Nature knows what it is doing – it equips a small human being with the right tools to make it easier for them to start outside their parent’s body. Natural childbirth , i.e. pushing through the birth canal, is a huge challenge, but it is the only way for the child to be properly stimulated (which makes them cope better in the first days of independent life) and at the same time colonize with good bacteria (which makes them more resistant). So much for the theory and plan of Mother Nature. Sometimes, however, this plan has no chance of success and here it appears, all in white: a caesarean section as a surgical solution to pregnancy.
What is a cesarean section?
In practice, a cesarean section is a laparotomy, i.e. an operation involving the cutting of the abdominal wall (skin, muscles, peritoneum and uterine muscle), performed only under strictly defined indications, defined by the Polish Gynecological Society.
When is a cesarean section performed?
A cesarean section can be performed in two modes: planned (so-called "cold"; specific indications for the section, if labor contractions do not begin by the scheduled date) or emergency (saving the life of the person giving birth or the child).
Planned cesarean section
In simple terms, a planned section is one that the patient knows about at the stage of pregnancy. It does not pose a threat to the life of the person giving birth or the fetus. It is most often performed around the 39th week of pregnancy. Some hospitals allow a companion to be present during this operation.
An elective planned cesarean section is performed based on medical indications from the pregnant woman or the child.
Indications for a cesarean section from a pregnant woman include psychological indications (for example, active mental illness), neurological, ophthalmological (condition of the retina), orthopedic (condition following a pelvic bone injury), cardiological (serious heart diseases), and placenta praevia.
Indications for a cesarean section from the baby include malposition (for example, transverse position), fetopelvic disproportion (when the baby is too large in relation to the pelvis), multiple pregnancy of more than 2 fetuses, or the position of the twins in a way that prevents vaginal delivery (twins positioned head down can and should be born naturally).
Emergency cesarean section
An emergency caesarean section is performed when the health and life of the person giving birth or the child is at risk. On the part of the person giving birth, this may be bleeding from the genital tract (features of placental abruption), complicated hypertension (untreatable, severe preeclampsia, HELLP syndrome), increasing fever, symptoms of infection, lack of progress in labor in the 1st stage – for example in the case of so-called cervical dystocia (when the cervix does not dilate or dilates only to a certain stage despite dynamic contractions) or in the 2nd stage (duration over 2 hours, the child is too high in the birth canal for forceps or vacuum delivery , there are features of fetal-pelvic disproportion). On the part of the child being born, it may be a prolapse of the umbilical cord or disturbances in the fetal heart rate.
Anesthesia for cesarean section
There are four types of anaesthesia for a cesarean section: spinal, epidural, spinal-epidural, and general. Only in the latter case is the person giving birth completely asleep and wakes up only after the operation is over.
The most commonly used is spinal block anesthesia. To do this, a thin needle is inserted into the subarachnoid space and a painkiller and anesthetic are injected. This takes a few minutes.
Epidural anesthesia (most commonly used during natural childbirth) involves placing a catheter into the epidural space (through which the nerves running to and from the spine pass), with a port leading outside the body so that doses of medication can be administered without reinsertion.
Spinal-epidural anesthesia is – as you might guess – a combination of the two. It is a safe option when there is a risk of prolonged caesarean section; after the operation is completed, painkillers are administered via the same route.
General anesthesia is used the least often – only when it is necessary to act quickly, because the life of the person giving birth or the child is in danger and there is no time to insert a needle into the spine. Of course, there are situations when it is already known that the incision will be performed under general anesthesia: too few platelets (clotting problems), significant spinal disc disease (inability to insert the catheter correctly), massive hemorrhage, some heart or nervous system diseases.
As I mentioned, unless general anesthesia is needed, the person giving birth remains completely conscious during the operation. They don't feel pain, but they do feel touch, which is hard to imagine if you haven't experienced it. When the wound widens, you feel a tugging and pulling sensation, your psyche tells you that pain will come soon, but it doesn't. Feeling in the lower limbs gradually returns 4 to 6 hours after the operation.
