Cesarean Delivery

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Cesarean delivery (also called a cesarean section or C-section) is the surgical delivery of a baby by an incision through the mother's abdomen and uterus. This procedure is done when it is determined to be a safer method than a vaginal delivery for the mother, baby, or both.

In a cesarean delivery, an incision is made in the skin and into the uterus at the lower part of the mother's abdomen. The incision in the skin may be vertical or horizontal, and the incision in the uterus may be vertical or horizontal.

A horizontal incision extends across the pubic hairline, whereas, a vertical incision extends from the navel to the pubic hairline. A horizontal uterine incision is used most often, because it heals well and there is less bleeding. Horizontal uterine incisions also increase the chance for vaginal birth in a future pregnancy. However, the type of incision depends on the conditions of the mother and the developing baby. If a woman is unable to deliver vaginally, the baby is delivered surgically by performing a cesarean delivery. Some cesarean deliveries are planned and scheduled, while others may be done as a result of problems that occur during labor.

There are several conditions which may make a cesarean delivery more likely. These include, but are not limited to:

• Abnormal fetal heart rate. The fetal heart rate during labor is a good sign of how well the fetus is handling the contractions of labor. The heart rate is monitored during labor, with the normal range varying between 120 to 160 beats per minute. If the fetal heart rate shows there may be a problem, immediate action can be taken, such as giving the mother oxygen, increasing fluids and changing the mother's position. A cesarean delivery may be necessary.
• Abnormal position of the baby during birth. The normal position for the baby during birth is head-down, facing the mother's back. However, sometimes a baby is not in the right position, making delivery more difficult through the birth canal.
• Labor that fails to progress or does not progress normally.
• Baby is too large to be delivered vaginally.
• Placental complications (such as placenta previa, in which the placenta blocks the cervix and presents the risk of becoming detached from the uterus too soon). Premature detachment from the baby is known as abruption.
• Certain maternal medical conditions (such as diabetes, high blood pressure or human immunodeficiency virus [HIV] infection).
• Active herpes lesions in the mother's vagina or cervix.
• Twins or other multiples.
• Previous cesarean delivery.

There may be other reasons for your doctor to recommend a cesarean delivery. As with any surgical procedure, complications may occur. Some possible complications of a cesarean delivery may include, but are not limited to:

• Bleeding
• Abnormal separation of the placenta, especially in women with previous cesarean delivery
• Injury to the bladder or bowel
• Infection in the uterus
• Wound infection
• Difficulty urinating and/or urinary tract infection
• Delayed return of bowel function
• Blood clots

A woman may or may not be able to have a vaginal birth with a future pregnancy, called a vaginal birth after cesarean (VBAC). Depending on the type of uterine incision used for the cesarean birth, the scar may not be strong enough to hold together during labor contractions.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

• Your doctor will explain the procedure to you and give you the chance to ask any questions that you might have about the procedure.
• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear. If you want to have a tubal ligation (a permanent method of birth control in which the fallopian tubes are cut, cauterized or banded to keep the eggs from getting into the uterus) as part of your surgery, you must sign a consent form for this procedure.
• You will be asked when you last had anything to eat or drink. If your cesarean delivery is a planned procedure and requires general, spinal or epidural anesthesia, you will be asked to fast (not eat or drink anything) for eight hours before the procedure, generally after midnight.
• Notify your doctor if you are sensitive to or are allergic to any medications, latex, iodine, tape and anesthetic agents (local and general).
• Notify your doctor of all medications (prescription and over-the-counter) and herbal supplements that you are taking.
• Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin or other medications that affect blood clotting. You may need to stop these medications prior to the procedure.
• You may be given medication to decrease the acid in your stomach and to help dry the secretions in your mouth and breathing passages.
• Plan to have someone stay with you after a cesarean delivery. You may have pain in the first few days and will need help with the baby.
• Based upon your medical condition, your doctor may need you to do other things to be ready for this surgery.

A cesarean delivery will be done in an operating room or a designated delivery room. Procedures may vary depending on your condition and your doctor's practices. In most cases, you will be awake for a cesarean delivery. Only in rare situations will a mother require general anesthesia (you will be given drugs that make you sleep) for this type of birth. Most cesarean deliveries today are done with a regional anesthesia such as an epidural or spinal. With these types of anesthesia, you will have no feeling from your waist down, and you will be awake and able to hear and see your baby as soon as he/she is born.

Usually, your baby can be brought to you while you are in the recovery area after surgery. In some cases, babies born by cesarean will first need to be monitored in the nursery for a short time. Breastfeeding can begin in the recovery area, just as with a vaginal delivery.

Clear Drape C-Section

Merit Health Wesley offers a clear drape C-section which allows parents whose babies are born via C-section to see the moment their baby is born. The drape maintains a sterile environment for patient safety but also includes a clear window for parents to see through, giving mothers who require a C-section delivery an experience similar to those who deliver naturally. The mother is unable to see above her abdomen, so the only thing she will see is the baby as soon as he or she is lifted out of the womb. Patients interested in this option should discuss with their doctor if this option is right for them.