How does a caesarean delivery take place? How should you prepare and what are the possible complications? How does the recovery after surgery take place? Let's see what happens, step by step. The article was written with the advice of a gynecologist and medical director of the Humanitas San Pio X obstetric-gynecological clinic and Stefano Bianchi, director of the gynecology and obstetrics unit of the San Giuseppe Hospital in our city.
Caesarean delivery: 52 photos from the operating room to understand how it happensgo to the gallery
It may seem mechanical, not natural. The solution that is used when the baby and the mother are in difficulty. But it is life. It is the coming into the world of a new ...
In this article
- Preparation for surgery,
- The hospitalization,
- The antibiotic,
- The engraving,
- Here comes the baby !,
- After birth, the last stages of the intervention,
- Dad can attend,
- Observation after surgery,
- The recovery in the following days,
- The possible complications.
In the case of a planned caesarean section, it all begins with a pre-hospitalization. Basically, Mom spends a morning in the hospital to perform blood tests, electrocardiogram, anesthetic visit e obstetric visit with ultrasound. During pre-hospitalization, the date of the surgery is fixed, usually one month later.
Preparation for surgery
It doesn't take much - typically, one is required pubic hair removal, which can be done safely at home, while bowel preparation (the enema) is no longer required. On the day fixed for the surgery, you must arrive at the hospital a fast from midnight previous.
At the time of admission, a cardiotocographic trace, for monitoring fetal well-being. Then the mother, who in the meantime has put on an operating gown and a cap, is taken to the operating room.
First, a small venous cannula is inserted into the woman's arm, through which drugs and any liquids can be injected. The maneuver is practically painless: like a blood sample, even if what is inserted is not a needle but a tiny flexible tube.
In most cases, a caesarean section is performed with loco-regional anesthesia, of the spinal or epidural type, safer for both the mother and the baby. In both cases, anesthesia is performed through a particular injection in the lower back and involves a loss of painful sensation from the navel down. As a rule, general anesthesia is practiced only in emergencies.
Throughout the duration of the surgery, the anesthetist monitors the vital signs the patient (blood pressure, heart rate and function, blood oxygen levels).
During the preparatory phase or at the beginning of the operation, a broad spectrum antibiotic is administered (antibiotic prophylaxis to avoid the risk of disease). After the surgery, the anesthetist or surgeon will decide whether to continue with the antibiotic or whether a single administration was sufficient.
After disinfection of the abdomen and after verifying that the anesthesia works with a few "pinches" on the belly done with tweezers, the surgeons - usually working in two, with the help of an instrumental midwife - can begin the surgery.
It starts with the skin incision, which is usually horizontal, a couple of centimeters above the pubis. Usually, the incision is 9-10 centimeters long but can be as long as 15. Only in rare cases may a longitudinal incision (from the navel to the pubis) be necessary: for example if the surgery is urgent or if the woman has already undergone operations on abdominal organs or if she has already had a cesarean section with a longitudinal cut.
After the skin, the subcutis (the abdominal fat layer) and the muscle fascia, a sort of film that encloses the muscles, are sequentially incised. These, on the other hand, are not cut, but only separated. Again, the peritoneum is incised, another film that encloses all the abdominal organs and finally the uterus, after having removed the bladder, which adheres to the front of the uterus itself.
Here comes the baby!
After the rupture of the amniotic sac, the surgeon finally reaches the baby, grabbing his head (if the presentation is cephalic) or the feet or buttocks (if he has a breech presentation).A total of 5-10 minutes passed from the time of the skin incision
The surgeon shows the baby to the mother, who can meet him for the first time, and then passes it to the midwife, who will cut the umbilical cord. Before the cut, however, the doctor "squeezes" the cord lightly, to get as much blood as possible to the baby. Generally, it is preferred to wait at least a minute after birth before cutting the cord, to promote the flow of blood (and therefore of iron) to the baby.12 PHOTOS
Newborns immortalized within seconds of birth (PHOTO)go to the gallery
Born with a caesarean or natural birth. Immortalized within seconds, minutes after their birth. They are the newborns protagonists of these strong but exciting images.
After birth: the last stages of the intervention
As in a natural birth, the afterbirth, that is, the expulsion of the placenta, which can be spontaneous (always through the incision made on the uterus) or helped by the surgeon.
At this point it becomes a real one "cleaning" of the inside of the uterus with sterile gauze or a special instrument, to eliminate any residual amniotic sac or placenta or blood clots. The last phase is represented by the closure (re-sewing) of the various incised tissues: uterus, peritoneum, muscle fascia, subcutis and skin. A is used for all internal fabrics absorbable thread, while for the skin they can also be used metal staples, which will be removed 4/5 days after surgery.In all, the surgery takes about 30-45 minutes
Can the father attend?
It depends on the hospital: in the vast majority of cases, the dad stays just outside the operating room and can see the baby immediately after birth.
Observation after surgery
When everything is over, the mother remains for about an hour under observation in a room next to the operating room: often already at this moment she can be with her baby (who in the meantime, after the bath and the visit of the neonatologist, has been with dad). If you wish, you can try attach it to the breast, because the medications you have been given do not interfere with breastfeeding.
The recovery in the following days
Obviously, Mom will have to deal with the post-operative pain, which can still be controlled with painkillers, and with one slower recovery compared to spontaneous birth. Suffice it to say that after a natural birth, the mother usually returns to her room on her lap, while after a caesarean she has to wait about 24 hours before getting back on her feet.
For this reason, a little more help may be needed in the first few days to care for the baby, compared to natural childbirth.
Towards evening, if she feels it, the mother can start drinking chamomile tea or water, but only the next day can she have breakfast and try to get up and walk, after removing the catheter. Often one is recommended for the first time abdominal band, to support the belly. Efforts are obviously prohibited.
The hospitalization usually lasts 3-4 days.
The possible complications
The caesarean is still an operation, which can cause complications, however rare. Among these, the most frequent is the bleeding, resulting in anemia and resorting to further therapies. They are also possibleinfection of the wound or uterine cavity (endometritis), injury to the bladder or intestines.
In the days following the birth, they can appear fever, difficulty in resuming bowel function, wound healing problems. There is also an increased risk of placenta accreta (that is implanted in the walls of the uterus) or of previous placenta in any subsequent pregnancies.
As for the baby, it appears that a cesarean performed before 39 weeks is associated with a greater rate of respiratory problems in the child. For this reason, if it is a planned caesarean it is advisable to do it after this date.
Sources for this article: consultancy from Stefano Bianchi, director of the gynecology and obstetrics unit of the San Giuseppe Hospital in our city; consultancy as a gynecologist, medical director of the Humanitas S. Pius X obstetric-gynecological clinic
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Questions and answers
What is done during pre-hospitalization before the planned caesarean section?
In the case of a planned caesarean section, it all begins with a pre-hospitalization. In practice, the mother spends a morning in the hospital to carry out blood tests, electrocardiograms, anesthetic examination and obstetric examination with ultrasound. During pre-hospitalization, the date of the surgery is fixed, usually one month later.
How is anesthesia done during a caesarean section?
In most cases the caesarean section is performed with loco-regional anesthesia, of the spinal or epidural type, which is safer for both the mother and the baby. In both cases, anesthesia is performed through a particular injection in the lower back and involves a loss of painful sensation from the navel down. As a rule, general anesthesia is practiced only in emergencies. Throughout the duration of the operation, the anesthetist monitors the patient's vital parameters (pressure, heart rate and function, blood oxygen levels).
How long does a caesarean section last?
The surgery takes about 30-45 minutes in all.
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- loco-regional anesthesia
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