What are some reasons that would mean I would need a cesarean?Prolapsed cord (where the cord comes down before the baby), Placenta Abruptio (where the placenta separates before the birth), Placenta Previa (where the placenta partially or completely covers the cervix), Fetal Malpresentation (transverse lie, breech (breech can sometimes be managed by External Version, exercises or a vaginal breech birth), or Asynclitic Position), Cephalopelvic Disproportion (CPD, meaning that the head is too large to fit through the pelvis.
This can also be over diagnosed, it can be caused by maternal positioning either from restraint to bed, lack of mobility or anesthetics.), Maternal medical conditions (active herpes lesion, severe hypertension, diabetes, etc. (please note that these conditions do not ALWAYS mean a cesarean.), Fetal Distress (This is a hot topic with the recent studies indicating that continuous electronic fetal monitoring increases the cesarean rate and does not show a relative increase in better outcomes. Discuss with your care provider how they define fetal distress and what steps are used to remedy the situation before a cesarean.), Maternal Exhaustion, and Repeat Cesarean, these are the main reasons for cesareans.
What type of pain relief is offered before and after a cesarean?If you have not already had a epidural or spinal anesthesia for labor, or this is a scheduled cesarean, and not an emergency cesarean, you will most likely be given a regional anesthetic (epidural or spinal). If there is a reason that you can’t get regional anesthesia or it is an emergency you will be given a general anesthetic. You may be offered or want to watch for someone giving you a pre–operative sedative. If you are not particularly nervous about the cesarean, you may want to forego this medication. It can reach the baby and make it harder to start the baby breathing after a narcotic (usually), and it can make you groggy and unaware during the birth. After the birth your regional anesthesia will help you be pain free for a few hours, after which you will be prescribed some other type of pain medication (narcotic or otherwise).
What is the procedure for a cesarean?Some of these may go in a different order, and a few left out, but these are the basics:
- A catheter inserted to collect urine.
- An intravenous line inserted.
- An antacid for your stomach acids.
- Monitoring leads (heart monitor, blood pressure).
- Anti–bacterial wash of the abdomen, and partial shaving of the pubic hair.
- Skin Incision (vertical or midline (most common).
- Uterine Incision.
- Breaking the Bag of Waters.
- Disengage the baby from the pelvis.
- BIRTH!!!! (Accomplished by hand, forceps, or vacuum extractor).
- Cord Clamping and cutting.
- Newborn Evaluation.
- Placenta removed and the uterus repaired.
- Skin Sutured (Usually the top layers will be stapled and removed within 2 weeks).