The lack of feeling in my legs was one of the most surprising sensations for me after the surgery. Touching my own legs was very strange. I felt the warmth of the skin and its elasticity, I could pinch and stroke myself, without feeling anything at all. Trying hard and still unsuccessfully to move my toes made me impatient and afraid of IF and WHEN I would be able to go for a walk with my own child! :) But does the anaesthesia hurt? No. This little prick is more of an discomfort.
What does a cesarean section LITERALLY look like?
The most common is a transverse incision above the hairline. This cut is more precise and aesthetic, but also reduces blood loss and the scar heals better.
Less frequently, a longitudinal incision is performed (from the umbilicus to the pubic symphysis) – usually in patients who have already had surgery using this approach (in this case, in order to avoid making another scar, the previous one is cut out and the abdomen is opened at this point), if there is a need for a larger space to safely perform the surgery (in the case of difficulties such as a myomatous uterus, ingrowth/pervasive placenta) or if the surgery is of a larger scope (for example, simultaneous excision of neoplastic lesions).
How long does a cesarean section take?
The entire operation takes only about 30 to 40 minutes, but the baby is removed after the first few minutes.
Cesarean section step by step
Below is a description of a cesarean section, starting from entering the emergency room and ending in the postoperative room.
Arrival at the hospital
For a planned caesarean section, the patient usually reports to the maternity admissions office with a pregnancy card and documents the day before the procedure. In some hospitals, especially the most popular ones, admission to the ward must be arranged even several weeks in advance. Some may also require a visit to the anesthesiology clinic before admission, in others the anesthesiologist conducts qualification in the hospital. In the admissions office, it is necessary to provide personal data, sometimes a CTG and a medical examination are performed (or this is only done in the ward), and finally the patient is taken to the pregnancy pathology ward using a hospital trolley. There, midwives take care of her. First, an intravenous catheter is usually inserted to collect tests and a cannula is left through which medications and fluids will be administered. Then the pregnant person is taken to the hospital room and given a bed, and may have a CTG and fetal ultrasound performed. The medical examination takes place in the examination room. If the obstetrician-gynecologist qualifies the patient for a cesarean section and the procedure is to take place the same day, immediately after the examination the midwife inserts a catheter and then prophylactically administers antibiotics, antiemetics and a solution to neutralize stomach acid. The patient changes into a disposable labor gown, removes jewelry (it is worth leaving it at home so it does not get lost) and waits to be transported to the cesarean section room. You should not eat for at least 6 hours before the procedure and you should not drink for at least 2 hours before.
In the case of planned operations, the patient is given a special liquid to wash herself in the evening and in the morning, as well as a hospital gown the day before. It is necessary to shave the lower abdomen (the place where the abdominal incision will be made). The midwife checks the effect and, if necessary, shaves again.
Preparations for surgery
Immediately before the operation, an electrolyte fluid drip is started. Then the patient is transferred to the operating theatre, where a catheter is inserted into her bladder.
The patient is usually laid naked on the operating table and covered with clean drapes. Everything around is sterile. First, the patient is treated by an anaesthesiologist. The incision is usually performed under spinal anesthesia, which means that the patient remains conscious, feels no pain from the waist down, and cannot move the lower part of the body, but can feel touch. For anesthesia, the patient is placed in a side or sitting position, and asked to arch her back in a "cat's back" (this facilitates access to the subarachnoid space, the vertebrae are as far apart from each other as possible). The anaesthetic is administered through a very thin catheter - a flexible tube with a diameter of about 1 millimeter.
Then the patient lies on her back, with her arms spread out on special supports. Equipment is connected that monitors vital signs (blood pressure, heart rate, temperature, and oxygen saturation).
During surgery, a situation may arise that requires conversion of anaesthesia, i.e. switching from spinal anaesthesia to general anaesthesia – anaesthetic drugs will then be administered intravenously and by inhalation, the person will be intubated and will not be conscious. Also during spinal anaesthesia, in the event of significant anxiety, worrying blood pressure or heart rate values, the anaesthesiologist may administer intravenously a drug that will slightly “drows” the patient.
