Dr. Francis SANWO

Caesarean section also known as C-section, or caesarean delivery, is a surgical procedure used to deliver a baby through incisions in the abdomen and uterus. A caesarean section is often necessary when a vaginal delivery would put the baby or mother at risk. A caesarean delivery may be performed based upon the shape of the mother's pelvis or history of a previous C-section.

 The World Health Organization recommends that caesarean section be performed only when medically necessary. Some C-sections are performed without a medical reason, upon request by someone, usually the mother.  It may be done with a spinal block, where the woman is awake, or under general anesthesia.

 Delivery after previous caesarean section is by either of two main options: Vaginal birth after caesarean section (VBAC) or elective repeat caesarean section (ERCS) Caesarean section history.

The history of caesarean section (C-section) dates back as far as Ancient Roman times. During this era, the C-section procedure was used to save a baby from the womb of a mother who had died while giving birth.

Historically, the surgery has always been performed to save the baby rather than the mother.

The first recorded case of a mother surviving the surgery was in the 1580s in Siegersausen, Switzerland where Jacob Nufer who was a pig gelder is said to have performed the operation on his wife when her labour was not progressing. The mother survived the operation and went on to have five more successful deliveries naturally.

The availability of cadavers during the seventeenth century and the development of anaesthesia in the nineteenth century both helped to enhance medical techniques, including the C-section procedure.

Queen Victoria used chloroform as an anesthetic during the birth of Prince Leopoldo in 1853 and this paved the way for its use in obstetrics and C-section.

Until the 1870s, the C-section technique remained relatively crude and the practice did not include surgical suture (stitches) to close the opened womb.

In 1882, German obstetricians, Adolf Kehrer and Max Sänger each developed methods for preventing uterine bleeding by using suture to close the wound.

With the advent of sterilization, hand washing and antibiotics, the surgical outcomes of C-section improved further still.

Oxytocin, a natural hormone secreted after birth was synthesized in 1951 at Cornell.

The hormone was found to reduce bleeding after C-section and is still used routinely today.

Regional anesthesia including spinal and epidural anesthesia have also been developed and become popular methods of relieving pain and improving outcomes after C-section.

Why is it done?

Caesarean section is done to prevent the complications of labor and factors increasing the risk associated with vaginal delivery which include: Abnormal presentation (breech or transverse positions), prolonged labor or a failure to progress (obstructed labour, also known as dystocia), fetal distress, cord prolapse, uterine rupture , hypertension in the mother or baby after amniotic rupture  and tachycardia in the mother or baby after amniotic rupture (the waters breaking). Others are :placenta problems (placenta praevia, placental abruption or placenta accreta), failed labor induction, failed instrumental delivery (by forceps or ventouse) and large baby weighing > 4,000 grams (macrosomia)

Other complications of pregnancy, pre-existing conditions, and concomitant disease, include: pre-eclampsia, HIV infection of the mother with a high viral load (HIV with a low maternal viral load is not necessarily an indication for caesarean section), an outbreak of genital herpes in the third trimester (which can cause infection in the baby if born vaginally),previous classical (longitudinal) caesarean section, previous uterine rupture and bicornuate uterus.

Other indications are as follows: Multiple babies. A C-section might be needed if you're carrying twins and the leading baby is in an abnormal position or if you have triplets or more babies.

You have a health concern. A C-section might be recommended if you have a severe health problem, such as a heart or brain condition.

Mechanical obstruction. You might need a C-section if you have a large fibroid obstructing the birth canal, a severely displaced pelvic fracture or your baby has a condition that can cause the head to be unusually large (severe hydrocephalus).

 

Classification.

It is most common to classify caesarean sections by the urgency of performing them.

Conventionally, caesarean sections are classified as being either an elective surgery or an emergency operation. Classification is used to help communication between the obstetrician, midwifery and anaesthetic team for discussion of the most appropriate method of anaesthesia. The decision whether to perform general anesthesia or regional anesthesia (spinal or epidural anaesthetic) is important and is based on many indications, including how urgent the delivery needs to be as well as the medical and obstetric history of the woman. Regional anaesthetic is almost always safer for the woman and the baby but sometimes general anaesthetic is safer for one or both, and the classification of urgency of the delivery is an important issue affecting this decision.

A planned caesarean (or elective/scheduled caesarean), arranged ahead of time, is most commonly arranged for medical indications which have developed before or during the pregnancy.

Some women request C-sections with their first babies — to avoid labor or the possible complications of vaginal birth or to take advantage of the convenience of a planned delivery. However, this is discouraged if you plan on having several children.

Risks

Like other types of major surgery, C-sections also carry risks.

Risks to the mother include: Infection (endometritis), postpartum hemorrhage, reactions to anesthesia, pulmonary embolism, wound infection among others.

 

Myths to ignore about C-section births.

Many people have something to say about C-sections, but there’s a lot you can ignore

 Here are some common myths about C-section births that you can disregard as soon as you hear them.

1. If you have a C-section you will never have a natural birth

Not necessarily true. VBAC (vaginal birth

after Caesarean) is common and many women go on to have a natural birth even if they had a C-section with their first.

2. You’ll have a long stay in hospital

Wanting to get home once you have your new baby is natural, but many will tell you, you will have to stay days in hospital if you have a C-section but this isn’t always true. In fact, if your C-section is straightforward, you can be home within 72 hours.

3. A C-section means you haven’t really given birth

Not true at all, after all, a baby has come from your body, you have given birth to your baby, yes with some help, but even having a vaginal birth, many need some help along the way.

4. The scar will be ugly

Today’s C-section scars are very discreet in most cases and you will barely even know it’s there.

 

Caesarean section is not a curse to motherhood but rather has role to play in ensuring and preserving it.