Česky
What is a caesarean section
A caesarean section, popularly known as an "emperor", is one of the oldest and most common obstetric procedures that ends a pregnancy. It is a surgical birth or section birth, of which around 20-25% take place in the Czech Republic each year. The baby is not born vaginally, but doctors use an incision to open the abdominal and uterine cavities and remove it from the mother's body.
How a caesarean section is performed
The obstetrician makes a surgical incision about 10 cm long, usually across the lower abdomen (just above the pubic hair). Only very rarely (e.g. concerns about fetal compromise, significant obesity or maternal bleeding) can an incision be made from the navel down.
Once inside the uterus, he removes the newborn, cuts the umbilical cord and detaches the placenta by hand. He or she cleans the uterus, completely removes the remnants of the placenta and amniotic sacs, closes the uterus and then closes the abdominal cavity layer by layer.
The skin is sutured with a special suture, where only the knuckle at the beginning and end of the wound is visible. The stitch is usually absorbable and the woman does not have to go in to have it removed. As a rule, a woman who has had a caesarean section spends more time in the sixth-form ward than after a conventional birth, up to six days.
How long does it take to give birth by caesarean section
A section birth usually takes around 30 minutes for an uncomplicated procedure, with the actual fitting of the baby taking just 3 minutes. The rest of the time, the doctor cleans the abdominal and uterine cavities and sutures the uterus and abdomen.
What to prepare for in a caesarean section
A woman always gets all the necessary information from her doctor well in advance. She will be informed about the procedure, possible risks and complications, as well as the aftercare. Everything depends on the course of the pregnancy and the current state of health. Of course, if you are unsure about something, ask.
"I see a visit to a physiotherapist as an appropriate preparation for a caesarean section, who will advise on how to exercise and how to relieve the stressed parts, as well as on how to return to normal body functioning in the postpartum period, when even a relatively small scar on the abdomen can upset the body's stabilisation system," advises Tereza Ježková, MD, head physician of the obstetrics department at Hořovice Hospital.
Most caesarean sections are performed under general anaesthesia, but in case of the need for general anaesthesia, full pre-operative preparation is required. During a caesarean birth, it is important that the anaesthesia affects the baby as little as possible, so it is necessary to make as much preparation as possible before the anaesthesia itself.
You cannot take liquids or food for at least six hours before surgery. You should go to the operating theatre undressed, without jewellery, watches or contact lenses.
The nurse will prepare you for the procedure by:
1. shaving your genitals and lower abdomen,
2. applying an enema or Yal cleansing solution,
3. bandages the lower limbs (to prevent thromboembolic disease),
4. inserts a urinary catheter (the bladder must be completely empty, otherwise it would cover part of the uterus),
5. administer antibiotics and anti-vomiting drugs,
6. rub the skin with disinfectant (from the breasts to the knees),
7. drapes the surgical field.
Planned and unplanned caesarean section
Simply put, there are two types of caesarean section: planned and unplanned, called an emergency caesarean section. What are the differences between them?
Planned section
The doctor opts for it when a vaginal birth is not possible or there is a risk of serious complications. The woman is informed about the planned procedure during pregnancy. The doctor informs her about the operation, sets a date and asks for her written consent.
The reasons for the planned caesarean section may be:
- the mother's health (e.g. respiratory diseases, diabetes, heart and blood vessel diseases, etc.),
- high maternal age,
- narrowed pelvis,
- condition after operations on the uterus and vagina,
- inappropriate position of the baby (oblique, transverse, pelvic end),
- multiple pregnancies with the risk of complications,
- previous birth ending in caesarean section,
- diseases or problems arising during pregnancy.
Unplanned (acute) section
As the name implies, this is an operation that the doctor decides on after considering the current situation while the labour is in progress or during pregnancy when a complication suddenly arises.
The need for an acute caesarean section does not imply general anaesthesia. Most acute caesarean sections are still performed under general anaesthesia with the full consciousness of the parturient and the possibility of an attendant in the operating theatre.