The face of the person giving birth is separated from the operating field by a curtain made of a piece of sterile material, or in some hospitals – by means of a transparent foil, to enable observation of the moment of birth.
When the anaesthesia is being prepared, the obstetrician-gynecologist and the second doctor who will assist in the operation put on caps, masks, plastic aprons, wash and disinfect the forearms and hands and enter the operating room. There they put on sterile aprons and gloves. They position the patient in the appropriate position on the operating table. They disinfect the skin of the abdomen and perineum. At the same time, they ask about the sensation of heat and cold when wiping the skin with gauze (to check whether nerve conduction has been interrupted). Finally, they start the operation.
Operation
The doctor makes an incision in the skin about 4 centimeters above the pubic symphysis – this incision is usually small, about the diameter of the fetus's head, but in some cases it can be wider – for example, when we are expecting a large child. Then he cuts through the layers of the abdominal wall and spreads the muscles and peritoneum (the thin membrane separating the abdominal muscles from the abdominal cavity) to the sides, exposing the uterine muscle. He makes a small incision in the uterus and then widens it manually. The uterus is incised in its lower section, on the border of the active and inactive parts (between the body and the cervix) not because of the visual effect, but so as not to disturb the course of the muscle fiber bands. This will allow for a natural birth in the future (VBAC – vaginal birth after ceaserian – vaginal birth after previous incision).
At this point, if the patient's waters have not broken before or only a small amount has broken, they may spill out or even "shoot" under pressure at the doctors (hence the plastic aprons under the sterile apron).
Then the operator manually pulls out the baby, sometimes the assistant has to apply pressure on the abdomen to help remove it (which can be unpleasant for the person giving birth). The baby is handed over to a neonatology nurse, who measures it, weighs it and administers intramuscular vitamin K. The neonatologist then examines the newborn. If the baby is in good condition, it should be returned to the parent and placed on the chest in skin-to-skin contact. Such early contact after a caesarean section is recommended by WHO and UNICEF. Most often, however, the gynecologist shows the baby to the person giving birth immediately after the baby is extracted and if the partner is present in front of the room, the baby is handed over to him/her, and kangaroo care can begin in the postnatal ward.
Meanwhile, in the operating room, doctors pull out the placenta, stitch up the uterine wound and check the inside of the abdominal cavity (for visible neoplastic changes, ovarian cysts or intestinal damage). It is important to observe the urine flowing from the catheter into the bag, whether it is not stained with blood, because this may indicate that the urinary bladder has been cut, which is a very common complication. The last stage of the operation is the suturing of the abdominal layers. The most aesthetically pleasing is the intradermal suture - we can only see its beginning and end, and the thread is guided inside the skin, but unfortunately it is not always possible to perform it.
After the operation
After the surgery, attention is paid to whether the uterus is contracting properly. So-called uterine atony may occur, i.e. the lack of its contraction after delivery, leading to hemorrhage. The patient may then require intravenous administration of oxytocin. Finally, the patient is taken to the post-operative room, where they can immediately try to put the baby to the breast. When the anaesthesia wears off, the person after delivery receives painkillers, usually intravenously. They do not affect breastfeeding . The intravesical catheter is removed when the patient starts walking and is able to urinate on her own. The bladder may be overfilled because many fluids are administered intravenously during the procedure.
First contact after cesarean section
Already at the stage of choosing a hospital, you should find out whether in the case of a caesarean section, contact between the person giving birth and the child is allowed immediately after the operation. If so, great! These first moments are very important - the baby immediately colonizes with the parent's "home" bacteria, which protects it from infections and makes it easier to adapt to new conditions. If this contact is impossible, it is worth making sure that the child is placed in the hands of the father as soon as possible. An unbuttoned shirt or a zip-up sweatshirt put on the bare body will make things easier - then it is easier to do kangaroo care in "skin-to-skin" contact.
