FAQ - Caesarean Section

Caesarean Section

What exactly is caesarean section ? (C.S.)

When the baby is delivered by taking a cut on mother’s abdomen & the uterus, it is said to be delivered by C.S. The history of this surgery is quite interesting, though there is dispute about it’s origin amongst the historians. It is said that the Roman King-Julieus Caesar was delivered by this unnatural route & hence the name C. S.

Indications of C. S. - In what conditions do we do CS ?

The frequency of use of this technique of delivery has increased due to newer research in obstetrics. Generally, whenever the natural delivery may be disadvantageous or hazardous to mother &/or baby, this route of CS is preferred. Let us review some of the important situations where CS is done-

Maternal indications:

(1) Contracted bony passage -(Contracted Pelvis) In ladies shorter than 5' in height, the pelvis i.e. the bony passage of delivery is likely to be small and hence CS has to be done. In India, especially in rural areas, early marriages lead to teenage pregnancies. The pelvic bones have not grown to their full capacity & hence the bony birth passage is contracted. 2) Genital Tumors- The tumors obstruct the birth passage due to their bulk & position & hence CS has to be done. 3) Two or more than two previous CS - In such cases, there is risk of the uterine scar getting weaker & sometimes rupture uterus is a possibility. 4) Maternal diseases - Severe pregnancy induced hypertension, Eclampsia, Diabetes, Cancer of cervix. In these conditions, CS is done, to reduce maternal & fetal risks. 5) Placenta at the OS- Placenta previa. In this condition, the mother can bleed dangerously if CS is not done timely. 6) Accidental hemorrhage- In this condition, the placenta separates from its position & blood clots accumulate in the uterus which has bad effects on coagulation mechanism in the body. In such cases timely CS can save mother & baby. 7) Genital Herpes & HIV infections. In this maternal viral infection, natural delivery proves hazardous to the baby & hence CS is done.

Causes relating to the baby

1) Fetal distress- The baby gets less blood supply & hence gives signals of getting asphyxiated in the uterus, -egirregular / slow heart sounds, passing motion in the uterus. In such cases the fastest way to save the baby from the in utero insult is CS. 2) Cord prolapse - The cord simply comes out from the OS before the baby & the blood supply to the baby gets hampered & hence CS is must. 3) Intrauterine growth retardation - If the baby is severely growth retarded, it can not withstand the labour pains. 4) Transverse lie with or without hand prolapse/breech presentation- In both these conditions, the baby does not present in the normal position i.e. head in the pelvis & buttocks in the fundus of the uterus. These are called malpresentations which necessitate the use of CS. 5) Bad obstetric history-in some cases, there is history of repeated abortions/fetal loss & there is no living issue, the mother may also be elderly in such cases, CS is a safe alternative.

Other Indications : Sometimes natural delivery becomes unsafe for both mother & the baby -eg- (1) Prolonged leaking - in this case the bag of waters ruptures early & may lead to maternal as well as fetal infection, CS can prevent this risk (2) Failed forceps Sometimes forceps application may not result in delivery of the baby & hence immediate CS is resorted to. There may be more than one causes or indications for doing CS in a single case & hence CS is mainly done to safeguard both-mother & baby.

Why is CS done as emergency, in spite of anticipating normal delivery ?

Many a times, the doctor tells the patient that she will deliver normally, but she has to undergo an emergency CS. Why does this happen? During antenatal check-ups & at USG exams it is not possible to diagnose cord round neck or true knot in the cord. Babies with such complications start getting heart rate variations during labour & hence emergency CS has to be done. Post maturity, decrease in the quantity of liquor, are also some examples where CS has to be done. Delivery is a dynamic process exerting lot of stress on the mother & the baby. Many unexpected problems may crop up & endanger the life of -ne baby &/or mother. At the time of emergency CS, the relatives need to comply & cc-operate with the doctor so that the CS is done as early as possible to save the baby. Many important things like booking the blood for the patient, calling the anaesthetist immediately have to be done within very limited time.

Anaesthesia for CS

CS can be done under general anaesthesia or spinal anaesthesia - in which the part below the abdomen is anesthetized by giving injection in spinal fluid at a particular site. Now a days, epidural anaesthesia used for painless labour can also be given for CS. Rarely, CS has to be done under local anaesthesiaThe obstetrician and the anaesthetist decide the type of anaesthesia suitable for a particular case according to maternal / fetal condition. The best suitable anaesthesia is chosen which will not do any harm / side effects to mother & or baby.

How is this operation done ?

After giving the suitable anaesthesia, a cut is taken below the umbilicus vertically, or transversely on the lower abdomen. The urinary bladder is pushed down and the uterus is incised transversely. The baby & placenta is delivered & the cut structures are sutured in place as they were before. Generally, the operation requires about one to one & a half hour.

Is blood transfusion must at every CS ?

As we do for any other major surgery, it is always better to keep blood ready, booked in the blood bank, through most of the times BT is not required. Blood Transfusion is mainly required when the mother is already anaemic &/or she bleeds more at the time of C. S. BT has to be given as a life saving measure in cases of uncontrollable, severe postpartum bleeding, (when the uterus does not contract)

What preoperative preparations are done before CS ?

For a planned CS, it is possible to take all preoperative measures but in an emergency case, we may have to make some changes. (1) Nil by mouth - At least for six hours before CS no water / food is given to the patient by mouth. This may not always be applicable at emergency CS. 2) Shaving of abdomen is done and the skin is cleaned with antiseptic lotions & liquids. Pre operative antibiotics also may be started. 3) Enema is given to evacuate the bowel. 4) The relevant information about CS & its risks are explained to the patient & written consent of the patient & relatives is taken. 5) Whenever possible The neonatologist is called in advance to take care of the new born at CS.

