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C-Section - Series

Normal Anatomy - C-section

C-Section Normal Anatomy 1

In a normal pregnancy, your baby is positioned head down in your uterus.

Indication - C-section

C-Section Risk Factors 2

Sometimes the baby is in a presentation, like breech (buttocks-first) or transverse (cross-wise), that makes a vaginal birth risky. Other times certain medical conditions, such as placenta previa (placenta is attached too low, blocking the baby's exit) or placenta abruptio (placenta is partially or completely detached, threatening the baby's oxygen and nutrient supply), make vaginal birth nearly impossible.

Your doctor will perform a cesarean (c-section) delivery if a vaginal birth is not safe or possible for you or your baby.

Indication - C-section

C-Section Anesthesia 3

Many doctors prefer using general anesthesia, which renders you unconscious, for emergency c-sections because it can be administered quickly and takes effect almost immediately. When the c-section is planned, the doctor may order regional anesthetics (a spinal or an epidural), which numb only the lower portion of your body.

Incision - C-section

After the anesthesia takes effect, the surgeon makes an abdominal incision. In non-emergency C-sections, the surgeon usually makes a horizontal incision (a bikini cut) across the abdomen, just above the pubic area. In an emergency situation, the surgeon occasionally needs to make a vertical cut, from below the navel to just above the pubic area. A vertical cut sometimes allows quicker access to the baby.

Procedure - C-section

C-Section Uterine Incision 5

Next, the surgeon opens the uterus with either a horizontal or vertical incision, regardless the direction of the skin/abdominal incision. A vertical incision on your uterus causes less bleeding and better access to the fetus, but renders you unable to attempt a vaginal delivery (must have another repeat c-section) in the future.

If you end up with a horizontal incision, you will have the option of either going through a trial of labor (TOL) or electing a repeat c-section.

The reason for the differences between the two is that patients with vertical uterine incisions have a much higher chance of rupturing the uterus (8-10%) in the future pregnancies, compared to only 1% in those with horizontal incisions.

Procedure - C-section

Finally, the surgeon cuts through the amniotic sac enclosing the baby. He then allows the amniotic fluid to escape.

Procedure - C-section

The surgeon reaches into your uterus and lifts your baby's head. An assistant pushes down on your upper uterus to help guide your baby out.

Procedure - C-section

C-Section Cut and Clamp 8

The surgeon will clamp and cut the umbilical cord.

Procedure - C-section

C-Section Scar 9

A typical hospital stay after c-section delivery is three to four days. Usually, your doctor encourages getting up and around soon after surgery to aid healing and prevent complications. For the first few weeks, your abdominal incision will be sore. The scar will lighten as it heals.

Updated: 12/9/2012

Irina Burd, MD, PhD, Maternal Fetal Medicine, Johns Hopkins University, Baltimore, MD. Review provided by VeriMed Healthcare Network.

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