Cesarean section is a surgical procedure in which an incision is made in the mother’s abdomen and uterus to remove the baby. It is indicated when it is believed that a vaginal delivery could pose a risk to the mother or the fetus. In certain situations, cesarean delivery is the only solution for the birth of a healthy baby, and therefore it should only be performed when necessary, always assessing the risks and benefits in each case, and avoiding unnecessary cesarean sections.
Cesarean section can be performed on a scheduled basis (before the woman goes into labor, when there are medical criteria that advise against vaginal delivery), during the course of labor or urgently. Although the procedure may vary slightly depending on the circumstances that lead to the cesarean section, today we explain, in general terms, how this operation takes place to extract the baby .
Mother pre-operator
The pre-operative period can only be carried out by mothers who already know in advance that they will have a cesarean section, or those who are susceptible to their delivery ending in a cesarean section. In both cases, the woman will go to the consultation with the anesthetist a few weeks before the delivery date (the gynecologist will decide the most appropriate moment, depending on the particular circumstances), where in addition to being asked about her medical history and informed orally and in writing of the anesthetic procedure, a blood test will be performed.
Likewise, you will have a final consultation with the gynecologist prior to the intervention , where the placement of the baby and the placenta, fetal monitoring and any other special conditions that may exist will be assessed. It is time to clarify any doubts you may have regarding the intervention and the postoperative period.
In the case of scheduled cesarean section , a two-hour fast prior to the intervention will be recommended for clear liquids, six hours for solids and eight hours for fatty foods. In addition, the woman must sign a series of consents (anesthesia and surgery) that must be delivered before or at the time of the operation.
Anesthesia
Depending on the type of cesarean section performed, the anesthesia may be epidural, spinal or general:
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Spinal anesthesia : as we read in [Cochrane] (https://www.cochrane.org/es/CD003765/PREG_anestesia-raquidea-versus-epidural-para-la-cesarea#:~:text=La%20anestesia%20regional% 20 (anesthesia% 20raqu% C3% ADdea, mother% 20 as% 20for% 20the% 20feto.) This type of anesthesia is considered to be more advantageous due to the simplicity of the technique, the speed of administration and the initiation of anesthesia It is considered the first choice technique in scheduled cesarean sections.
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When it comes to a cesarean section performed in the course of labor , the same epidural anesthesia that was being used will be the one used for the operation.
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In the case of emergency cesarean sections, general anesthesia is usually the most used technique, although the spinal may also be used.
Here you can read more information about the different types of anesthesia used during labor.
Preparation in the operating room
Before starting the operation , some procedures will be carried out once the woman enters the operating room, although these may vary according to the protocol:
- Bladder catheterization : as we read in the Protocol for Caesarean sections of the Sant Joan de Deu Hospital in Barcelona, there is not enough evidence to justify the systematic use of bladder catheterization in caesarean sections, so there will be hospitals that opt for this practice and others those limited to only a few cases.
- An intravenous line is placed in the arm or hand for medication (antibiotic, pain relievers, serum ..)
- Electrodes, pulse oximeter, and nasal oxygen goggles are placed on the hand or foot
- The hair around the surgical area is trimmed and the skin is cleansed with an antiseptic solution.
- The abdomen is covered with sterile drapes and a sheet will be placed over the chest, as a curtain, to hide the surgical area.
Typically, the operating room has two gynecologists (who will perform the cesarean section and an assistant), a pediatrician, two nurses (one of them scrub nurse), a nursing assistant, and the anesthetist, who will be the one who will control the patient’s heart rate at all times. the mother, her blood pressure, her breathing, and the level of oxygen in her blood.
Cesarean section step by step
The estimated average time from the beginning of the cesarean section until the baby is extracted is 10 minutes, although the total duration of the procedure rises to about 30-40 minutes (somewhat more if the cesarean section is used to make a tubal ligation) . To reach the baby, five layers of tissue must be traversed:
- It begins by making an incision in the skin with a cold scalpel. This incision can be vertical or horizontal.
- Abdominal fat is separated
- The aponeurosis is cut, which is a region formed by different connective tissues that are responsible for protecting the muscles.
- The fascia (membrane that covers the muscles) of the anterior aspect of the rectus abdominis muscles is separated and the abdominal muscles are separated , not cut.
- The peritoneum, which is a tissue that lines the abdominal wall and most of the organs in the abdomen, is torn with the fingers.
- Once the uterine cavity has been reached, the doctor makes an incision in the uterus and the amniotic sac to allow the amniotic fluid to drain so that the baby can be removed.
- After the baby is born, the umbilical cord is cut and the placenta removed.
Before closing it is necessary to check that the uterus is empty, does not present tears or remains of the placenta. Next, the uterus is sutured with absorbable suture (that is, the thread will be reabsorbed only after a while) and then all the layers that have been sectioned will be repaired until reaching the skin.
Depending on the technique chosen by the gynecologist, the skin will be closed using staples or with a continuous suture. Finally, the area is covered with a dressing.
Resuscitation and aftercare
After the cesarean section, the woman will go to a resuscitation area where she will be monitored at all times by health personnel. The time that you will spend in this room is highly variable, as it will depend on how the cesarean section has passed and the effect of the anesthesia, although it is usually between one and three hours. In some hospitals it is possible that the mother is accompanied by her baby and her partner, although in others, the skin-to-skin must be done by the father in the room while the mother recovers.
The anesthesia will stop working after one or two hours, and from that moment it will be necessary to administer medication to alleviate post-surgical pain . If you are going to breastfeed your baby, make sure that the medication prescribed for you is compatible with breastfeeding. Low molecular weight heparin injections are also usually indicated to avoid the risk of thrombus.
A few hours later, the urinary catheter will be removed so that you can stand up and start walking . At all times, the nurses and the gynecologist will check that your uterus is regressing correctly, there are no bleeding and the wound does not become infected.
If all goes well, after three days you will be discharged with instructions on how to take care of your wound, when to return for consultation to remove the stitches and check the scar, and when to go to your first postpartum visit.
Photos | iStock
Via | Surgical procedure in urgent cesarean section – University of Zaragoza, Clinic Barcelona, Stanford Children
In Babies and More | A plasticine cesarean section: the viral video of a medical mother explaining to her four-year-old son how he was born, Cesarean delivery: seven tips that will help you recover more easily, How is recovery after cesarean section?
