C Section

Purpose: The causes of a planned or elective C-section delivery include:

• History of a previous C-section delivery

• The baby is positioned in a breech position (bottom or feet first) and cannot be turned

• The baby is lying sideways (transverse position)

• Placenta previa, a condition in which the cervix (opening to the womb) is blocked by the placenta (an organ in the uterus that provides nutrition and oxygen to the growing baby)

• A twin pregnancy, with the first baby being in a breech position

• In case of three or more babies

• If the woman is unwilling to undergo labor pain

• The causes of an unplanned or emergency C-section delivery include:

• The baby’s head does not fit through the pelvis (the lower part of the torso, between the legs and abdomen) during labor, or does not move down

• The baby is showing signs of distress or there is a compromise in the baby’s health

• The labor is not progressing well, that is, if the cervix is opening too slowly or not opening at all, or the contractions are not strong enough

• A health disorder, like high blood pressure, that makes labor risky for the mother and the baby

• The umbilical cord (a cord providing oxygenated blood and nutrients to the body) has prolapsed (fallen down) through the cervix and into the vagina after the waters have broken
  

The following tests are recommended before a C-section delivery:

1. Blood tests: It helps in checking the various blood parameters, and if there is an underlying medical condition like diabetes or thyroid problems. An increased level of leukocytes (white blood cells) during labor may indicate an infection. Blood tests also help in determining the blood type and hemoglobin levels of the mother.
2. Urine tests: This test helps in checking if the kidneys are functioning well.
3. Fetal heart rate monitoring: It helps in measuring the heart rhythm and heart rate of the baby.
4. Ultrasound: Sound waves are used to check the fetal position and maturity.

The procedure is usually done under spinal anesthesia (anesthesia is given in the spine region to block the pain from the chest downwards). 
The procedure can also be performed under epidural anesthesia, which is given to reduce the pain during labor, and if it is working well, it can also be used in case of an emergency C-section delivery.
Very rarely the procedure may be performed under general anesthesia (the patient is put to sleep during the procedure) if the baby needs to be born quickly.

• The doctor makes a cut (incision) in the abdomen and uterus (each approximately 10 cm long).
• The baby is lifted out through the incision.
• Sometimes, forceps may be used to lift out the head of the baby.
• The baby is carefully checked.
• The baby can be held by the mother soon after delivery. Skin-to-skin contact helps in strengthening the bond with the baby and making breastfeeding easier.
• The umbilical cord is cut and the placenta is then removed.
• An injection may be given to contract the uterus and reduce bleeding.
• Antibiotics may be given to reduce the chances of infection.
• The doctor stitches (sutures) back layers of muscle, fat, and skin.
• A dressing is applied over the wound area.

The complications associated with a C-section delivery are:

• Blood loss
• Blood clot formation in the legs
• Infection
• Pain in wound area or abdomen
• Allergic reactions to anesthetic agents
• Problems with attempts at having a vaginal birth in the future
• Requirement of a C-section delivery for future births
• Back pain, especially in the area of an epidural or spinal injection
• Burning sensation or pain on urinating
• Inability to pass urine
• Inability to have bowel movements
• Constipation
• Urinary incontinence (leaking of urine)
• Excessive loss of blood from the vagina
• Foul-smelling discharge from the vagina
• Shortness of breath
• Coughing
• Pain or swelling in the calf (lower leg)
• Wound edges that look infected or pull apart

• A woman usually stays in the hospital for 3 to 5 days after C-section delivery.
• Take adequate rest after the procedure.
• Arrange for help for a few days after the procedure.
• Avoid heavy lifting for six weeks after the procedure.
• Go for gentle walks every day after the procedure.
• Do your pelvic floor exercises, as recommended by your physiotherapist.
• Eat a well-balanced, healthy, high-fiber diet.
• Drink lots of fluids to avoid constipation.
• Use a warm water bottle over the wound area.
• The doctor may prescribe medications to relieve pain after the procedure.
• Keep the wound area dry and clean.
• Inform your doctor if you notice any signs of infection, like pain, swelling, or redness.
• High-waist compression underwear may be worn for six weeks after the procedure to provide abdominal support.
• Avoid sex till you are comfortable and the doctor gives you a go-ahead for the same.
• It is normal to have some itching and numbness around the scar region.
• It is normal to have some vaginal bleeding for a few days after the procedure.
• Avoid driving a car for six weeks after the procedure.