All about C-sections

What happens during a C-section?


A cesarean or C-section is performed either during pregnancy, when the woman is not yet in labor, and these C-sections are usually planned. C-sections can also be performed when regular contractions of the uterus have already started; these are usually emergency C-sections. The most common reason for an emergency C-section is that the baby is beginning to suffer from an insufficient inflow of oxygenated blood and is in danger of suffocating.


C-sections are always performed under anesthesia. The mother’s abdominal wall is usually opened using a low transverse incision, also called a bikini cut, as it is in a cosmetically more appealing position and is usually covered, even in a bikini. The surgeon must make sufficient room in the abdomen to avoid damaging the other organs or the large abdominal veins. The intestines need to be moved aside and the urinary bladder pushed down and away. The surgeon can then open the uterine cavity. The delivery of the baby is followed by the immediate manual removal of the placenta to prevent bleeding and the uterine cavity is checked. Finally, the cut in the abdomen is closed in layers.


If there are no complications, the procedure takes around 45 minutes. After surgery, the new mom is temporarily transferred to the intensive care unit for monitoring and further treatment while the baby is brought in periodically for positioning and attaching.


The recovery from a C-section is more painful than after a spontaneous delivery although there are now effective ways to alleviate the pain without affecting the quality of the milk. The woman usually loses more blood during a C-section than during a spontaneous delivery and antibiotics are more often required after the operation. After about 24 hours at the intensive care unit, the woman is usually transferred to a regular postpartum department.


New moms are normally discharged 5 or 6 days after the C-section, which is almost the same as in the case of a spontaneous delivery. The discharge is always preceded by a medical checkup. The abdominal skin is usually closed with a single suture, which is removed painlessly before the discharge. Alternatively, an absorbable suture can be used; if this is the case, it is left in the skin and absorbed within two or three weeks. Pregnant women who inquire about “elective C-sections” should be aware that repeated C-section deliveries usually involve more complicated surgery. The tissues are rigid and scarred after the previous procedure and the surgeon often has to deal with multiple adhesions and other irregularities in the abdominal cavity, which can make accessing the uterus much more difficult.


Indications for C-sections


The only indications for a C-section are the risks to the health of the mother, the child, or both. If a C-section is performed after labor has started, it is only done during the first stage of labor, when the baby is still positioned freely above the pelvis. Once the baby has already descended into the pelvis, this type of surgery is no longer possible, as it could result in serious injuries to both the mother and the child. If you have previously delivered via a C-section, it does not mean that your next pregnancy also has to be a C-section, unless the baby weighs more than 4 kilograms (8.8 pounds). However, if the baby is heavier than that or you have already undergone two or more C-sections, you will need to have a C-section in each following delivery. This is because there is an increased risk of uterine rupture during a spontaneous delivery.


Possible complications and prevention


In most European countries, the number of C-sections has been steadily rising. In 1997, 11.9% of deliveries in the Czech Republic were cesarean deliveries; this number increased to 17.9% in 2005 and 26.8% in 2014. As the number of surgeries increases, so does the number of related complications. Besides the complications that can occur during surgery and in the early postoperative period, experts are now focusing on the long-term consequences of C-sections.


One possible serious issue is the formation of post-surgical adhesions. Adhesions complicate the healing process and can form after any abdominal surgery. According to existing literature, the rate of adhesion formations after C-sections is quite high (at least 25%). Adhesions can cause both early and long-term abdominal pains, can negatively affect intestinal activity, decrease the chances of conceiving again, and can complicate any future C-sections. There are two ways to prevent adhesions: one is to follow the principles of atraumatic surgery; the other is to apply anti-adhesion devices. It is known that the risk of adhesion formation in the area of surgery is highest during the first seven days after the procedure. This must be prevented by inserting or applying a mechanical membrane, which is then absorbed within a month. Hyalobarrier gel is an easily-tolerated anti-adhesion device that consists of 100% hyaluronic acid, which is produced naturally in the human body and is completely absorbed within a month. No allergic reactions have been reported. The efficacy of the gel in abdominal procedures has been attested by clinical studies.


Complications can also occur during the healing of the surgical wound. The wound always heals with a scar. Even though surgeons try to minimize the scar by using gentle surgical techniques and suitable suture materials, the resulting scar can be quite noticeable and perceived negatively by the patient. This is caused by individual differences in the scar healing and maturation process. While the process is genetically determined, there are ways to improve the result. Scars always form during skin wound healing and cannot be prevented, but steps can be taken to heal the scar so that it is as unobtrusive as possible. The scar maturation process takes about three to six months, and sometimes up to a year. In the beginning, the scar is red and only turns pale after several months. Scars can never be completely removed; they can only be made less visible. Besides the normal scar healing process, there is also a pathological process that results in the formation of keloidal or, more frequently, hypertrophic scars – raised tissue around the scar that spreads out. To prevent excessive scarring, a special dressing should be applied as soon as possible after the wound has healed, preferably immediately after the removal of the sutures. To achieve optimal results, it is important that the dressing – in this case, the Mepiform dressing – is used 24 hours a day for at least 3 months, based on the type of scar and the individual patient.


However, scar care should start immediately after surgery because the final appearance of the scar can also be improved by the right choice of the band-aid used. It is clinically proven that using special band-aids with a soft silicone layer has a positive impact on the final appearance of the scar. A highly absorbent surgical dressing is a good choice as due to its special construction, it takes excellent care of surgical wounds, helps speed up the healing process and also improves the condition of the sutures and the surrounding skin. Mepilex Border Post-Op has a superabsorbent core that can absorb a large amount of exudate or blood and turn it into gel. The absorbent pad has a specific perforation pattern that gives patients unobstructed movement with the dressing while making sure that the dressing stays in place even when applied to the more mobile parts of the body. This means fewer dressing changes, which also helps to keep the costs down. A patented adherent layer made of soft Safetac® silicone maintains the optimal environment for the skin and mechanically prevents hypertrophy.


C-sections in the news (in Czech)