Cesarean section

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Alternative names
Abdominal delivery; Abdominal birth; C-section

Definition
A C-section, also called a cesarean section, is the delivery of a baby through a surgical abdominal incision.

Description

A C-section delivery is performed when a vaginal birth is not possible or is not safe for the mother or child.

Surgery is usually done while the woman is awake but anesthetized from the chest to the legs by epidural or spinal anesthesia. An incision is made across the abdomen just above the pubic area. The uterus is opened, the amniotic fluid is drained, and the baby is delivered.

The baby’s mouth and nose are cleared of fluids, and the umbilical cord is clamped and cut. The baby is handed to the pediatrician or nurse who will make sure that breathing is normal. The mother is awake and she can hear and see her baby.

Due to a variety of medical and social factors, C-sections have become fairly common—about 26% of all births in the United States in 2002 were C-sections.

Indications

The decision to have a C-section delivery can depend on the obstetrician, the delivery location, and the woman’s past deliveries or medical history. Some of the main reasons for C-section instead of vaginal delivery include the following:

Reasons related to the baby:

• Developmental abnormalities of the fetus, such as hydrocephalus or spina bifida
  
• Abnormal fetal heart rate pattern
  
• Abnormal position of the baby within the uterus, such as crosswise (transverse) or buttocks-first (breech)
  
• Multiple babies within the uterus (triplet and some twin pregnancies)

Reasons related to the mother:

• Extreme maternal illness, such as heart disease, toxemia, preeclampsia or eclampsia
  
• Active genital herpes infection
  
• Maternal HIV infection
  
• Previous surgery in the uterus, including myomectomy and previous C-sections

Problems with labor or delivery:

• Prolonged or arrested labor
  
• Very large baby (macrosomia)
  
• Cephalopelvic disproportion (baby’s head is too large to pass through mother’s pelvis)

Problems with the placenta or unbilical cord:

• Umbilical cord prolapse (the umbilical cord comes through the cervix)
  
• Placenta attached in abnormal location (placenta previa) or prematurely separated from uterine wall (placenta abruptio)

Risks

C-sections have become very safe procedures. The rate of serious complications, such as maternal death related to C-section delivery, is extremely low.

However, certain risks are higher after C-section than after vaginal delivery:

Risks due to anesthesia:

• Reactions to medications
  
• Problems breathing

Risks related to surgery:

• Bleeding
  
• Infection

Additional risks specific to C-section:

• Infection of the bladder or uterus
  
• Injury to the urinary tract
  
• Injury to the baby

Expectations after surgery

Most mothers and infants recover well, with few problems.

Women who have C-section deliveries can often have a normal vaginal delivery with later pregnancies, depending on the type of C-section performed and the reason the C-section was performed.

About two-thirds of women who attempt a vaginal birth after cesarean (VBAC) delivery are successful. However, there is a small risk of uterine rupture associated with VBAC attempts, which can endanger the mother and the baby. It is important to discuss the benefits and risks of VBAC with your obstetric health care provider.

Convalescence
The average hospital stay after C-section is 2 to 4 days. Recovery takes longer than it would from a natural birth. Walking is encouraged the day of surgery to speed recovery. Pain can be managed with oral medications.

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