Indications of emergency caesarean section
During the process of labor there are certain situations when one has to take a decision to do a caesarean section (CS). These are:
- Fetal distress: It is a situation where the fetal heart pattern signifies that there is not enough oxygen supply to the baby and so the baby is showing signs of distress on the fetal heart rate pattern. There may be tachycardia, bradycardia, and low beat-to-beat variability.
- Non progress of labor: The dilatation, effacement of cervix is slow or not there even with good uterine contractions. If there is no progress of labor for 4 hours with good uterine contractions then it is an indication for cesarean section. The no-descent of the baby’s head also might be responsible. The head fails to rotate at times.
- Antepartum haemorrhage: Bleeding may start before the contractions begin due to either low lying placenta or separation of the placenta from the uterus.
- Cord prolapsed: This happens if the membranes rupture and the head is still not fixed or from the side of the head.
- Meconium stained liquor is not as such an indication for caesarean unless there is fetal heart changes of distress or the meconium is very thick and there is minimal or no liquor.
- Cervical dystocia if the cervix fails to open up.
- Indications of elective cesarean section: When the decision for cesarean is taken because the vaginal delivery is not possible or risky to the mother or the baby.
- Previous myomectomy (in which the cavity of uterus was opened) or a previous hysterotomy scar on the uterus.
- Grossly contracted pelvis or poliomyelitis of patient.
Cord around neck is not an indication for cesarean-section unless there is so much tightening that there is fetal distress. However, distress usually happens during labor. It is unlikely to get tightened during pregnancy.
Anesthesia for cesarean
The cesarean is done either under spinal, epidural or general anesthesia. Most of the emergency CS is done under spinal anesthesia. It is fast and it does not involve the aspiration risk if the mother is full stomach. Epidural is another option but it takes a little more time. It has the advantage of the patient being upright faster wherein after spinal, a patient is advised to rest for 24 hours and therefore she is catheterized. General anesthesia is the fastest but there is a risk of the drug going into the baby through placenta if the baby is not delivered faster. The preferred course is regional anesthesia because one can listen to the cry of the baby and also see and hold the baby.
Procedure of caesarean
After the anesthesia the woman’s bladder is catheterized. The abdomen is cleaned with antiseptic solution and then draped with the sterile sheets. A transverse incision is given at the pubic hair line. And the abdomen is then opened in.
Complications of caesarean
Why is the rate of Caesarean rising?
Many changes over the years have had a greater effect on the process of delivery. Caesarean rates have increased by almost 10 percent in the government hospitals to 20 percent in the private hospitals over the previous years.
Multiple convergent factors are responsible including changes in patients and their pregnancies, in options available and in provider’s expectations and evaluation of risk.
The pregnant women are now much heavier and they are much older. There has been an increase in the assisted reproductive techniques with the result in the increase in multiple births. These factors are responsible for the higher CS rates. Women are leading a more sedentary lifestyle.
Earlier, the women were more physically active in performing more household chores. Doing various things they used to sit, bend squat on the floor which nowadays women hardly do. The babies are also heavier and pelvises have become more rigid due to the current lifestyle. Even now the women who perform all the household chores have an almost 90 percent normal delivery rate. The level of risk of an adverse outcome that was tolerated in the past to avoid cesarean delivery is no longer acceptable.
In the earlier years, doctors had a greater tolerance towards the maternal and neonatal complications resulting from normal delivery.
Many defend increasing CS rate by citing concern about legal jeopardy. There is always a risk of being sued. More induction of labor is also responsible for the high CS rates.
Ways to cope with a c-section surgery
Going through a C-section surgery is a different experience altogether, however it is quite often a last minute surgery decision, probably stretching to a three days stay in hospital and you may not have been geared for it psychologically.
A C-section is major abdominal surgery. And when you mingle that with the rigors of having a new baby- your very own creation- you truly have to give yourself time to recover.
Holding your own baby in your hand is a blissful miracle for any mother, however after your caesarean if you are wondering about what kind of feeling it is and how long you will feel this way, here are some advices on how to cope with it:
It’s a pain inside, you can’t really identify where
One must understand that in a C-section, surgery is a normal procedure. Whether you have gone through caesarean via spinal anesthesia or general anesthesia, you will need some pain relief for few days to come. Pain relief may be given via injection or drop. Your doctor’s advice and prescribed course should be judiciously followed.
When you are emotionally not prepared for the surgery
Noted studies have revealed the fact that many mothers who have been prepared in advance for C-section as informed by doctor ahead of time or as a matter of individual choice, are able to cope with it in a much better way than those who are not aware of it and are bound to take last minute decision.
However, feeling guilty or regretting the fact that you were unable to avoid this step is quite normal. It is then, best to vent out your emotions by asking questions from your doctor at any given point of time. Partner’s encouragement is also very essential to help you go through this whole procedure.
General discomfort after the surgery
There can be fair amount of body ache and common uneasiness where the opening was, after the surgery. You might feel your skin stretched out where the incision is and also some burning sensation inside your stomach. There is a feeling of numbness which can last for about one to two months or in some cases even six to seven months.
Breastfeeding is normal after C-section
Experts suggest that it is a complete myth that mothers who are not able to deliver child naturally have problems in breastfeeding. However, it is usual to feel a bit contemplative about moving too much, right after the surgery, so it is advisable to be mild and gentle with yourself.
Going back home and coping with the child
Doctors suggest that in normal cases one must stay in hospital for three to four days after a C-section. However, it is always recommended by experts to make sure you ask any last questions or queries before you leave the hospital. One must be clear about the dosage and names of medicines you have been prescribed by your doctor.
It is advisable not to over-tire yourself; meanwhile using household-help when it is at hand can be a good option.
One must understand that everybody’s body is different and reacts differently to similar situations. Some gentle exercises such as stretches or light abdominal stretches after the incision has healed can also be a good option. However, refer to your doctor before starting anything.