Caesarean section: answers to your questions
Whether planned or unplanned, Caesarean section is a controlled surgical procedure, decided to avoid a “painful” childbirth for you and your baby. Why is it practiced? How’s it going? Ten answers to your questions.
1. What is a Caesarean section?
- Whether it is programmed (called “prophylactic”) or unexpected and performed in an emergency during labor, Caesarean section consists in bringing the baby “high” by practicing an incision on the lower abdomen, uterus.
Today, it affects about 20% of births in France, and almost half of them are scheduled.
- Exceptionally, there are also cases of caesarean of convenience, where it is programmed at the request of the future mother. Since the Caesarean section is not, like any surgical procedure, a kind gesture, it will be up to the doctor to ensure that this decision is well matured and shared.
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2. When is it practiced?
- A Caesarean section may be planned during pregnancy or decided midway through childbirth. In the case of a scheduled caesarean section, the date of confinement is fixed twelve to fifteen days before the end of the pregnancy: the uterus is still at rest, and it is easier to intervene before the contractions begin.
- It may also be decided during labor after an attempt at a low birth.
3. What Causes Caesarean Causes?
- Maternal or fetal pathology may require caesarean section: if the baby is stunted, for example. The inferior insertion of the placenta that covers the cervix (this is called a placenta praevia ) can cause hemorrhage during childbirth and sometimes requires a caesarean delivery.
- In the event of an outbreak of genital herpes at the time of delivery, the risk of transmission of the virus to the baby in some cases leads to the intervention.
- 30 to 35% of Caesarean sections still have a disproportion between the mother’s basin and the volume of the baby whose “measurements” will be taken at the end of pregnancy.
- The obstetrician also sometimes decides to intervene if, like 5% of babies, a toddler obstinately refuses to present the head first in the pelvis.
4. What motivates an emergency Caesarean section?
Even well followed, a pregnancy can reserve surprises until the last moment! If the baby’s heart rhythm has a severe abnormality, it is then necessary to finish the delivery quickly, thus to perform a caesarean section. Similarly, if the cervix does not dilate and the work progresses poorly (dystocia), the baby may face difficulties in descending.
5. What happens before the procedure?
- Like any surgery, the caesarean is performed in the operating room and not in the delivery room, under general or loco-regional (epidural) anesthesia.
General anesthesia is administered intravenously, except in cases of contraindication to the epidural or extreme urgency because it acts immediately.
- The epidural, which only sensitizes the lower half of the body, works in about twenty minutes and allows the mother to remain conscious, thus to welcome her child from birth. An infusion will then be made to allow the possibility of injecting drugs according to their needs.
- Before the incision, the pubic hair is shaved, and a urinary catheter is installed so that the surgeon is not disturbed if the bladder fills during the operation (this probe will remain in place for about 24 hours after caesarean section).
- The skin of the belly is then painted with antiseptic, while sterile sheets – called operative fields – isolate the area of the operation and limit the patient’s field of vision: she no longer feels the bottom of her belly and sees Not what happens there. All she has to do is wait for the midwife to put her baby in her arms!
6. How is the Caesarean section performed?
- The surgeon usually incises the skin 3 cm above the pubic bone (when the hair has repelled, the scar will hardly be visible). It then spreads the muscles of the abdominal wall to be able to penetrate into the cavity where the uterus is located. In a few minutes, the surgeon extracts the baby. The umbilical cord is cut, and the midwife can present it immediately to the mother before giving it the usual care, as for a “classic” childbirth.
- During this time, the surgeon removes the placenta, checks that the uterus is empty and closes it quickly to avoid bleeding. All this is painless.
- According to the habits of the motherhood, the skin is stitched with threads (mostly absorbable) or staples. The entire operation lasted only thirty to sixty minutes.
- The mother is then placed in the recovery room with her baby and monitored for about two hours during which the “constants” are checked every 15 minutes (pulse, tension …). If necessary, analgesics are prescribed.
7. Is it possible to breastfeed after a caesarean section?
Mothers who wish to do so can usually breastfeed their newborns after a caesarean section: with the help of a midwife or baby nursery, the baby is put to the breast, his mother comfortably in a lying or lateral position Not too much to solicit the scar. It should be noted that the rise in milk may be later due to fatigue.
8. Are the layer sequences different?
- At the end of the procedure, the anesthesiologist removes the catheter from the epidural and injects analgesics and anti-inflammatories that relieve the pain. About twelve hours after the Caesarean section, a light meal is offered to the young mother, and the midwife helps her get up and sit in an armchair. It is important to stand up quickly to prevent phlebitis (formation of a blood clot in the veins).
- Intestinal transit resumes activity approximately 24-48 hours after surgery: light and high-fiber meals are served, but gas is often painful when continuing transit.
Hospitalization for a Caesarean section is somewhat longer than for a low birth: four to ten days following the establishment. The threads are most often removed on the fifth or sixth day or just before the exit.
- Once home, it is important to ensure that the activity is only gradually resumed. It should not be forgotten that fatigue is very often more important after a caesarean delivery. After a few weeks of rest, it will be nothing but an old memory!
- The scar can be sensitive, even painful, for a few days. On the other hand, it will be virtually invisible after some time.
9. Can there be complications after birth?
Complications – hemorrhages, urinary infections, circulation disorders … – are increasingly rare. Around the scar, a possible hematoma or abscess in the abdominal wall will be quickly controlled by the treatments.
10. Caesarean one day, Caesarean always?
- Before considering the second pregnancy, it is better to wait six to twelve months for the scar to have time to consolidate.
- A new low-birth delivery will be possible under certain conditions. If the previous Caesarean section were linked to a permanent cause (pelvis too narrow), it would impose itself again. On the other hand, if the operation was motivated by an “accidental” cause, a low-birth delivery is a priori possible provided the baby presents well, and the childbirth is natural.
- If it is legitimate to try the delivery by little route, a second Caesarean, called iterative, is however frequent (50% of the cases). Finally, after two Caesarean sections or more, on the side of the doctors as well as the future mothers, the decision to again caesar is unanimous.
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