According to the recommendations of the World Health Organization, after surgery under general anesthesia, skin-to-skin contact should be applied as soon as possible (ideally within 2 hours after the procedure). It is important that the person after giving birth can already respond to the needs of the child and be in CONSCIOUS contact with it. However, in the case of spinal anesthesia, the person giving birth should be able to see the child, greet it and put their cheek to its mouth in the delivery room.
Exactly. This is one of the things I was completely unprepared for. The baby's father was waiting just outside the room, ready to do kangaroo care. I was sure I would see the baby for a brief moment right after he was taken out, and then only in the postnatal ward. Meanwhile, after the initial drying of the newborn, the midwife held him up to my cheek and said, "Please speak to her nicely, just like you spoke to your belly; greet her, let her hear and calm down." SUCH A SUBLIME MOMENT, and my mind was completely blank, only the chirping of crickets. I started crying, said, "Hello, beautiful" (oh, horror, probably the worst thing I could have said!), and then added, "It's good to see you, you're about to meet daddy."
In the postnatal ward, when the condition of the person after giving birth allows, they should be immediately allowed to have contact with the baby, and despite the delay, the newborn should be undressed and cuddled to the parent's naked body. It is good if the baby finds and starts to suckle the breast.
How I feel after surgery
Don't be afraid of pain after surgery. Painkillers are given so that you can make your first attempt to get out of bed about 8 hours after surgery. You start with strong doses and slowly move to weaker ones, after which the drugs are given only on request if the pain persists.
Why is it important to get up after 8 hours? This prevents blood clots and embolisms. In addition, quick mobilization means a quick return to fitness.
In the case of spinal anesthesia, you may feel body tremors and cold right after the operation. There is often a severe headache. However, after general anesthesia, you may experience nausea, vomiting, sore throat (after the endotracheal tube) and general weakness. Additionally, there is a build-up of secretion in the lungs, which must be coughed up, which is painful.
It is natural to feel a "pulling" sensation in the lower abdomen and fear related to physiology: sneezing, coughing or defecating suddenly become challenges that you also have to prepare yourself for mentally. A large amount of gas and "sloshing" in the abdomen are completely normal.
Some people have problems with defecation after surgery. Until the intestines start working normally again (movement and upright posture!), you are not allowed to eat anything. The first meal is usually rice gruel, then a light diet is used. It is important to get fiber from food and drink plenty of water to facilitate proper defecation. If the problem persists, a laxative suppository is given.
…and when home?
A person after a caesarean section usually stays in the hospital for 2 full days. Longer hospitalizations result from the health condition of the parent or child, when observation is necessary. After giving birth, the person is discharged with the child, but if the newborn requires longer observation, they stay with it until discharge. The exceptions are premature babies, sick babies, babies requiring an incubator and prolonged hospitalization. Due to the child's condition, the parent cannot breastfeed the child and is usually discharged from the hospital earlier.
Seams
If regular stitches (non-dissolvable) were used to close the wound, they will be removed 6 to 8 days after delivery. This is done in the treatment room at the hospital where you gave birth. The removal of the stitches is painless and takes only a moment.
Wound hygiene, scar care
As long as you have the dressing on the wound surface, you can't get it wet, so you need to protect it during bathing, for example with a towel. If you take your first shower right after surgery, it's better to leave the bathroom door open and warn other people that you're going to wash. If anything happens, call for help or ring the nurses' bell (if there's a bell in the bathroom).
The wound after the incision must always be clean. Wash it with mild agents (necessarily with good composition) 2 or 3 times a day and dry it with a clean disposable towel. Air the wound a lot and wear loose underwear made of breathable materials. Mesh postpartum panties work great for some people. In my case, this was not a good solution - they rolled up and their elastic stopped exactly at the height of the scar. It did not depend on the size, because I tried every available one. In the end, I put on regular, cotton underwear, and when I could afford it, I lay without them on a postpartum pad.