 What care is taken after the operation ?

(1) After the operation, I. V. fluids is given for about 12 to 24 hours. Intra-venous antibiotics are given to prevent infection. Analgesics are used to lessen the postoperative pain. (2) Water & food is given to the patient only after the doctor advises to do so. (3) The patients pulse, BP, temperature, the abdomen, presence / absence of bleeding is checked periodically. (4) In spite of some pain, it is better to get up in bed, walk to the toilet & breast feed the baby as early as possible, with the help of the hospital staff. (5) The patient can breast feed the baby even if intravenous fluids are going on. (6) Generally, stitches are removed on 5TH to 8TH day & if the wound is dry, she is discharged home.

 What care has to be taken at home after discharge ?

The patient can take bath, if the wound is healthy. The wound must be washed with water and mopped dry with soft clean cloth. The scabs should not be removed, they will fall off on their own. Some amount of itching sensation at the site of wound is normal but scratching should be avoided. Antiseptic ointments may be applied as per doctor’s advice. It is not advisable to apply oil or talcum powder on the wound. The diet of the patient should be a balanced diet. The tablets of iron & calcium should be taken at least till breast feeding is on. The inner wound in the abdomen takes about 1 1/2 months to heal completely & hence any work causing tension on abdominal wall should be avoided -eg- lifting of heavy objects should not be done. Post - partum exercises can be done under doctor’s supervision & advise.

What about contraception after CS ?

At the time of third CS, tubectomy i.e. sterilization operation can be done at the time of doing CS itself. Vasectomy - i.e. male sterilization can be done if patient has undergone 2 or more CS. Copper T can be put in after one CS at 6 weeks after CS. Oral contraceptive pills, injections & other mechanical devices can also be used according to doctors advise.

Why should next pregnancy be spaced at least 2 years after the CS ?

To avoid physical and mental burden on the mother next pregnancy should be spaced adequately i.e. at least for 2 years. If next pregnancy occurs earlier than this period, the wound on the uterus remains weak & may still weaken at next pregnancy. The scar on abdomen also gets weaker and incisional hernia may become a bothersome problem.

What are the risks of CS operations ?

CS is a major operation & entails some risks, which can be prevented to some extent. The examples of risks are - profuse bleeding at or after the operation, hypotension, injury to urinary bladder or other nearby organs, infection. Rarely, the matter in the fluid around the baby passes in mother’s blood vessels leading to a dangerous condition called amniotic fluid embolism. There are some anaesthetic complications also but due to good & effective drugs & good techniques of operations & anaesthesia, the risks have been minimised today.

What care should be taken in next pregnancy ?

As soon as the patient knows that she is pregnant, she should get examined by the doctor as early as possible. Sometimes, especially in rural & uneducated class of patients, the antenatal check ups are purposefully avoided & the patient is taken to the hospital directly when she goes in labour. This can prove dangerous for the patient. 20

Is normal delivery possible after C. S. ?

If the previous CS has been done for a non-repetitive cause then next time, normal delivery is possible.

Why has the incidence of CS operation increased today ?

Today, every pregnancy is a very precious pregnancy. The picture of olden times - large number of pregnancies with some neonatal / infant deaths is no more seen. Every pregnancy must end up in safe delivery & a healthy baby is the motto of today’s society. CS operation has become a much safer operation than in olden times due to progress in subjects of anaesthesia, surgical techniques & medicine in general. Hence even if natural delivery entails any minimum risk to mother &/or baby, CS is resorted to. Now-a-days, it is seen that some of the pregnant ladies do not like or want to undergo painful labour & hence there is a demand from such patients for CS & the doctor is really pressurised to do so. The relatives also become anxious & repeatedly question the obstetrician about the possibility of CS. The decision of doing CS. Should be left to doctor’s acumen. In some cases, CS may have to be done due to such social pressure. For this, the patients need to be educated about the process of labour & how the patient can co-operate leading to a normal delivery. This can really prevent some of the unnecessary CS. Though the risks of CS have been minimised today, it is ultimately a major operation & it does entail some unexpected & unanticipated risks. Doctor-patient communication- Many a times, the relatives & the patient have a doubt in mind about whether the CS is really necessary. The CS is being done to earn money and is being done unnecessarily & in spite of normal delivery being possible is one of the thoughts always present in their minds. For this the patient must be communicated in a very convincing & scientific way, the reason for doing CS. In. case the patient asks for, the doctor should be open enough to call another doctor for opinion. In “high-risk” cases eg-B.O.H., diabetes, twins, previous CS, the doctor has to take tremendous risk to conduct a normal delivery. In fact, conducting a normal delivery for such patients is more difficult, demanding & time consuming for the doctor, it is a great mental tension for him too. In such cases, the fees charged the doctor for normal delivery & CS should be about the same amount so that “money - earning” factor may be wiped off from the patients mind. During frequent antenatal visits the doctor should develop go communication with the patient & her relatives. Some information about CS whether CS is anticipated in her case & why may be communicated to her during her visits so that indicated CS are really done & unnecessary CS are avoided.

 

Asmita Movement


You are here: Home

Academics

Sample image

Careers at Gupte Hospital

Sample image

Contact Us

Sample image
You can reach us at: 904,
Bhandarkar Road, Pune 411 004.