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Birth by Cesarean

Rachel O'Reilly

By Aaryn Leineke

As a doula, I believe when both mother and baby are healthy, the safest form of delivery is a natural vaginal birth without medical intervention. That said, I also believe that all types of birth are beautiful, and the ability to perform safe cesarean deliveries has without question been one of the most important advances in obstetrics during this century. The bottom line is, women are strong and powerful, and every way of giving birth is a miraculous process -- hiccups included.

Natural birth, vaginal birth with medical interventions, or a cesarean birth (C-Section) are three different ways to bring your baby(ies) earthside. A C-Section is the delivery of a baby via a surgical incision through the mother's abdomen and uterus. Cesareans can be scheduled in advance due to high-risk pregnancy (for mother and/or child), multiple babies (however, many twin pregnancies can be born vaginally), breech position or Transverse lie, Placenta previa or Placenta abruption, and other conditions or circumstances. A cesarean can also be required or suggested unexpectedly, due to unforeseen complications during labor.

Below is the general process you can expect from a C-Section birth.

I. Delivery: The mother is rolled into an operating room and placed on an operating table. If there is time to perform an epidural or spinal anesthesia for the surgery, this is usually done at this time (if it was not already applied during an earlier stage of her labor). If the surgery is a “true” emergency where there is no time to perform a spinal anesthesia, the mother will receive general anesthesia (being put to sleep) just before the surgeon is ready to begin. It’s important to know that these drugs can make the baby somewhat slow to adapt to life, and can increase the risk for respiratory distress requiring resuscitation.

The mother’s arms are placed with straps on boards extending directly out from her body. This allows easy access to the mother’s veins to administer medicine. It also prevents the mother from unconsciously reaching down to her baby during the surgery, which could contaminate the operation and increase risk of infection.

The mother’s abdomen is carefully washed and disinfected in order to prep for surgery. A cloth is hung from two poles at the mother’s shoulder to prevent her from seeing the surgery and allows the anesthesiologist to pay close attention to the mother’s nose and mouth to administer medications when needed.

The operation begins with an incision in the skin of the abdomen (the outer layers of the skin only), usually at the top of your pubic line. After cutting the skin, the doctor will cut through layers of fat tissues (which all women will have, but all vary in amounts) and then through thick fibrous layer called the fascia. The doctor then makes an incision through a thin, filmy layer called the peritoneum (the sac lining the abdominal cavity and containing the organs). The uterus and bladder, among other organs, are not visible. The bladder usually sits on top of the uterus and must be carefully moved before the doctor can make the incision on the uterus and deliver the baby. Once the uterus is opened, the delivery can proceed.

After the uterus has been opened, the amniotic sac would be considered ruptured. At this time, the doctor will act fast with great care to get the baby safely from the mother’s womb. Many hands work to suction the amniotic fluids, from the operations and baby’s mouth, while gently delivering the baby without twisting the neck, body or limbs in the process. The baby stays connected to the mother via his or her umbilical cord. As with vaginal birth, the doctor will clamp the umbilical cord until ready to cut the connection from the mother to baby. This will prevent bleeding from either side of the cut umbilical cord.

Once the umbilical cord has been cut, the nurses will take the baby to a warmer table to clean and swaddle him/her. If the mom is available, she can hold her newborn baby.

II. Post-Delivery: The doctor still has important work to do, with the act of repairing the incision in the mother’s uterus high on the list. First, however, the placenta must  be removed. In most cases, the doctor can reach into the uterus and peel the placenta off the uterine wall. On the other hand, if the bleeding is not too heavy, some doctors prefer to to gently pull the umbilical cord, which will cause the uterus to contract, and the placenta will fall away from the uterine wall on its own. After removing the placenta, the doctor will wipe the inside of the uterus with a cloth to remove any remaining pieces of placenta or membrane, and will then close the incision on the uterus using dissolvable sutures.

The bladder does not need to be reattached to the the uterus, as this will happen naturally within a few weeks. The peritoneum (the lining of the abdominal cavity) also heals spontaneously. The human body is magic, isn’t it?!

Closing the fascia (the thick fibrous layer of tissue that envelops the body beneath the skin) is usually done with dissolvable sutures as well. The fascia heals more slowly than the uterus, so in some cases a doctor will decide to use permanent sutures (which would remain in place for the rest of the patient’s life).

Finally, the doctor will make sure there is no bleeding in any of the layers beneath the skin. Once each layer is carefully closed, most surgeons will use titanium staples to close the outer wound without much effort, generally yielding a thin scar. The staples need to be removed 3-5 days after the operation. After a light bandage is applied to the mother’s wound, she will be transferred from the operating table to a bed and taken to the recovery room where, she can hold her newborn baby, practicing skin to skin contact and letting the baby attempt breastfeeding.

III. Recovery: A cesarean is a major surgery. Most women will experience a lot of pain as the anesthesia wears off. Many hospital staff will be available to monitor the mother and make sure she is comfortable after the surgery. She should be able to walk, eat and drink normally after 24 hours.

There is no question that the cesarean section rate has skyrocketed in the past 30 years. In 1970’s the national cesarean section rate was 4%. By the end of the twentieth century, the rate was about 22%. While cesareans are an incredible medical intervention that have saved many women’s lives, there are many people who still feel that some unnecessary surgical births are being done. The number of cesarean sections performed by any single obstetrician is related not only to how well s/he practices medicine, but also to the doctor’s type of practice. I recommend asking your doctor their cesarean rate for their personal practice, and decide if they are the right doctor for you based on your birth plan.