What does a cesarean scar look like? At first, it is a red line (or lines). It will slowly lose color until it becomes lighter than the skin color and becomes barely visible. Often, there is a noticeable lump under the skin - directly under the scar or slightly above it - which can be disturbing. These are palpable seams of deeper layers of the skin - completely normal, they will disappear with time.
There are many products on the market with onion extract or silicone, which make the scar softer, more elastic and less visible. They can be used when the wound has healed and is not covered with scabs. Using such ointments will reduce the risk of unsightly lumps called keloids appearing on the scar (they can be surgically removed).
Important! If your scar suddenly becomes red, painful, swollen or – even worse – develops a fever or starts to discharge, consult your midwife or doctor.
When can you shave?
As soon as the scabs fall off and the wound is completely healed.
When to use a postpartum belt?
First of all, I would like to point out that I am talking about a postpartum belt, the purpose of which is to strengthen muscles, maintain proper posture, prevent hernias and enable exercise. I am not talking about "slimming" belts or belts that "help shrink the belly after childbirth".
Interestingly, according to experts, there is no such thing as a medical indication for using postpartum belts. The relaxation of the reproductive organs, urogenital diaphragm and other body structures during the postpartum period is a process that should not be disturbed by the increase in intraabdominal pressure resulting from the use of a belt.
According to urogynecological physiotherapists, using a belt, slimming panties or tightening underwear during the postpartum period may lead to unfavorable changes, such as prolapse of the reproductive organ, problems with its proper functioning and urinary incontinence.
However, if someone has actual indications to wear a belt, they should remember a few rules. The most important (mandatory!) when using it is to DO EXERCISES so as not to weaken the abdominal muscles or cause dysfunction of other organs. Squeezing the belt somewhat replaces the work of the muscles, so if we do not exercise, we weaken them and make them lazy. Another important thing is not to buy the belt on your own and "by eye". We always do this under the supervision of an expert - a doctor or physiotherapist. After assessing the post-operative scar and the condition of the abdominal muscles, they will select the right size and recommend the time of wearing it (no longer than a few hours a day). According to specialists, a belt after a caesarean section should be put on no earlier than 4 weeks after the surgery - assuming that healing is proceeding properly.
We also encourage you to read about the pelvic floor muscles - why and how to exercise them .
Physical activity after cesarean section
Anything that promotes the health of a person after giving birth is good. Getting back into shape should be gradual, depending on the individual's ability to regenerate and how the pregnancy itself went. The "holy" period for the body is the postpartum period, which is about 6 weeks after the surgery. Later, depending on your own well-being, but above all on the doctor's assessment during the postpartum check-up, you can decide to start exercising.
In addition to gynecological check-ups, consultation with a urogynecological physiotherapist is important. He assesses the condition of the abdominal muscles: rectus and transverse, and in case of problems, selects a rehabilitation method. If there are no contraindications, you can fully enjoy returning to your favorite activities. So it is not true that "running or cycling after a cesarean section is prohibited for a year", which I managed to read on one of the parenting websites. The main thing is to remember that the body is still recovering. It is worth starting with short and calm routes, and over time, setting yourself greater challenges.
According to experts, it is only 6 months after a caesarean section that the body is ready to return to activity: running, cycling or swimming. If it is still too early, pain appears in the lower abdomen or around the scar - then it is worth consulting a doctor.
When can you have intercourse?
After childbirth (natural or after cesarean section), sexual intercourse should wait until after the postpartum period, unless the doctor finds contraindications during the postpartum check-up.
It is normal, however, if despite the green light from the doctor, all the lights in your head are flashing red. First of all, you have to be mentally ready, and after a cesarean section it may be a bit more difficult. The mere awareness of a serious operation with an incision in the abdominal wall can be overwhelming. Add to that all the hormonal changes... A lot is happening - both in your body, your psyche and your life. You sleep less, you have a lot of new responsibilities and a constant emotional rollercoaster. It is not surprising if you do not feel like adding the sex goddess to the range of your new personalities. Also remember that no one has the right to demand intercourse or any kind of closeness from you if you are not ready for it in any way or if you simply do not feel like it!
