Synonyms
Incision binding, Sectio caesaera
Epidemiology
In Germany, almost every third child is now born by Caesarean section, but only a small percentage is born by express Caesarean section at the request of the mother. Worldwide, the average Caesarean section rate is about 20%, but it varies considerably from country to country.
Shapes of the cesarean section
It is possible to distinguish between a primary and a secondary caesarean section. If the birth has not yet been induced, i.e. if no rupture of the bladder has occurred and/or no contractions have yet started, this is called a primary caesarean section. This includes both a caesarean section on request and other situations described above, in which a caesarean section was already planned in advance.
A secondary caesarean section is when it is performed during childbirth, i.e. when the contractions have already started. This is mainly indicated in the case of obstetric complications. For the incision, an anesthetic procedure is necessary as an anaesthetic, either in the form of general or regional anaesthesia.
Regional anesthesia is usually preferred to general anesthesia, as the mother can experience the birth with full consciousness despite being painless. However, a caesarean section is sometimes only possible under general anaesthesia, as there are certain contraindications for the regional anaesthesia procedure, such as coagulation disorders. In the case of an emergency caesarean section, regional anesthesia is also usually dispensed with for time reasons.
In addition, the psychosocial situation of the patient must be taken into account when choosing the procedure. In the much more common regional anesthesia, a distinction is made between two procedures: spinal anesthesia and epi/peridural anesthesia (so-called PDA). Both procedures lead to a loss of pain perception in the lower half of the body, but do not affect the consciousness of the expectant mother in any way.
By means of a puncture with a very thin needle in the area of the lumbar spine, a local anaesthetic is introduced into spaces close to the spinal cord, which leads to a blockage of the pain transmission in the spinal cord and the nerves emanating from it. The main difference between the two procedures is the place of application of the painkiller. The advantage of epi/peridural anaesthesia over spinal anaesthesia is that pain can also be regulated during or after the operation, since after the puncture an access to the spinal canal remains, through which medication can still be applied from the outside.
This is not possible with spinal anesthesia because of a single puncture and injection. Before the actual operation can be started, the pubic area must be shaved and the entire surgical area must be extensively and thoroughly disinfected. To be able to work under sterile conditions, the surgeon will apply a sterile foil to the skin around the area.
The operation begins with an incision through the abdominal wall, which is usually made transversely slightly above the pubic mound. In principle, a longitudinal incision between the navel and the pubic bone is also possible, but is hardly ever used today. In the past, it was common practice to open the deeper tissue layers by incision, but today the so-called “gentle caesarean section”, also called Misgav-Ladach-sectio, is increasingly used.
This is a surgical method in which the abdominal wall, abdominal cavity and uterus are opened further with the help of the fingers and stretched sufficiently. This method is gentle on the tissues, vessels and nerves are damaged less frequently and the operation wound heals more quickly, so that mothers can usually be discharged from hospital more quickly. After opening the uterus, the child is taken out and the umbilical cord is cut.
The entire procedure usually takes no more than a few minutes. While the baby is first cared for by a midwife, the surgeon has to remove the placenta together with the umbilical cord from the uterus and carefully close the individual layers again with sutures. The skin incision is held together with the help of surgical clamps.
If the operation and the following time have gone without complications, the mother is usually mobile from about the third day after the operation and can be discharged home with her child after an average of seven days in hospital.In general, the mortality risk for healthy women is naturally higher with a Caesarean section than with childbirth. The risk is assumed to be two to three times higher. The most common complications are probably wound healing disorders and infections.
Likewise, adhesions can occur in the wound area, which can impair a subsequent pregnancy. As with any other operation, Caesarean section can lead to increased bleeding and injury to other organs and structures located in the vicinity of the surgical site. Particularly at risk are the intestine, bladder, ureter and nerves.
Perforations can occur, which often lead to a life-threatening inflammation of the peritoneum (peritonitis). Injury to nerve structures leads to numbness, in the worst case to permanent paralysis. The bladder catheter required for the operation can lead to urinary tract infections and disturbances in the emptying of the bladder.
The risk of thrombosis with embolism is increased due to the mother’s initial bedriddenness after the Caesarean section. In principle, each pregnancy should be thoroughly assessed to determine whether a Caesarean section is necessary or desired by the mother, and this should be discussed critically with the attending physician and the midwife, taking into account the advantages and disadvantages.
