of the inferior uterine segment : the cesarean section is performed with an incision of the low transverse abdominal band, at the level of the inferior portion of the uterine body, about 1-2 centimeters above the pubis; subsequently, the muscles are moved until they reach the uterus wall. The vertical incision of the lower segment is used only for certain abnormal presentations and if the fetus is excessively large for gestational age. In these cases, the transverse incision is not performed, as it could extend laterally towards the uterine arteries, sometimes causing excessive blood loss.
Different types of caesarean section
Depending on its timing and how it is performed, the caesarean section is mainly distinguished in:
- Elective : it is a cesarean section that is programmed (day and time), based on a maternal or fetal problem, around the 38th week of gestation. Unlike the spontaneous birth, the mother does not face the typical contractions of labor, since the birth is decided from the outside. Many women require a cesarean section: the motivation is to avoid pelvic floor damage (with subsequent incontinence), as well as serious fetal complications during childbirth. However, these indications are controversial, have little scientific evidence and require careful evaluation by your doctor.
- In labor (or emergency) : caesarean section is performed when the woman already has contractions, due to a problem that arises during labor; it can be more or less urgent, based on the degree of risk of the mother-child couple.
During a caesarean section, medical specialists in neonatal resuscitation must be available.
After cesarean delivery
At the end of the operation, the woman is kept under observation in a room adjacent to the operating room.
The caesarean section involves a hospital stay of about 5 days, therefore longer than that following a vaginal birth. Usually, if there are no complications, the new mother is allowed to get up the day after the surgery.
After cesarean delivery, in the area where the incision was made, the appearance of pain or burning is possible, especially when changing position or getting out of bed; in this case, it is possible to take an analgesic, after consulting the doctor. These symptoms should decrease in intensity within a week or two.
As in the case of natural parts, even with caesareans, there may be vaginal discharge of a semi-fluid mixed with blood; these secretions progressively diminish until they disappear.
After about a year, it is possible to have a new pregnancy without risk.
Course of the caesarean section scar
Immediately after the operation, the scar of the cesarean section has a reddish or pinkish color. Over time, the pigmentation darkens, taking on a shade ranging from purple to brown, depending on the color of your complexion. After about a year, the scar will lighten to a light or brown hue, becoming more and more similar to the color of the skin.
Several factors can affect the cesarean section healing process, thus altering its appearance. In some people, for example, very thick scars (keloids) are formed.
Risks and complications
If practiced by women in good physical condition, caesarean section does not present dangers; such occurrence can occur, however, when complications arise during pregnancy.
The procedure can determine localized pain in the cutting area and difficulty in performing trivial movements, such as getting out of bed or lying down or lifting weights. The duration of these effects is very subjective and can vary from a week up to about a month. These consequences translate into some difficulty in managing the newborn, at least in the first few days after birth.
Other possible complications associated with cesarean delivery include:
- Recovery after slower delivery;
- Abundant blood loss;
- Infection of the wound or of the uterine cavity;
- Thrombosis risk;
- Possible bladder damage and intestinal injuries;
- Placenta accreta (which is implanted in the walls of the uterus) in subsequent pregnancies.
As for the newborn, caesarean section can lead to respiratory problems after birth and breastfeeding may be more difficult, given the slower recovery of the mother.
Natural childbirth after cesarean section
In most cases, cesarean section, if once used, is also necessary for subsequent pregnancies, since vaginal delivery increases the possibility of incurring uterine rupture. This risk is greater in women who have had multiple caesarean sections or a vertical incision, especially if it affects the muscular portion of the uterus.
However, the birth of the child by natural means can be successful in about 75% of women who have had only one previous cesarean section with a low transverse uterine incision.
After a previous caesarean section, vaginal delivery is possible with adequate assistance from the beginning of labor, and the operating room must be set up in such a way as to allow the timely execution of an operation, if complications arise.
