Although for many centuries cesarian section was an accepted procedure for attempting to save the baby after the mother’s death, it was not until anesthesia and aseptic surgery were developed in the 19th century that cesarian section became feasible as a means of saving both the baby and the mother in a difficult childbirth. In fact, although childbirth through cesarian section was once an operation of last resort, today it accounts for more than 20 percent of all births in the United States.
Even though many critics think the pendulum has swung too far, there is no doubt that many women and babies are alive today because this alternative to vaginal delivery was available.
A cesarian section is a surgical procedure that involves incisions through the abdomen and into the uterus. The infant is then lifted out. Many conditions call for a cesarian section. Some premature infants tend to have a better chance of survival when delivered in this way. Infants in breech or other abnormal positions more often than not are delivered by cesarian section. When the in fant is too large or the mother’s birth canal is unusually small, a cesarian section is the only safe way of delivery.
Sometimes abnormalities of the uterus or vagina obstruct the birth canal and necessitate this operation. If a mother has preeclampsia, diabetes, genital herpes, or hypertension, a cesarian section may be indicated. Placental abnormalities such as placenta previa often require cesarian section. In the event of twins or multiple fetuses, many physicians advise this procedure. When labor is prolonged because of insufficient uterine contractions, many physicians believe a cesarian section is better for both the mother and the baby.
Some believe that the procedure is done too often and that physicians do a cesarian section whenever they are faced with the possibility of a difficult birth, just to make sure that all precautions have been taken. Some of this so called defensive medicine is practiced, but the threat of a lawsuit is not the reason for most cesarian sections.
Improved fetal monitoring techniques now provide vital information about the health of the fetus and its ability to withstand labor and delivery. If it appears that the fetus may be jeopardized, most physicians are quick to perform a cesarian section. At the same time, improvements in the operation itself, in anesthesia, and in antibiotics make the procedure safer for the mother than it once was. In addition, more women are postponing pregnancy until later in life. These women and their infants are at higher risk of medical complications than their younger counterparts. Hence, cesarian births in this group are more common.
If you need a cesarian section, you will be given an anesthetic. Unless the procedure is being done because of an emergency- in which case you will be put to sleep with a general anesthetic you will have either epidural or spinal anesthesia which allows you to remain awake without feeling pain. Most hospitals now allow your partner to be in the operating room, unless you are having an emergency cesarian.
It takes a little less than an hour to perform a cesarian section. Two types of incisions into the abdomen can be used. One is the so-called bikini cut, which is a horizontal incision near the pubic hairline. The other is a vertical cut from the navel to the pubis. Once the incision reaches the uterus, one of two commonly used incisions can be made. The most common method is a horizontal incision in the lower part of the uterus called a lower uterine transverse incision. This incision heals better and is associated with less chance of uterine rupture. On occasion, your physician will use a vertical incision to open the uterus. This incision allows more access to your uterus and is used, for example, when an infant is large or when an infant is known to have an abnormally large head.
After the uterus is opened, the physician may use a forceps to extract the baby from the womb. The placenta also is removed, and the wound then is stitched closed.
Although cesarian section is safer than it used to be and most women recover well, there can be complications. It is a major operation and, as with any other one, there is a risk of infection at the surgical site as well as bladder and kidney infections. Hemorrhage is rare, but when it does occur it can be severe. The death rate for women who have a cesarian section is 2 to 4 times higher than that for women who have a vaginal delivery.
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