a c-section or cesarean section is a
type of surgery that's used to deliver a
baby
basically the surgery begins with the
mom receiving anesthesia whether that's
local anesthesia so she remains awake or
general anesthesia that puts her to
sleep then the surgeon makes an incision
on the abdomen so usually the incision
is horizontal or transverse so it goes
across the abdomen about one to two
inches above the pubic hair and the
reason why we tend to prefer that
horizontal incision is because it tends
to cause less post-operative pain and
the wound from it tends to heal better
and it tends to be stronger and also
because it results in a better cosmetic
appearance since the scar from the
horizontal incision kind of blends in
with the crease at the bottom of the
abdomen so it's not as noticeable
sometimes though if the surgeon needs to
get in more quickly either because the
mom is bleeding a lot or or because the
baby is in danger the incision that's
made will be vertical so up and down the
abdomen kind of like this since that's a
quicker way of getting in and generally
vertical incisions cause less bleeding
now after the incision is made the
surgeon then makes his way through all
the layers of the abdomen to access the
uterus he then makes an incision in the
uterus to remove the baby then the
umbilical cord is clamped and cut the
placenta is removed and then finally
when everything's done the uterus and
the abdomen are stitched and stapled to
close and generally speaking most women
provided that everything goes well are
able to go home in about three days so
how common is this and and why would a
woman need to have a c-section rather
than a vaginal delivery well one in
every three babies born in the u.s. is
born through a c-section and that's not
even the highest rate in the world the
highest rate in the world is actually
seen in China at 46 percent of all
births so that's quite a bit now in
terms of cool
it's a c-section I guess you can split
things off into two groups so they're
the women the group of women who have
planned c-section so they know from
before they're going to get a c-section
so there's planned c-section versus the
group of women who have unplanned or
emergency c-section so there's plenty
sections versus unplanned or emergency
c-sections
so sometimes c-sections are planned in
advance several weeks before the mom
goes into labor and the most common
reasons for planning a c-section include
for example if the mom has had a
c-section in the past that's a pretty
common reason to have a c-section if she
has a history of a c-section in the past
if the baby is very large so that's
called fetal macrosomia fetal macro
macrosomia macro for large and Soma for
body so the baby has a really large body
which tends to make vaginal delivery
pretty difficult so in that case we
opted for a c-section another indication
is if the mom has an infection such as
herpes or or HIV so infections that can
spread to the baby as the baby's passing
through the vaginal canal so we attempt
to avoid that transmission of infection
by delivering the baby through a
c-section if the moment is carrying more
than two babies two babies or more or if
the mom has a condition called placenta
previa so a condition called placenta
placenta previa in which case the
placenta blocks the way to the vagina so
the baby can't act exit through the
vagina its path is blocked and and
speaking of that any type of mechanical
obstruction to delivery such as a
uterine fibroid or or displaced pelvic
fracture anything that would block the
way of the baby through the vagina would
be an indication for a c-section in
other cases the mom plans on having a
vaginal delivery and she goes through
with the vaginal delivery but plans
change during labor and she needs to
have a
urgency c-section so some of the reasons
for an unplanned and an emergency
c-section include contractions that are
not strong enough to get the baby out so
labor isn't progressing as quickly and
as effectively as it should which if
labor lasts too long that can be
detrimental to the baby it could be to
the baby not getting enough oxygen
so we decide to go in through an
emergency c-section to get the baby out
as quickly as we possibly can another
indication is if the moms pelvis is too
small and that's a discovered during
labor again because the labor isn't
progressing as it should and if the baby
is in an odd position such as sideways
or or chin first or feet first whatever
it might be if the baby is in an odd
position that's that's a good reason to
do an emergency c-section and also if
the baby's life is in danger so for
example if its heart is beating too slow
or if a mom's life is in danger so for
example if she's bleeding too much
those are both very good reasons to have
an emergency c-section and these are
just the most common reasons for having
a c-section by no means are they the
only situations in which a c-section is
necessary okay so c-sections just like
