C-Section (Cesarean Delivery)

Pregnancy happens when a sperm from a man meets the egg in the woman's body mostly after sexual contact. This fertilized egg gets attached to the lining of the womb and grows into a baby. The most common sign of pregnancy is when you miss your monthly period. Pregnancy takes around 40 weeks to complete, starting from the first day of your last normal period. The whole process of pregnancy happens in three stages, which are known as trimesters. Three months make one trimester, thus completing the nine months of pregnancy. The first trimester is from week 1 to week 12, the second from week 13 to week 28 and the last one is from week 29 to 40.

Normally, the baby is delivered through the vagina (vaginal delivery). It is the natural method of giving birth. It is good for both the mother and her child.

In a C-section, which is also known as the caesarean section, the baby is taken out from the mother's womb by making a cut in her belly and the womb. After taking the baby out, the belly and the womb are stitched back together. The stitches that are used to close the womb dissolve themselves with time. Most deliveries happen through the vagina but due to some complications during pregnancy, C-section needs to be done to safely deliver the baby. Sometimes, it is also the only way of saving the lives of the mother and her child.

C-section is planned when there are certain complications to normal vaginal delivery. There are different indications to why it should be performed including the decision of the mother as a separate indication even if there are no complications in pregnancy. The surgery is usually planned as per the assessment of risk factors before the delivery date. Consultation and cooperation of other physicians, family members and the mother are important before carrying out the surgery. Sometimes, C-section needs to be performed as an emergency procedure when there are complications during labour pain.

The following are the indications to perform a c-section:

• There is a deformity in your pelvis (a bony structure near the base of the belly, which includes the hip bone and it connects legs to the lower back) making it difficult for you to deliver through the birth canal.
• The size of your pelvis is small.
• The size of the head of the baby is bigger than the birth canal could fit.
• The labour is not making that much contractions to open the cervix, which is the neck of the womb, and let the baby come out through the birth canal.
• If the umbilical cord gets pinched. The umbilical cord carries oxygen-carrying blood and nutrients to the baby and waste-carrying blood away from the baby.
• If the baby has an abnormal heart rate or any other medical condition, then it delivered surgically and treated for the respective condition.
• If you have any uncontrolled long-term diseases, such as high blood pressure, diabetes, and so on.
• Diabetes that happens during pregnancy is known as gestational diabetes, which can have complications. The baby born through c-section to a mother who has gestational diabetes weighs more than that of a mother without the condition.
• Normally, when the baby is delivered, its head comes out first from the birth canal and then the body. However, in some cases, the baby is not positioned normally and instead of the head, the legs start to show up first from the birth canal. This is known as breech. In such a condition, a C- section is done.
• When you have more than one baby in your womb and the first baby to come out has legs towards the birth canal (breech).
• If you have delivered a baby in your previous pregnancy through a C-section.
• If there are any early complications related to pregnancy.
• In case you are suffering from any genital disease, such as genital herpes then it is not safe to take the baby out through vaginal delivery as it can infect the baby.
• If you have problems related to the placenta (a flat chord connecting the womb to the baby, which nourishes and maintains the growth of the baby), such as placenta previa in which the placenta moves from its original position and comes to the lower part of the womb, it can block the baby from coming out through the vagina and lead to vaginal bleeding.
• If there is a cancerous growth in your womb which blocks the birth canal.

Before undergoing a caesarean section, there are certain things which are to be followed so that the surgery is a success and there are no complications during and after it.

• Your doctor will advise you to undergo certain imaging tests, such as MRI, X-ray, CT scan and lab tests such as complete blood count (CBC), urine test to check if there is any abnormality present.
• It is advised to fast for at least 6 hours before surgery and not to drink or eat anything during this period.
• The numbing agent will be tested on you for any allergic reaction before using it during surgery.
• There should be extra blood available that matches with your blood group. If there are any complications during surgery, such as injury to any blood vessel, which can lead to increased blood loss, this extra blood will be used in that situation.
• Your doctor will plan the surgery and your cooperation is required for that. You should ask your doctor if you have any doubts regarding the surgery.
• You should tell your doctor if you have any long-term diseases, such as high blood pressure and diabetes.
• Tell your doctor about any previous surgery or if you’re taking any medications.
• Any addiction to alcohol or tobacco should be informed to your doctor
• You will be asked to give consent before going for surgery.