When to perform an acute caesarean section:
- The fetus is at risk of oxygen deprivation,
- severe bleeding has occurred,
- a prolapsed umbilical cord or fetal limb is detected,
- non-progressive labour.
Caesarean section on request
Although doctors state that a section birth is up to 6 times riskier than a vaginal birth and there must be a medical reason to perform it, there are many mothers who request it. "Planned caesarean section has a low risk of complications in the long run. Personally, I think that a woman who primarily requires a C-section always has a reason for it and should be able to talk about it and make a free decision," says the doctor.
According to the current Czech legislation, a caesarean section is not possible on request and the only exception is women who have a diagnosed psychological illness or a diagnosed fear of childbirth (this phobia is called tokophobia).
What are the types of anaesthesia
The choice of appropriate anaesthesia depends on many factors and must be assessed by doctors for each individual woman in labour. It depends on the reason for the caesarean section, time availability and the mother's wishes.
"General anaesthesia is rarely used, simply put, in very acute situations. With general anaesthesia, one has to take into account that there is a transfer of general anaesthetics through the placenta to the baby, so it is advisable to reduce the time to equip the baby to a minimum, which can be difficult for more complicated procedures," the doctor adds.
General anaesthesia
It is most commonly used for acute caesarean sections with a risk of major bleeding. The patient is put to sleep and does not perceive the procedure itself. The disadvantage is that it forces the doctor to fit the baby as quickly as possible so that it is least affected by the drugs. At the same time, the mother has no immediate contact with the newborn after delivery.
Spinal anaesthesia
The anaesthetic is injected using a thin needle, by puncturing the spinal canal in the lumbar spine. The advantage is that only the lower half of the body is anaesthetised and the parturient is conscious throughout the operation without pain. If the situation permits, the mother can see the newborn immediately after delivery.
Possible complications
Like any operation, a caesarean section carries some complications.
What are the most common complications that can occur?
- A multiplied risk of uterine hypotonia and major blood loss with the need for transfusion,
- difficulty in fitting the fetus and greater possibility of uterine injury,
- injury to surrounding organs (urinary tract, intestines),
- wound infections,
- Increased temperature (reaction of the body to the procedure),
- complications associated with anaesthesia, allergy to disinfection or certain drugs administered.
Pregnancy after caesarean section
If a woman has had a caesarean section without complications, she can become pregnant again and carry the foetus to term. Vaginal delivery after a caesarean section is also possible and unless contraindications are present (defective scar, too large a fetus, incestuous placenta), the woman should be encouraged to have a vaginal delivery. "This is not recommended in cases where there has been a uterine rupture in a previous delivery, when the uterus has been opened from an incision at the apex of the uterus or in cases where it is not possible to give birth vaginally in general," explains MUDr. Jezkova.
However, the likelihood of another section is greater in such cases. If the mother has already undergone a second caesarean section, it is recommended to end the pregnancy again by caesarean section.
If you are planning another pregnancy, be sure to consult your doctor. The recommended time is a year to allow all birth wounds time to heal sufficiently.
When was the first caesarean section performed?
Although the procedure may seem like a recent discovery, it is not. As early as the 7th century BC, the Roman ruler Numa Pompillius issued a law forbidding the burial of a dead pregnant woman without removing the fetus from her body.
Supposedly the first historical incision on a living woman was made by the Swiss diviner Jacob Nufer in 1500, in a procedure he knew from castrating pigs. That is, he cut open the abdomen, pulled out the fetus and sewed up the wound. Mother and child survived. Some authors dispute this case, and refer to the German J. Trautmann as the first surgeon to perform this procedure. He is said to have operated on his wife in 1610, who died on the 25th day after the operation.
At that time, the mortality rate was almost 100%. The main cause was infection. The success rate of the procedure began to increase with the discovery of disinfection and penicillin. The introduction of anaesthesia also played a significant role. As modern medicine progressed, procedures became safer. Surgical techniques improved, anaesthesia was perfected, advances in pharmacology occurred, better suture materials were developed and much more.
Source.
