Cesarean section: The course of the operation

Preparing for surgery

Most cesarean sections are performed using epidural or spinal anesthesia. Only in emergency cases, when it is not possible to use these types of anesthesia, general anesthesia is used (the patient is unconscious during the operation).

Preparation for the operation involves strapping the patient's arms to the table for safety. In addition, a special curtain is pulled over the chest area. An IV is placed and a catheter is inserted to drain urine during and after the operation. The pubic area is shaved and then treated with an antiseptic solution along with the abdomen. The incision site is covered with adhesive film for greater protection of the area being operated on.

Blood pressure, heart rate and blood oxygen levels are monitored before, during and after the operation. The patient is also given a dose of antibiotics to avoid inflammation after delivery.

The progress of a cesarean section and the birth of a child

Once the anesthesia begins to take effect, the doctor will make an incision in your lower abdomen and uterus. You may feel pressure as the baby is extracted. The doctor will then remove the placenta and stitch it up. After the surgery, you will be taken to the recovery room where you will be under the direct supervision of nurses and doctors for 1-4 hours. You will be given detailed instructions on what to do to ensure a speedy recovery.

Caesarean Section: Who Can Perform the Surgery

Caesarean section is performed by a physician with the appropriate qualifications, namely:

• surgeon
• family doctor with cesarean section practice
• perinatologist

Caesarean section: Indications

Caesarean sections are performed on a schedule (planned in advance) or in emergency cases when the health of the mother and child is at stake.

Planned cesarean section

A cesarean section is planned in advance for medical reasons, namely:

• The fetus is in an abnormal position (including breech presentation).
• Poor blood circulation in the placenta.
• Risk factors and impossibility of vaginal delivery.
• Large fruit weight (4.5 kg and more).
• Maternal medical conditions that may worsen during labor (eg, heart disease).
• The placenta blocks the cervical canal.
• Open wounds of genital herpes in the prenatal period (risk of transmission of the disease to the child).
• HIV, which can be transmitted to the baby during birth.
• Multiple pregnancy. The direction and incision of the suture depend on the position of the fetuses. A cesarean section is especially performed in case of multiple pregnancy if:
  • twins are in the same amniotic sac (risk of umbilical cord intertwining);
  • the birth of triplets or Siamese twins is expected;
  • the uterus is stretched and contracts weakly (risk of prolonged and difficult labor);
  • The twins are positioned incorrectly and are too large.

Women who have had a previous cesarean section also often plan to have a repeat surgery. Indications for a repeat cesarean section include:

• clinically narrow pelvis (discrepancy between the size of the mother's pelvis and the size of the fetus's head);
• factors that increase the risk of uterine scar rupture during childbirth (vertical incision, presence of 3 or more uterine scars, birth of triplets or more, fetal weight of 4.5 kg or more);
• lack of access to continuous medical supervision during attempts at vaginal birth or the necessary equipment.

Caesarean section in emergency situations

Sometimes a caesarean section is not planned, but is performed after the onset of labor. Medical indications for a caesarean section in emergency cases:

• fetal distress syndrome;
• premature detachment of the placenta;
• umbilical cord prolapse;
• weakness of labor;
• cessation of labor;
• discrepancy between the size of the mother's pelvis and the size of the fetus's head.

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