Also read our article on how to talk about sex with your partner .
Complications
A cesarean section is a serious operation, so it is associated with a high risk of complications. During the procedure, damage to the bladder, ureters or intestines, bleeding, and extensive injuries to the uterine muscle may occur. Getting pregnant again may be difficult, and if successful, it may be a high-risk pregnancy. Due to the fact that the uterine wall at the scar is weakened - non-functional - there may be impaired embryo implantation and a greater risk of abnormal placenta implantation in the form of placenta praevia and increta. Sometimes, a history of cesarean section is a risk factor for isthmic-cervical insufficiency in the next pregnancy. There is also a risk of uterine muscle rupture at the scar site after the incision.
Also characteristic is back pain in the area of epidural anesthesia – this is an undesirable symptom that goes away after a few days, spine pain (felt even several years after the surgery), pain between the shoulder blades combined with numbness in the hands, as well as shoulder pain and breathing problems.
In turn, the risks for the child include respiratory problems (and – related to this – a higher risk of asthma in the future compared to children born naturally).
Why is natural childbirth better than a cesarean section?
Natural childbirth is, as the name suggests, more in line with nature. Contractions herald the beginning of labor, oxytocin is released - the baby also has the opportunity to prepare for birth. This is when the baby's body releases hormones that stimulate proper lung development. The baby receives a shot of adrenaline, thanks to which it wakes up with a great desire to live, has a stronger sucking reflex, which also promotes lactation because the initiation of feeding is not delayed, as in the case of a cesarean section.
The advantage of passing through the birth canal is not only the possibility of colonization with bacteria from the person giving birth (extra immunity), but also the gradual adaptation process. In the case of a cesarean section (especially if contractions have not occurred before), it is a bit like this: the child is suddenly torn from its world and no one asks it whether it is ready for this or not. It experiences the shock associated with this change: starting with the temperature difference (about 10 degrees), ending with the change in light intensity or noise. Difficulties in catching its first breath do not make adaptation easier, and the child, instead of drawing the best bacteria from its parent, first comes into contact with the hands of doctors.
As mentioned earlier, a cesarean section is an operation that carries the risk of many complications that rarely occur, but anyone who agrees to the procedure must be fully aware of the consequences. If someone thinks of a cesarean section as a guarantee of maintaining a figure, they can be sorely mistaken. Often, an "overhang" forms above the post-operative scar, i.e. a fold of skin visible even through clothing.
However, these are arguments that could dissuade patients from a possible cesarean section "on demand". Such a practice is not available in Poland - there must always be indications for a cesarean section. However, in other cases, when it comes to saving lives, there is no time or space to think about complications.
Trivia
- Tokophobia is a panic fear of pregnancy and childbirth. Until recently, it was a sufficient indication for a cesarean section.
- The origin of the name "Caesarean section" is currently unknown, but there has been some speculation. For a long time, it was believed that the name came from the way Julius Caesar was born. A little later, a theory emerged that the word "Caesarean" evolved from the Latin caedere , meaning "cut." Another clue concerned a set of Roman laws that stated that the child of a dying or dead pregnant woman should be removed from her womb before burial—the laws were called Lex Caesarea .
- More and more doctors around the world believe that a planned cesarean section should be postponed until contractions occur. This prevents iatrogenic prematurity (a situation where a child is born too early because, for example, the due date was incorrectly determined, and as a result has breathing problems that can lead to death).
- Based on pelvic measurements alone, it is difficult to determine with full certainty whether there is a fetal-pelvic disproportion (when the baby is too large for the pelvis), which is why a "trial of labor" is most often performed, and if natural labor does not progress, a cesarean section is performed.
- If you feel like sneezing or coughing after a cesarean section, pull your legs towards you (bend your knees) and hold your stomach.
Created at: 06/08/2022
Updated at: 16/08/2022
