During a C-section, your organs are usually just moved aside so that the doctor can see your uterus better. But the organs stay within the abdominal cavity and aren’t taken out. In rare cases, the intestines may be temporarily lifted out for better visualization and space to operate, but not permanently.
When is cesarean delivery recommended?
C-sections can be planned ahead of time if there are anticipated childbirth complications or if the mother has had a previous cesarean delivery (elective cesarean delivery). Sometimes, if vaginal delivery fails or complications arise during labor, an emergency cesarean delivery may be performed.
Doctors may also recommend cesarean delivery in the following cases:
- Stalled labor: If labor does not progress, usually because the cervix doesn’t dilate enough despite intense contractions for several hours.
- Baby is in distress: If the baby’s heart rate changes or there is meconium staining in the amniotic fluid. Meconium is the first stool the baby passes after birth. However, if in distress, the baby can pass the meconium while still in the uterus, inhale it, and develop lung complications as a result.
- Twin pregnancy: If the mother is pregnant with multiple babies, such as twins or triplets.
- Baby is in an abnormal position: If the baby’s feet or buttocks present at the birth canal first (breech) or the baby is positioned side or shoulder first (transverse).
- Abnormal position of the placenta: If the placenta is covering the opening of the cervix (placenta previa).
- Prolapsed umbilical cord: If the loop of the umbilical cord slips through the cervix ahead of the baby.
- Maternal health conditions: If the mother has serious health problems, such as a heart or brain conditions, active genital herpes infection, or other sexually transmitted infections.
- Mechanical obstruction: If there is a large uterine fibroid obstructing the birth canal, displaced pelvic fracture in the mother, or the baby has an unusually large head (hydrocephalus).
- Previous cesarean delivery: If the mother has had a previous C-section. Depending on the type of uterine incision and other factors, the doctor may recommend another cesarean delivery.
How is cesarean delivery performed?
Most cesarean deliveries are done under regional anesthesia, which numbs the lower half of the body. So the mother will be able to remain awake during the procedure but not experience pain during it. Sometimes general anesthesia may be required if there is an emergency.
During a C-section, the abdomen is cleansed and a catheter placed in the bladder to collect urine (it’s removed 24-48 hours after delivery). The incision is usually made horizontally over the lower abdomen and uterus, although in rare cases a vertical incision may be made between the umbilicus and the uterus (this is called a classical incision).
Once the baby and placenta are delivered and the bleeding is controlled, the incision is closed in layers. The mother and baby are usually discharged from the hospital in 3-5 days unless there are other complications.
What are complications of cesarean delivery?
Cesarean delivery, like any surgical procedure, comes with some risks compared to vaginal delivery. However, in many cases, cesarean delivery is safer for the mother and baby. Women who undergo cesarean delivery may take more time to recover than women who have a normal delivery.
Complications of cesarean delivery include:
When is a cesarean hysterectomy needed?
In some cases, a hysterectomy may be needed after cesarean delivery to save the mother’s life. It is usually unplanned and performed only performed when other conservative treatment options fail or are not available
Cesarean hysterectomy is usually necessary in the following conditions:
- Abnormal placentation: In abnormal placentation, the placenta fails to separate from the underlying uterine tissue. Risk factors for abnormal placentation include previous uterine surgeries and previous cesarean delivery. Abnormal placentation may be detected prior to delivery based on ultrasonography or magnetic resonance imaging (MRI) tests or a history of risk factors. It can also be detected at the time of delivery.
- Postpartum hemorrhage: Postpartum hemorrhage or bleeding usually occurs when the muscular layer of the uterus fails to contract, also called uterine atony. The doctor may attempt other less invasive techniques to control the bleeding, such as medications, balloon tamponade, uterine/iliac artery ligation (tying of the blood vessels) on both sides, or compression sutures. When all other measures have failed, a hysterectomy may be performed. This is because if there is significant blood loss after delivery, the mother could develop a condition called disseminated intravascular coagulation (DIC), which causes widespread, uncontrolled bleeding from different parts of the body. DIC usually requires multiple transfusions with multiple blood products and is potentially fatal.
- Tumors of the uterus or cervix: If the mother has been diagnosed with cancerous or noncancerous tumors in the uterus or cervix after getting pregnant, a cesarean hysterectomy may be performed to help limit the spread of cancer. Other treatments, such as radiotherapy and chemotherapy, may be required along with surgery as well.
Following a hysterectomy, a woman is no longer fertile and hence, would never be able to get pregnant again. Therefore, cesarean hysterectomy is usually only performed as a last resort.
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