Caesarean section is a medical procedure that aims to expel the baby through the incision in the abdomen and uterus of the mother, usually made just below the waist line.
In many cases, a cesarean section is performed with a type of epidural anesthesia where the mother can remain awake during the surgery. The majority of mothers undergoing cesarean delivery can be discharged from the hospital 3 to 5 days after the surgical procedure. But to fully recover, routine maintenance is needed at home and periodic control to a gynecologist for a period of approximately one month.
Indications for Caesarean section
Caesarean section can be done if the mother wants a labor by elective surgery or as an emergency measure when the doctor feels the mother's pregnancy is too risky to be born normally. Your doctor will likely consider a cesarean section in several conditions such as:
- The fetus does not get enough oxygen and nutrition, so it must be born as soon as possible.
- Mothers have infections, such as genital herpes infections or HIV.
- The delivery process did not go well or the mother experienced excessive vaginal bleeding.
- The mother experiences a pregnancy with high blood pressure (preeclampsia).
- The mother has a placenta position that is too down (placenta previa).
- The position of the fetus in the uterus is abnormal and the doctor cannot correct its position.
- Obstruction of the birth canal, for example due to narrow pelvis.
- The umbilical cord exits through the cervix earlier than the fetus or the umbilical cord is compressed by the uterus when contracting.
- Underwent a cesarean section in previous labor.
- Mother contains more than one fetus at the same time (twins).
Warning of Caesarean section
If you are going to have a labor with scheduled cesarean section, the doctor will consult with an anesthetist to avoid the negative effects of the anesthetic drug on the patient.
You will not be allowed to drive the vehicle at least 6 weeks after the operation, so it is advisable to contact family or relatives to drive you home after surgery.
Before Caesarean section
Some tests that doctors may do before a caesarean section are:
- Blood test. Patients will be advised to undergo a blood test, so the doctor can find out your hemoglobin level and your blood type. Blood type tests need to be done in preparation for transfusion if needed.
- Amniocentesis. This test may be recommended if you are going to have a cesarean section at around 39 weeks of gestation. The doctor will check the maturity of the fetal lungs by examining the amniotic water sample in the laboratory.
Patients are required to fast for several hours before surgery. The doctor or nurse will inform you how much time you need to fast. The doctor will also prescribe several medicines to the patient before undergoing a cesarean section such as:
- Antibiotics
- Antiemetics (to prevent nausea)
- Antacids (to reduce patient's stomach acid levels)
The doctor can also ask the patient to clean the entire body with antiseptic soap before a cesarean section is performed. This aims to reduce the risk of infection. Patients are also asked not to shave their pubic hair, as this can increase the risk of infection at the surgical site.
Caesarean Procedure
The initial preparation that the doctor will make to the patient in the operating room is to provide anesthesia and empty the bladder. This is usually done by means of a catheter.
Anesthetics are given generally are epidural or spinal anesthesia which will only make the lower body numb, but the patient is still awake. But keep in mind, for some conditions, your doctor may give general anesthesia, where you will fall asleep during the process. Consult with your doctor about the type of surgery that best suits your condition.
The following is a sequence of cesarean section procedures commonly performed by doctors:
- The patient will be placed on the operating table with the head slightly raised.
- After that the doctor will make an incision of 10 to 20 centimeters in the patient's abdomen and uterus. Usually the incision is made horizontally slightly below the waist line. But if it feels more appropriate, the doctor can also make a vertical incision below the navel.
- The patient's baby will be removed through an incision made. This process usually takes 5 to 10 minutes. In this process, the patient will feel a slight pull.
- If everything is normal, the doctor will generally show and give the baby to the patient shortly after being removed from the stomach.
- The doctor will then remove the placenta from the uterus, and give the injection of the hormone oxytocin to stimulate uterine contractions so that the bleeding will decrease and eventually stop completely.
- The doctor will close the incision in the uterus and abdomen with stitches. All cesarean section procedures will generally take 40 to 50 minutes.
After Caesarean section
The patient will be moved from the operating room to the treatment room when all cesarean procedures have been performed and the patient's condition is normal. The doctor will prescribe painkillers to reduce pain in the incision. Patients will be advised to get up and walk shortly after returning to the treatment room.
Normal bleeding will occur from the vagina in the first few days after a cesarean section. This blood is called lokia. In the first three days, lochia can be sufficient in number and bright red, and the color will slowly turn brown, until finally yellow to white.
However, what to watch out for is if there is a lot of blood that comes out, you have to replace the dressing more than twice in 1 hour for at least two consecutive hours. In addition, lochia is considered abnormal if it is still red and the amount is still very large on the 4th day after a cesarean section, or if your lochia smells bad and you have a fever.
The doctor will also take care to prevent blood clots. Handling that can be given, among others, is by compression stocking or by injection of anticoagulant drugs.
In addition, patients will be given counseling assistance to breastfeed their babies. The catheter will be removed when the patient can walk or about 12 to 18 hours after the cesarean section is complete.
When going out of the hospital the doctor will suggest a number of things the patient must do during the recovery period at home, namely:
- Supporting the abdomen with a pillow when breastfeeding.
- Avoid lifting anything heavier than a baby and resting a lot.
- Drink plenty of fluids to replace fluids lost during cesarean section and breastfeeding and prevent constipation.
- Avoid sexual intercourse until the time allowed by the doctor. Usually patients are prohibited from having sex four to six weeks after a caesarean section.
- Take pain medication according to doctor's prescription.
Some of the following steps can also be taken by the patient against the incision, which is to clean and dry the wound slowly every day, be aware of signs of infection in the former incision, and wear loose clothing made from comfortable.
Consult a doctor immediately if the patient feels the following:
- Swelling or pain in the lower leg.
- Severe pain.
- Pain when urinating.
- Urine leakage.
- The appearance of pus or smelling liquid from the cut.
- Incision wounds become red, painful, and swollen.
- Coughing or shortness of breath.
- Heavy vaginal bleeding. You need to be vigilant if you have to replace pads more than twice in 1 hour for at least two consecutive hours.
Complications of Caesarean section
Caesar is one of the major surgeries that has several risks for both mother and baby. Some of the risks that can develop in babies born by cesarean section are:
- Surgical injury. Although rare, incisions in the baby's skin can occur during the surgical process.
- Respiratory disorders. Babies born by cesarean section are more at risk of breathing abnormally faster during the first few days after birth.
While some of the risks that can befall on mothers undergoing cesarean section are as follows:
- Bleeding is getting worse. Caesarean patients will usually experience more severe bleeding when undergoing a cesarean section when compared with normal labor.
- Surgery injuries. This can occur in the organs around the uterus.
- Blood clots. Caesareans can experience blood clots in blood vessels, especially in the legs or pelvic organs.
- Increased risk of complications in subsequent pregnancy. Although rare, cesarean section can increase the risk of problems for subsequent pregnancies, such as stitches in the open uterus, the placenta attached to the uterus, and fetal death in the uterus.
- Wound infection. This will be more risky in the delivery process by cesarean section than normal.
- Anesthetic side effects. Although rare, caesarean patients can feel the negative effects of anesthesia such as severe headaches.
- Infection and inflammation of the lining of the uterine membrane. This can cause fever, vaginal discharge that smells, and pain when urinating.
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