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A C-section is the delivery of a baby through a surgical opening in the mother's lower abdomen area. It is also called a cesarean section.
Problems with the baby:
Abnormal heart rate in the baby
Abnormal position of the baby in the womb, such as crosswise (transverse) or feet-first (breech)
Developmental problems such as hydrocephalus or spina bifida
Multiple pregnancy (triplets, and sometimes, twins)
Health problems and medical history in the mother:
Active genital herpes infection
Large uterine fibroids near the cervix
HIV infection in the mother
Previous uterine surgery
Severe illness in the mother, including heart disease, preeclampsia or eclampsia
Problems with labor or delivery:
Baby's head is too large to pass through the birth canal
Labor that takes too long or stops
Very large baby
Problems with the placenta or umbilical cord:
Placenta covers all or part of the opening to the birth canal (placenta previa)
Placenta prematurely separated from uterine wall (placenta abruptio)
Umbilical cord comes through the opening of the birth canal before the baby (umbilical cord prolapse)
A C-section delivery is done when it is not possible or safe for the mother to deliver the baby through the birth canal.
The procedure is usually done while the woman is awake. The body is numbed from the chest to the feet using epidural or spinal anaesthesia.
The surgeon makes a cut across the belly just above the pubic area. The womb (uterus) and amniotic sac are opened, and the baby is delivered.
The health care team clears the baby's mouth and nose of fluids, and the umbilical cord is cut. The paediatrician or nurse makes sure that the infant's breathing is normal and that the baby is stable.
The mother is awake, and she can hear and see her baby. The father or another support person is often able to be with the mother during the delivery.
A caesarean section usually takes 30% minutes. In an emergency, the operation can be done within 30 minutes.
A screen will usually be placed across your abdomen during the procedure so you do not have to watch the operation being done. However, you can choose to have the screen lowered to see your baby being born.
During the procedure, the operating table will be tilted sideways to an angle of at least 15 degrees. This takes the pressure off your womb and abdomen, reducing your chance of getting low blood pressure and feeling sick during the operation
Once your baby has been delivered through the incision made in your womb, the placenta soon separates and is also removed. The wall of your womb and abdomen will be closed with stitches that will later safely dissolve.
You may be given an injection of the hormone oxytocin once your baby is born, to encourage your womb to contract and reduce blood loss.
Your healthcare team will encourage you to have skin-to-skin contact with your baby as soon as possible.
(1) (2) (3)
Fig 1: Illustration of Caeserean section procedure
Fig 2: Illustration of incision made for CS delivery
Fig 3: Illustration of exposed Uterus
Fig 4: Illustration of incision on day and 1 year later
A C-section is a safe procedure. The rate of serious complications is extremely low.
The main risks to you when having a Caesarean section include:
Infection of the wound
Infection of the womb lining, known as endometritis, which can cause fever, womb pain and abnormal vaginal discharge
Damage to your bladder or ureter (the tube that connects the kidney and bladder), which may require further surgery
Risks to your baby
The most common problem affecting babies born by caesarean section is breathing difficulties, although this is mainly an issue for babies born prematurely.
For babies born at or after 39 weeks by caesarean section, this breathing risk is reduced significantly to a level similar to that associated with normal delivery.
Straight after the birth and in the first few days of your baby's life, they may breathe abnormally fast. This is called transient tachypnea. Most newborns with transient tachypnearecover completely within two or three days.
A C-section may also cause problems in future pregnancies. These are rare and include:
Placenta previa (abnormal placental position)
Placenta growing into the muscle of the uterus and has trouble separating after the baby is born (placenta accreta)
These conditions can lead to severe bleeding (hemorrhage), which may require blood transfusions or removal of the uterus (hysterectomy).
Risks due to any surgery are:
Risks due to anesthesia may include:
Reactions to medications
Risks related to surgery in general may include:
Blood clots in the leg or pelvic veins
Do's and Don'ts:
In the first few weeks after giving birth, try to get as much rest as possible.
