What to Expect in a C-Section

Low transverse C-section; the surgery

Low Transverse C-Section
In a low transverse C-section (LTCS), the doctor cuts through the lower uterine segment of the uterus, which typically doesn't involve the same tissue as a classical C-section. This region of the uterus has less muscular fiber, and is less easy to tear or rupture with future labors.

There are still risks with a LTCS, but they seem to be fewer in nature. The uterine scar will tear less easily, as we already suggested. However, even though many women can deliver subsequent babies vaginally after this procedure, many doctors still advise going the C-section route with subsequent babies, just to be on the safe side.

What Happens During a Planned C-section?
In a planned C-section (make note of the word "planned" because procedures might work differently in an emergency), the doctor will review the patient's history, make recommendations, and schedule a certain day and time for the surgery.

Before the Surgery
On the day prior to the surgery, the patient is asked not to eat or drink anything after midnight because she should ideally have an empty stomach in order to keep from aspirating. Aspiration occurs when the patient vomits the contents of her stomach, the contents go back into her throat, and then possibly fall back down the windpipe and into her lungs. This is obviously not a good thing and could be life-threatening. The doctor will ask the patient to show up at the hospital at a specific time. (Dr. John stresses how important it is to be on time. Even though it is several hours before your surgery, there is a lot of prep work that has to be done.) The patient will also be informed of any requisite postoperative restrictions, as well as ensuring that she has adequate help after the surgery.

On the morning of the surgery, the nurse will evaluate the baby's heart rate and mother's contraction pattern by using external monitors placed around the mother's abdomen. In addition, the nurse will check the mother's vital signs. The nurse, doctor, and anesthesiologist will review the records again to evaluate any medical complications. Consent forms will be signed and witnessed. The surgeon will ask the mother if she has any questions and will explain what will happen, if that has not already occurred.

Once everything is set, the patient will be taken to the operating room (OR). The nurse may or may not do a shave of the pubic area, depending on the physician's preference. A Foley bladder catheter is inserted to drain the bladder so that it is not in the way of the operating field (basically, they deflate it). At this point, the anesthesiologist takes over. If the indication is not urgent, the patient will receive a regional anesthetic (most likely a spinal) so she stays awake, but the region being worked on is numb. In this way, the patient does not have to be intubated as she is breathing on her own. This is considered to be much safer than a general anesthetic where the patient is put under and is not conscious. (Much nicer to be conscious for your baby's birth.)

If the baby has been continuously monitored up to this point, the monitors are taken away so that the abdomen can be prepared for surgery. The preparation consists of applying sterilizing solutions to kill all the germs on the surface of the skin. Many times it is an iodine solution. If you're allergic to iodine, let the doctor know earlier. Also, let them know if you're allergic to latex.

Before the surgery begins, a hip roll is placed beneath the patient's right hip, to tilt her slightly to the left. They do this for the same reason that the doctors don't want you sleeping on your back during the latter stages of pregnancy – because the uterus being heavy can rest on the vena cava, which can restrict the blood flow to the baby.

The patient is then draped, and the surgeons take their places on either side of the patient. Often, there is a second surgeon (who might be a resident) assisting the primary surgeon (your doctor). Obviously, the primary surgeon will be the person performing the operation.

At this point, the surgeon will check with the anesthesiologist to verify that the anesthesia is adequate – in other words, they will do a test to make sure the patient can't feel anything in the appropriate area and therefore is ready for surgery. Now the father or significant other is allowed into the operating room. That person will be draped in a gown and facemask to preserve the sterile environment, and he (or she) will be positioned at the head of the bed next to you.

The drape is elevated above the patient's chest so that her face is shielded from the operative field. This is done for two reasons: Doctors want to keep the patient's face shielded from anything that could splatter on it; they also don't want her seeing the trauma of her innards coming out. Let's face it – that would be a disgusting thing to witness. So, it's a combination of emotional and physical safety issues.

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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