What is a cesarean section

A cesarean section (or 'C-section') is a surgical procedure for delivering a baby. It is usually performed when a normal vaginal delivery may be risky or impossible. The operation involves an abdominal and uterine incision. The abdominal incision may be horizontal, just above the pubic hairline, or vertical extending down from the bellybutton. The incision in the uterus runs horizontally across the lower part of the uterus (low transverse or low segment incision). Cesarean sections are usually done under general anaesthesia. The whole procedure takes between 35 to 40 minutes.

What are the complications linked to a c-section?

Cesarean sections are more painful, more disabling, requires a longer hospital stay, and is four times more risky than a normal vaginal delivery. Uterine infection is one of the common complications associated with cesarean sections and it occurs ten times more frequently than in vaginal deliveries. Other complications arising from are thrombophlebitis, urinary tract infection, respiratory problems in the newborn
and complications of anaesthesia. However, doctors are constantly making improvements in surgical technique. This, accompanied by the swift pace of medical advancement, serves to reduce the risk of this procedure.

"Once a section, always a section." - Is this true?

It was a widely accepted belief that most women, whose earlier childbirth was done through a cesarean section, had to have a repeat cesarean section for subsequent childbirth. Initially, the 'classical' method of doing a cesarean was to make a vertical incision in the upper part of the uterus. Incisions like this are more likely to rupture when labour begins leading to bleeding that could put the lives of both the mother and baby at risk. However, a woman who has had a low transverse incision (as opposed to the classical vertical incision) in the uterus is a better candidate for a vaginal birth after cesarean (VBAC). This is because this incision cuts through the lower part of the uterus that has fewer muscles and is less full of blood vessels lowering the chances of bleeding due to uterine rupture. The present practice for women who have had previous cesarean sections with a low transverse incision in the uterus is to give them a trial of labour and vaginal birth. However, the doctors should be prepared to perform an emergency cesarean should the need arise.

Breech babies

Doctors often perform a cesarean as a matter of course when the baby is in a breech position. A breech is when the baby's feet or bottom enter the birth canal first instead of the head. This makes a vaginal delivery particularly risky because there are more chances of a prolapsed cord or fetal injury. If the doctor and his team have some experience in doing vaginal breech deliveries, they can attempt to do the procedure in the following conditions: the baby is expected to weigh less than eight pounds; the woman has a normal pelvis; and the baby is in a frank breech with legs extended and head flexed.

Failure of labour

Dystocia is the medical term for failure to progress in labour. Some women have ineffective uterine contractions that lead to prolonged labour. The woman may be unable to push the baby out under her own steam. If the contractions are weak and irregular, doctors usually administer oxytocin to stimulate contractions. However, if this has no effect, the doctors may have no choice but to perform a cesarean.

Fetal distress

Fetal distress is also often a reason why doctors decide to do a cesarean section. In cases of prolonged labour and fetal distress, some doctors would prefer to do a cesarean section as the safer option to performing a mid-forceps or low-forceps delivery. They are of the opinion that a cesarean is less risky for the baby in these situations.