Avoid walking upand down stairs too often as your wound site may be sore. But take gentle walks daily to reduce your risk of blood clotting.
You should take regular painkillers at home for as long as you need them.
Look after your wound to prevent infection by wearing loose comfortable clothing and cotton underwear, and gently cleaning and drying the wound daily.
You will be allowed to consume fluids 12 hours after and gradually consume semisolid and lastly solid foods.
Common things to expect at home:
The average hospital stay after C-section is 2 - 4 days. You should be able to get out of bed fairly soon after the operation, and your wound dressing will be removed after 24 hours.
In general, it will take about six weeks for all your tissues to heal completely. Before this time, basic activities, such as caring for your new baby and looking after yourself, should be possible.
You may not be able to do some activities straight away, such as driving a car, exercising, carrying heavy things and having sex. Only start to do these things when you feel able to do so.
You may suffer pain for 3 to 4 weeks after delivery so avoid too much of stretching and bending
Vaginal bleeding as in periods can continue in moderate amount for up to 3 weeks.
Follow your doctor's advice in feeding technique and posture as your tummy may pain and back may also hurt at the site of anesthesia
You might feel tired but make a habit of brief walks daily.
You can take body massage only by doctor's advice 3 weeks after C-section
Walk early and recover fast. Brief walks are needed sooner to reduce risk of blood clots
After 6 to 8 weeks you may opt for activities like cycling, swimming, playing sports as per doctor's advice
Ask your doctor before going for vigorous exercise
Lifting heavy weights is NOT allowed at least for 3 months
Bend your knees instead of back to pick up stuff from the ground
STAY FIT AND ACTIVE
Tummy exercises to be done as per doctor's advice only
Time Span Post C-Section
Walk early and recover fast. Brief walks are needed sooner to
reduce the risk of blood clots
Push the pram or buggy briskly, remembering to keep your back
straight. Walking is great exercise, so try to get out as much as you can
2nd week onwards
Squat down to pick things up from the floor. Hold heavy objects
close to your body. This is also something you're likely to be doing a lot.
If you squat rather than stooping, with your knees bent and your back
straight, you'll strengthen your thigh muscles and avoid damaging your back.
Pelvic floor exercises strengthen perineal muscles, which can
help to stop incontinence, and make sex better too. You can do this exercise
either sitting or standing.
Squeeze and draw in your back passage at the same time.
Close up and draw your vagina (front passage) upwards.
Do it quickly, tightening and releasing the muscles
Then do it slowly, holding the contractions for as long as you
can (but not more than 10 seconds) before you relax.
Repeat each exercise 10 times, four to six times a day.
Deep stomach exercises will help to firm your stomach:
Lie on your side with your knees slightly bent.
Let your tummy sag and breathe in gently.
As you breathe out, gently draw in the lower part of your
stomach like a corset, narrowing your waistline.
Squeeze your pelvic floor at the same time.
Hold for a count of 10 then gently release.
Repeat 10 times.
4th or 5th week onwards
Play energetic games with older children. You can exercise by
running about with them. Find outdoor space if there's no space at home.
Run upstairs. You probably go up and down the stairs several
times a day, so think of it as good exercise!
When your lochia (postnatal bleeding) has stopped, you can try
swimming. Swimming is good exercise and it's relaxing too. If you take your
child with you, try to have someone else there too so that you get a chance
Ways of easing back pain
The following tips will help relieve an aching back:
While feeding, always sit with your back well supported and straight.
Place a pillow or cushion behind your waist.
Kneel or squat to do low-level jobs, such as bathing your baby
or picking things up off the floor. Avoid bending your back.
Make your knees work instead. Change nappies on a waist-level
surface or while kneeling on the floor.
To lift heavy objects, such as a carrycot or an older child,
bend your knees, keep your back straight and hold the object close to your
body. Make your thigh muscles work as you lift.
Keep a straight back when you push a pram or buggy.
Alternatively, carry your baby in a sling.