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What are some valid reasons for a cesarean?
Prolapsed cord (where the cord comes down before the baby), placental abruption (where the placenta separates before the birth), placenta previa (where the placenta partially or completely covers the cervix), fetal malpresentation (transverse lie, breech, or asynclitic position), cephalopelvic disproportion (CPD), meaning that the head is too large to fit through the pelvis. This is often 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., 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.
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 an 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.)
- You will be moved to the Recovery Room (If the baby is able s/he can go with you.)
How long will it be until my baby is born?
It is generally 5 minutes from the time that they make the initial incision until the baby is born. The rest of the surgery will take between 30 and 40 minutes, including repair.
What is a partner’s role during a cesarean?
Most hospitals will allow you to go into the operating room with your partner, or if you feel unable to, she may be accompanied by one other person (some hospitals will allow two if one is the doula). Contrary to popular belief, most people do not faint in the operating room. The mother will be provided a drape to block her view of the surgery, feel free to stay behind the curtain with her if you are worried. Just being there for her and telling her what is going will help her. Sometimes the doctor will allow you to cut the cord, carrying the baby to the nursery, and take pictures. Make sure that you ask about these particular things.
What is an Emergency Cesarean?
Basically, an emergency cesarean would be one that meant a matter of minutes was all that remained before the serious threat of loss of life or damage became imminent. Generally, this would be a placental abruption, a prolapsed cord, ruptured uterus, etc. General anesthesia is usually used, in combination with a vertical incision (for the matter of time), and your partner is generally not allowed to accompany you.
What is a Planned Cesarean?
A planned cesarean is simply one that is scheduled ahead of time.
What is a Repeat Cesarean (RCS)?
A repeat cesarean is a scheduled cesarean after having had a previous cesarean.
What is a CBAC?
CBAC stands for “Cesarean Birth After Cesarean”. This is usually used to refer to an unplanned cesarean after a precious cesarean.
What will my recovery be like?
Everyone's recovery will be different, depending on your age, body type, and general health. However, some basics of recovery will be to remember that you have just had major abdominal surgery as well as given birth to a new baby. You may be plagued with gas pains from being opened, incision pain, uterine contractions (your uterus will still need to work to get back to it's original size). You may be extremely tired from medications, labor (if you had one), or just in general. Your staples will usually be removed about 4-7 days postpartum. Try to take everything easy. Do as little as possible, although walking as soon as possible is very helpful in your recovery. The rule of thumb is to not lift anything heavier than your baby. When you get home, take the steps only once a day (if at all). Make a nest on the couch and nap there during the day. Get as much help as you can with your cleaning, food preparations, and other children.
You can start doing breathing exercises the first day in the hospital, someone will show you how. Then each day you can gradually find small exercises to do to get back into shape. Do not return to your previous exercise routine without permission of your care provider. Overdoing it will only slow your recovery.
By the end of six weeks, some people say they are feeling pretty good, although still dealing with some pain and sleeplessness. After this period you can usually resume most activities (Some doctors will allow you to drive after about 2 weeks, others request that you wait the entire 6.).
Can I still breastfeed if I had a cesarean?
Certainly you can. It may take some more effort on your part, but do not hesitate to ask for help. Your hospital should have a lactation consultant on hand to help you get started. Start breastfeeding as soon as possible, for some this will be in the recovery room, for others you may have to pump for a sickly baby or to encourage your milk supply. There are different positions that will be helpful to you in breastfeeding after a cesarean, like the football hold, or any other position that keeps the baby off of your incision.
I had one cesarean (or more!), will I have to have another cesarean?
Recent studies have shown that there was an over 80% success rate for VBACs. Finding a care provider who is supportive and being educated are still the keys to preventing an unnecessary cesarean, even if it is a repeat cesarean.
One of the biggest fears of having a woman labor after having had a previous cesarean was the fear that her scar would rupture. That is very unlikely, especially with the mid-line or transverse incisions that are the most common today. Talk to your care provider about any fears you have and read books, talk to others who have experienced VBAC.