all surgical procedures are not without
complications so for example with each
c-section one of the biggest
complications that you'll hear about the
risk of placental attachment disorders
increases so the risk of placental
placental attachment disorders increases
so there's some disorder something's
going wrong with the way that the
placenta attaches and this is in
subsequent pregnancy so pregnancies
following that c-section so a lot of
that has to do with the fact that each
c-section causes scar tissue to form in
the uterus and that scar tissue can
cause the placenta to attach to the
uterus incorrectly so the placenta can
attach in the wrong location such as
with placenta previa right or the
placenta can adhere to or stick to the
uterus too strongly too firmly
which is called placenta accreta so the
risk of placenta previa and placenta
accreta which are two types of placental
attachment disorders increases with
future pregnancy following a c-section
and there are some other complications
including complications related to
anesthesia which of course occurs with
any major surgery there can also be
damage to the bladder the the blood
vessels or the intestines during surgery
and generally c-sections do involve
longer healing time than vaginal
deliveries do and of course there's also
the risk of infection as a result of all
that instrumentation inside the body
that's occurring throughout the
c-section so pretty standard surgery
related complications but let's talk
about a couple of issues unique to
c-sections so firstly there's a lot of
thought and and some pretty decent
evidence to suggest that c-sections are
associated with an increased risk of
respiratory problems in the baby and
perhaps with an increased risk of death
of the baby as well and also keep in
mind that with a c-section we're making
an incision into the uterus a pretty
large incision and then we're sewing
that incision up after delivering the
baby and sure these incisions tend to
heal pretty well but imagine that with
future pregnancies the uterus stretches
out and during delivery it contracts
with with great pressure and because a
scarred area of the uterus isn't as
strong as the rest of the uterus that
portion that scarred portion is really
prone to rupture
so uterine rupture is a grave
potentially fatal complication of
c-section and it's this fear of uterine
rupture that's led to a greater than 100
year long debate over how to deliver a
woman who's had a c-section in the past
this is a really controversial issue in
medicine so if you think about it there
are three possibilities for a pregnant
laboring woman who's had a c-section in
the past she can choose from the very
GetGo to have a planned elective
c-section that's that's kind of the
first possibility right she can plan
from the very beginning to have an
elective c-section so that's the first
possibility she could also attempt to to
labor right which is called a toe Lac so
T o tol AC which stands for a trial of
labor after cesarean so she could try to
labor and that toe Lac could be
successful so it could end with a
vaginal delivery everything could go
well after she Labor's and the baby
could be delivered vaginally or the toe
Lac could fail and would have to be
followed by an emergency c-section so
those are kind of the three
possibilities either she could choose
from the very GetGo to have a planned
elective c-section or she could try to
labor which could end with a vaginal
delivery could all go great and be
successful and end with a vaginal
delivery or the tolai could fail and it
would have to be followed by an
emergency c-section and I'll tell you up
until about 30 ish years ago every woman
who had ever had a c-section in the past
was told that every delivery of hers in
the future would have to be a c-section
but considering all the complications
that we just talked about associated
with c-section in the 80s we really sat
down and really thought about whether
that's necessary and we realized that in
some women who had a c-section in the
past it's worth it to attempt a toe Lac
to avoid the complications of a
c-section because the toll that could
proceed successfully right and we would
in that case avoid the complications of
a c-section whereas in other women
mainly those women who have a really
high risk of uterine rupture where the
toe Lac it's necessary to stick to
c-sections for every delivery after the
woman's first c-section and deciding
which of those categories a woman falls
into is really no easy feat so there's
no real standardized way of deciding
which women are good candidates for toe
Lac and which aren't we really
currently we really do things on a
case-by-case basis
which hopefully will change in the
future as we gather more data on the
topic but currently as it stands it's a
very controversial issue and we tend to
manage things on very case-by-case basis
so in a nutshell those are some details
about c-section