• After preparing you for surgery, your doctor will give you a numbing agent so that you do not feel pain during the procedure.
• The numbing agent is mostly given in the spine so that you are conscious but the lower part of the body is numb. You will be aware of your surroundings but you will not feel the pain.
• Another way to numb your body is by giving general anaesthesia in which your whole body gets numb and you are not conscious during the procedure.
• A  small thin tube with a needle in front, known as a catheter, is inserted in the vein of your arm so that the medicines and fluids can be delivered to your body.
• Your belly will be washed and cleaned so that it does not have any germs.
• Your pubic hair will be shaved or trimmed.
• The surgeon who is a specialist in a C-section will make a cut in your belly. This cut is around 10 cm long and is also called a bikini cut. It is made near the pubic hairline in the lower part of the belly. The cut made is usually horizontal but sometimes in case of an emergency situation, the surgeon can make a vertical cut from your navel to the pubic hairline as well.
• After making the cut, the muscles are separated until the womb is visible. A cut is then made on the womb, which can be horizontal or vertical, to expose the baby.
• The baby is taken out of the womb through the cut. The mouth and nose of the baby are cleaned immediately to take out excess fluid. This will help the baby breathe.
• After taking the baby out, the umbilical cord which is still connected to the baby's navel is held tightly and cut.
• The baby is then shown to the mother from there by lifting it up.
• It is given to the nurses for full-body examination to check if there is any abnormality present.
• The fluid inside the womb, which is known as amniotic fluid, is sucked out and the placenta is removed by making a cut.
• After the procedure, the cuts made in the womb and belly are stitched back.
• The average cost of C-section in India is INR 46,500 to INR 80,000. It can differ from one hospital to another and also from location to location.

In the hospital

• After the C-section, you will have to stay in the hospital for three to four days.
• The stitches that were placed in the womb will dissolve themselves but the ones on your belly will have to be removed after a while.
• After the surgery, you will be shifted to the recovery room. Your health status will be monitored there and if the baby is born healthy then it will also be placed in the recovery room by your side. If your baby has any complications, then it will be kept in a special care nursery where it will be monitored.
• You will initially have difficulty in drinking and eating when you slowly recovering from anaesthesia. So, fluids will be given to you through your vein with the help of a drip.
• You should start breastfeeding the child as the first breast milk is full of essential nutrients and defence proteins that provide resistance to fight infections.
•  Your doctor will also prescribe you medicines for pain. 

At home

• It will take around 4 to 6 weeks to recover from a C-section. So, after going home, you should take good care of your health.
• Since it is major surgery, you should rest up for a few days and avoid exertion.
• Avoid doing moderate to heavy work for the first six weeks, and focus on taking care of yourself and your baby.
• You should not do any heavy exercises. Try walking slowly and only for a few minutes.
• Do not climb stairs for the first 2-3 weeks.
• Do not lift anything heavier than the baby.
• You should drink a lot of water to avoid constipation.
• Avoid having sex for a few weeks after surgery.
• Stay happy and avoid taking any kind of stress as it will keep you and your baby healthy.
• Take nutritious diet and include green vegetables and fruits in it.
• Avoid direct exposure of the wound to water and keep your it clean and dry.
• Do not put pressure on your belly and avoid stretching or bending too much.
• Support your belly while sitting and walking.

A c-section is usually a smooth procedure and most women recover from it successfully. However, there may be certain risks associated during and after surgery. These are discussed below:

During the C-section

• A reaction to the numbing agent.
• There can be damage to the surrounding organs.
• You may also have excessive bleeding if any blood vessel gets damaged during the procedure.
• The baby can have breathing problems if the C-section is performed before 39 weeks of the estimated delivery date.
• An injury to the baby may occur while making a cut in the womb. 

After surgery

• Infection
• High fever
• Vaginal bleeding
• Foul-smelling discharge from the vagina.
• Swelling in feet.
• Breathing problems.
• Long recovery period.
• Painful monthly bleeding.

Your doctor will ask you to come for follow-up visits after surgery to see if there are any complications or abnormalities during the recovery period, also known as the postpartum period. The postpartum period very sensitive and needs extra care that involves the following things:

• Checking your weight and blood pressure.
• Breast and pelvic examination.
• Checking your wound to ensure it is healing properly.
• Ensuring that your womb is returning to its normal size.
• Counselling you about family planning methods.

You should ask your doctor if you have any questions about your health or baby. If you feel low or depressed, you should tell your doctor. Motherhood is a new experience for every pregnant woman and is full of impassioned moments. Good health, a healthy diet, taking care of the baby and a happy environment helps a lot in getting the best moments in this period.