Sunday, June 13, 2010

Cesarean Section

Cesarean Delivery

Even though a woman has had excellent prenatal care and good preparation, there are situations that do arise when cesarean delivery is the only safe way to accomplish a good outcome, which means a happy and healthy baby. It is very important to know that the method of birth must be secondary to the safety and health of both baby and mother. Cesarean birth requires the delivery of the baby through the mother’s abdominal wall and it is considered major abdominal surgery.

Sometimes, a woman will know ahead of time that her baby will be delivered via C/S and she can schedule at her convenience for thirty-nine weeks gestation. Breech presentations ( baby is legs or bottom down ), transverse-lie ( baby sideways ), known cephalopelvic disproportion ( big head unable to pass through birth canal ), previous cesarean section and myomectomy, which is removal of uterine fibroids ( increased risk for uterine rupture and hemorrhage with labor ), placenta previa ( placenta partially or completely covering the cervix thus preventing the baby from exiting through the vagina ) are all reasons that may be identified beforehand and will necessitate a C/S.

Maternal medical conditions can also make vaginal delivery a great risk to mother and baby. High blood pressure ( pre-eclampsia ), heart disease, genital herpes, diabetes and of course, when there is a question of a baby with known anomalies that would make vaginal birth unsafe, C/S is the method of delivery that your provider will explain to you.

Then there are cases when you attempt to labor and at some point it becomes obvious that vaginal delivery is unsafe or impossible. Umbilical cord prolapse (the cord precedes the baby out of the vagina), placental abruption (hemorrhage) are situations where the baby’s oxygen supply is greatly at risk. If the baby doesn’t respond well to labor and it is monitored for late decelerations in heart rate or if your cervix just doesn’t dilate the way it is supposed to, you are a candidate for C/S.

So you are not a failure if you must deliver your baby via an incision in your abdomen. You are still delivering a baby and a healthy one at that. Often we decide well before we are pregnant and certainly while we are pregnant how the delivery is going to be. If we do not expect the unexpected and allow our selves to be open and flexible, there is a much better chance that we won’t suffer the guilt of perceived failure that immediately puts us at increased risk for postpartum depression.

So, if you deliver via C/S, you will most likely have a low, small and transverse incision near your hairline. In very rare cases, a vertical incision is necessary, usually for true emergencies because it is faster to deliver a baby that way.You will be alert and awake and aware due to the miracle of epidural anesthesia. Your birth partner will be allowed to be present. Your baby may need extra fluid suctioned because she didn’t travel down the canal and she may be observed in the nursery for some hours, just to make sure she is okay. You will recover for a few hours in a special recovery room for moms who have had “sections”. And then you will be admitted to your postpartum room and stay there about three days. Your baby may room-in with you and your partner may stay with you the entire hospital stay.

You will have the benefit of the epidural for pain relief for about 24 hours and then you will have pain medication by mouth and a prescription to take home with you for more. You will be able to breastfeed your baby and you should ask for a lactation consultant to assist you with finding the most comfortable and efficient positions, useful after abdominal surgery.

You will be able to care for your baby at home. The surgical staples will be removed before you are discharged and there are plenty of stitches inside to keep you all together. No driving for two weeks and a visit to your doctor at about two weeks also. Then you should get the okay for walks outside and doing just about anything ( but vigorous exercise ) that you want to do. You will have the same lochia (vaginal discharge) as a woman who delivers vaginally. Bleeding that goes from the amount of a heavy red period to a discharge that gets brown, pinkish and finally creamy yellow. Bathing and showers are absolutely fine immediately and if you have hemorrhoids, sitting in a tub of water ( sitz bath ) will really help a lot. Kegel exercises should be done from day one. And after you have been up in the hospital with assistance, at least the first time, you can walk and let your body tell you when enough is enough. In fact, early walking is recommended. Try to limit the amount of times you take the stairs, plan on a place for the baby (and you ) to rest during the day to avoid going up and down too much. Splinting, by placing a pillow for counter pressure, and holding it over the incision site is a good way to avoid that pulling feeling when getting up, using stairs and changing position.

As after any major surgery, rest and good nutrition and hydration will enhance the process. Call your provider with questions and report drainage from the incision site or a temperature over 101 degrees F. The lochia ( vaginal discharge ) should not smell foul, although it does have a very distinctive odor. Do not blame yourself or consider your self less a woman or a failure because your baby didn’t come out of your vagina. It came out and you are a mother. If you have worries about being alone with the baby or you aren’t sure that motherhood is for you, if you dread that cry and have difficulty getting out of bed, if you cry all the time or are sure that you aren’t bonding like you “should”, please call your provider.