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A cesarean birth is when the baby is delivered from the abdomen through incisions in the abdominal and uterine walls. It is said that Julius Caesar was delivered by cesarean section and the name cesarean remained. There was an old Roman law, "lex caesaria" that by law required abdominal surgery be performed with certain guidelines. These guidelines included a woman who was either dead or dying. The baby would be saved for the state. It is also derived from the Latin word "caedre," to cut. Due to folklore and many references in myths we do know that surgical delivery of babies has existed for many centuries.
When a mother died in these long ago centuries and she was carrying a baby the baby would be surgically removed to save the living fetus. It was not until the sixteenth century that this cesarean surgical delivery was performed to save both the mother and the child. In the later part of the 1700's and early l800's in America cesarean sections were performed. As a uterine suture was not yet performed, the death rate was high for both the mother and child. Adolf Kehrer and Max Sanger in l882 started using silk sutures to close the wound of the cesarean section.
Cesarean births were performed in the late l900's although they were considered a conservative procedure. During the l930's surgical deliveries become more of an option along with more sterile operating methods and anesthesia and risks were reduced. Today doctors are using the cesarean method of childbirth as a precautionary measure when necessary.
Cesarean childbirth may in the thoughts of some in the medical profession be used when not necessary. In discussing cesarean children it is necessary to mention some of the reasons that perhaps too many are performed unnecessarily. The policy of "Once a cesarean, always a cesarean" has become a standard It is thought by some that in America cesarean childbirth has become an acceptable alternative to vaginal birth. Some think that cesarean births have reached epidemic portions. The threat of malpractice suits is another reason for some physicians to perform perhaps unnecessary caesarean sections as they are fearing the child may be less than perfect if delivered vaginally. There are those who think that physicians are putting the thought of a malpractice suit above the medical criteria for the surgical procedure. Sometimes there is a lack of training involved in the management of labor especially in the instance of a breech fetus. Some physicians feel that the outcome of a cesarean is more superior than the outcome of a vaginal birth. The age of women having a first child has increased thus some physicians feel more confident in performing a cesarean section. Sometimes physicians just lack the training to perform breech births and turn to the surgical procedure of cesarean childbirth.
There are two main considerations for determining if a cesarean section delivery is necessary. One category of "absolute indications" that can determine there is no other method of the delivery of a healthy, living child. The other category is "relative indications" when the physician determines there will be a better outcome if a surgical delivery is performed for the mother and the child.
For most cesarean section childbirths the decision is not made until you are in the hospital. The factors will vary such as it may be impossible for a vaginal delivery and naturally you must have trust in your primary physician. This can be very frightening and even devastating if this surgery is imperative to your health and that of your unborn child. The fetus may be in severe distress or many other factors may contribute to the decision for this surgical procedure. There are many reasons for a cesarean such as the baby is in a transverse position, uterine hemorrhage or placenta previa.
There are two main types of anesthesia administrated to the mother such as a general (inhalation) anesthesia making the mother unconscious during the surgical delivery. The other consists of a conduction (spinal or epidural) anesthesia that numbs from the waist down and allows the mother to be awake during the delivery. Each type of anesthesia will have advantages and disadvantages, side effects and risks. The complications of the childbirth will help your physician to determine the best possible use of anesthesia for the procedure. If you are given the choice then it will be your own decision as both procedures are almost l00% safe today.
Unless the caesarean section is performed in an emergency procedure you will usually go to the hospital on the same day the surgery will be performed without eating or drinking for approximately l2 hours. Blood and urine will have been drawn or may be drawn again before surgery. The Anesthesiologist will come in your room and discuss the type of anesthesia you will be given.
In the operating room after you have been given the anesthesia the bladder is catheterized and a tube is in to keep your urine draining.
The surgeon will make a cut in the skin by one of four methods. These methods include a side to side (low transverse incision)or an up and down (vertical incision). Another cut will be made in the uterus and will be either a side to side (a Kerr incision) or an up and down (classical incision). The subcutaneous tissue will bulge upward after the skin is cut and become flooded with blood, then the surgeon will cut beneath the subcutaneous tissue to the layer of fibrous tissue. This fibrous tissue holds the muscles and abdominal organs of the abdominal wall in place. He will incise this fibrous layer and then make an incision that allows the muscles to this tissue to be pushed out of the way. He will now be able to see the uterus under peritoneum that is a layer of thin tissue. He then lifts this peritoneum away and makes an incision having the bladder and uterus accessible. He peels away the bladder from the uterus and makes an incision in the uterus underneath. If the cesarean is an emergency he may not peel away the bladder.
He then makes a very careful incision through a thin segment so as not to harm the membranes around the baby or the baby. He places two index fingers into this small incision that opens the uterus and fluid is spilled. If the baby is assuming a normal position his head will be down. Under this incision the surgeon can just place a hand inside the uterus under the head and then push the baby out. He will be assisted by another medical professional to help push out the baby.
As the baby is brought out of the mother there will be a small ear syringe to suction his throat. The rest of the baby's body will be removed and the baby will cry when he is in the air. The cord will then be clamped and the nurse will wrap the baby and hand him to his mother if she is awake, if not she will see him when she awakes.
The placenta will either separate on its own or will be peeled off the inside of the uterus. The uterus can be brought out of the abdominal cavity to be visible. The surgeon will then make running and individual stitches to sew the hole in the uterus closed. Pitocin will be given to the mother to help the uterus contract and to decrease the bleeding. There will be some small sutures used to tie and retie bleeding blood vessels. Spaces in the abdominal cavity called "gutters," are then cleared of blood and fluid. Then the uterus is placed back in the abdominal cavity, the bladder is sewed on the surface of the uterus and the peritoneum is closed. The closing of the abdominal wall will begin at this time with the muscles over the peritoneum pushed in place and sewn if necessary. The fascia known as a thick fibrous layer holds all the abdominals in so this layer is closed with individual stitches that will not come loose. The subcutaneous tissue will be closed in long stitches and then the skin will be stitched with nylon or silk thread or even stapled. A bandage is put on the incision.
The mother will be taken to the Labor and Delivery Recovery Room so that she may be monitored by her temperature, oxygen saturation, heart rates and blood pressure. The amount of vaginal bleeding (lochie) will be monitored and also the firmness (contractions) of the uterus (fundus) will be monitored. Necessary pain medication will be given in the Recovery Room. After a few hours or whenever the medical professional deems you will taken to either your hospital room or perhaps a Postpartum (after childbirth) room.
The new mother will be monitoring during her stay in the hospital, provided medications for pain, etc. and instructions will be given for the care of the baby such as breast feeding. New mothers usually are allowed to walk by at least 12 hours after the surgical procedure. The catheter will remain sometimes for up to 24 hours if necessary, the incision will be checked and all precautions will be taken. As your body starts to function you will be allowed liquids and then foods. It will depend on the physician and his evaluation of your recovery for the time you will remain in the hospital after the delivery by surgical procedure. He will then instruct you in caring for yourself after you go home and make an appointment for him to examine you to be sure you have healed properly from the surgery..
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