Definition and Overview

Also referred to as C-section, Caesarean section or delivery is a surgical procedure that involves creating either a horizontal or vertical incision in the abdomen to access the uterus to deliver a baby instead of through the vagina. This can be an emergency (urgent) or scheduled surgery.

C-sections have been performed since the 1880s. Since then, the rate of women undergoing the procedure has increased by more than seven times. In the United States, more than 32% of childbirth is via this procedure, which suggests that at least one in every four pregnant women go through it.

However, the World Health Organization (WHO) and other well-known associations promote vaginal delivery over C-section. In fact, WHO recommends reducing the C-section rate to only 10% to 15% primarily because it carries far more risks when compared to vaginal delivery. Risks include long-term morbidity of the mother and possible death for both the mother and the child.

Who should undergo and expected results

A Caesarean surgery can be performed for two major reasons: (1) the mother prefers it and (2) there is a medical need.

When the procedure becomes elective, it is called Caesarean delivery on maternal request (CDMR). In this scenario, a mother chooses the surgery even if there's no medical evidence to strongly support the decision. Groups such as the American College of Obstetricians and Gynecologists (ACOG) say that in the absence of a childbirth emergency or any condition that may endanger both the mother and the baby during delivery, Caesarean l birth should be highly encouraged. Moreover, obstetricians and gynecologists, who specialize in taking care of the mother during pregnancy, must conduct a comprehensive and individualized counseling, which includes discussing the possible risks and benefits associated with the procedure.

In many cases, however, C-section is recommended because of a health threat, such as the following:

  • Fetal distress
  • "Wrong position" of the baby – ideally, the baby's head should come out first. In some situations, however, the baby is in a breech position (the buttocks and, less commonly, the legs and knees are closer to the cervix) or transverse (the baby is sideways)
  • There is an increased risk the uterus will rupture
  • Labor issues such as prolonged and distressful labor, as well as failure to properly induce the mother
  • Issues affecting the placenta
  • Increased risk of hemorrhage of the mother
  • The mother is currently infectious (e.g., diagnosed with HIV)
  • Increased risk of injury to the baby
  • Previous C-section delivery
  • Delivery of more than one baby – note, though, that it is possible to deliver one of the babies vaginally and the other through C-section
  • Large babies or those who weigh more than 8 pounds
  • Mother's preexisting conditions like pre-eclampsia
  • Death of the mother while giving birth


C-section may not be performed if the mother is diagnosed with a pulmonary disease or the baby has certain congenital defects. Further, it is not encouraged before the baby has turned 39 weeks or before it has fully developed lungs.

How the procedure works

All mothers are encouraged to prepare for C-surgery even if they prefer or, according to the doctor's opinion, are more likely to deliver vaginally.

If the C-section is scheduled, the obstetrician will inform the mother and the primary caregiver (such as the father) the best date to conduct the operation. The mother is also expected to undergo diagnostic tests such as complete blood count (CBC), screening for infectious diseases, and blood clotting exams, which can help determine the risk of hemorrhage during and after childbirth. If the baby needs to be delivered before he/she turns 39 weeks, additional exams like amniocentesis and imaging studies including ultrasound scans to monitor fetal movements will be performed.

At least 12 hours before the procedure, the mother will be asked to fast. She will also meet with some members of the surgical team such as the anesthesiologist.

During the surgery, the mother is attached to an IV line that administers fluid, a catheter to drain the bladder, and several monitors that track the mother's vital signs and the movement of the fetus. Antibiotics may also be provided to prevent the development of infections.

Anesthetic is then administered. Although mothers may be given general anesthesia, it's better if it's local anesthesia, which is usually given through the spine (epidural). This helps the mother stay awake during the procedure.

The operating table is positioned at a certain angle to reduce childbirth risks like low blood pressure. Meanwhile, a covering is placed over the abdomen to prevent the mother from seeing the actual procedure, although she may choose to look while the baby is being pulled out.

An incision is then made in the abdomen. It can be vertically (laparotomy), where the incision runs toward the pubic area from the navel, or horizontally (hysterotomy), which is in the bikini line. As much as possible, the incision is made horizontally as it allows mothers to try vaginal delivery on the next baby (vaginal birth after Caesarean or VBAC). It also has fewer risks and complications.

The abdominal muscles are then stretched to access the uterus, and incisions are made in the womb. Amniotic fluid is drained and the baby is pulled out, head first. Once the entire body is pulled, the doctor will present the baby to the mother, and the incisions are closed.

It usually takes around an hour to complete the entire procedure, and most of it is dedicated to repairing or closing the incisions.

Possible risks and complications

C-section risks and complications can include infection and hernia, which are also common in other types of surgeries. A potentially life-threatening complication is massive blood loss. For this reason, oxytocin, a hormone, is provided, and the mother's vital signs are closely monitored throughout the procedure.

Mothers who undergo C-section may have a higher chance of experiencing maternal problems in succeeding pregnancies. Studies have also shown that they can develop mental disorders such as post-traumatic stress disorder (PTSD) and post-partum depression. The procedure may also cause a uterine scar that leads to placenta issues like placenta accreta, which is characterized by a deep growth of placenta blood vessels on the uterus, which can trigger serious bleeding.

References:

  • Berghella V, Landon MB. Caesarean delivery. In: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Obstetrics: Normal and Problem Pregnancies. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 20.

  • Cunningham FG, Leveno KJ, Bloom SL, et al. Caesarean delivery and peripartum hysterectomy. In: Cunnigham FG, Leveno KL, Bloom SL, et al, eds. Williams Obstetrics. 23rd ed. New York, NY: McGraw-Hill; 2010:chap 25.

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