What to Expect in a C-Section

The surgery, continued

Next, the doctor makes the incision in the skin. Typically, it's called a Pfannenstiel skin incision (otherwise known as a bikini cut), which is a horizontal incision just above the pubic hairline. Several layers of tissue are cut before the surgeon is inside reaching the uterus.

From the patient's perspective, all she should feel is a little bit of pressure or tugging and pulling, but she shouldn't feel any sharpness or pain.

After the surgeon reaches the uterus, he will study the anatomy to decide where the baby is lying and where to make the cut to optimize getting the baby out. There will be some gentle dissection behind the bladder in order to create a space to expose the incision site on the uterus. The reason the surgeon takes so much care is that he is trying to preserve the mother's option of having a baby vaginally in the future.

The physician will make a low-transverse uterine incision. The incision will be large enough to pull the baby out, possibly 8-10 centimeters (the doctor can stretch it more with his hands). The surgeon will go slowly before the next cut, with the assistant suctioning away the blood that obscures the surgeon's vision. There is lots of blood pouring into the hole he is cutting, so he must trust his tactile feel to reduce injury to the baby. Once the doctor feels that he is inside the uterus, he will stretch open the incision and put one hand inside to protect and deliver the baby's head. Usually, he will be aided by an assistant who is applying pressure on the top of the uterus to push the baby forward.

The baby's head can't be pulled out until it's actually peeking out. The surgeon will use a little force to push the mother's uterus down, thereby squeezing the baby out of the incision.

From the mother's perspective, she'll feel tugging and a lot of pressure. She will not be asked to push, but she will definitely be aware of the tugging and pulling.

The Baby Delivered by C-Section
When the baby is delivered, there tends to be a lot of amniotic fluid that comes out, so the doctor will suction the baby's mouth and nose to aid the baby's breathing efforts. He'll clamp the umbilical cord, cut the cord between two clamps, and one of the doctors will hand the baby to a nurse so that the baby can go immediately to a warmer. (The doctor might show you the baby briefly, but don't count on it. The immediate concern is to get the baby evaluated.) After the baby is on the warmer, the neonatal resuscitative team (NNR) will work on the baby and make sure that it is progressing as it should.

The way the staff handles a baby delivered by Cesarean is different than the way they handle a vaginal birth because of the increased risk to both mother and baby in a C-section. For example, the baby may have more of an adjustment or transition period from intrauterine to extrauterine life by being delivered from a C-section. In a vaginal delivery, the squeezing of going through the birth canal pushes the fluid in the baby's lungs out and can facilitate breathing of the baby once it's delivered. However, in a C-section, depending upon whether labor occurred or not, much of this fluid may still remain in the baby's lungs, so the baby is often given oxygen and the baby's back is massaged (palpation) to increase the expulsion of fluid.

The Surgery Continues...
Once the baby is out, the OB will focus his attention back on the mother (his primary patient) because she is still bleeding from the uterus, which must be controlled immediately. The placenta is delivered next. The surgeon places his hand inside the uterus and peels the placenta off the uterine wall. Simultaneously, the anesthesiologist administers Pitocin, which will help the uterus squeeze down upon itself to cut down on the blood loss. Typically, if the patient hasn't received antibiotics up to this point, she will receive them now. Antibiotics are a key factor because they will reduce the chances of infection, since virtually all the contents of the uterus have spilled into the patient's abdominal cavity , including lots of bacteria (not to be too graphic here, but yeech – I'm beginning to notice that doctors get a kick out of describing gross stuff).

Once the placenta is out, the doctor focuses on closing the incision he made. There tends to be a lot of bleeding at this juncture, so visualization is a challenge. The team uses a combination of suction and gauze sponges to find out where they need to sew. They start at one end of the uterine incision and work across to the other side, closing the incision site. Often, the OB will perform a second layer of closure on top of the first one. Some doctors feel that this is helpful to prevent a uterine rupture in the future.

Next, the surgeon will look for any signs of bleeding that haven't been addressed yet and cauterize those areas. The pelvic region may be irrigated with sterile water or saline. The doctor will remove any large clots and begin the closure of the various layers of incisions that were previously incised, including the skin. The skin may be closed with suture materials or staples.

From the Doctor's Perspective...
Studies show that the healing rates from using either staples or suture material are the same. Dr. John, however, likes sutures better because they are dissolvable. "With staples, you have to remove them in three days, say the morning of going home. Sutures don't have to be removed since they dissolve on their own. Some doctors think it's faster to work with staples, but I still prefer sutures."

excerpted from:

Reproduced from Absolute Beginner's Guide to Pregnancy, by John Adams and Marta Justak, by permission of Pearson Education. Copyright © 2005 by Que Publishing. Please visit Amazon to order your own copy.

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