For many expectant mothers, a cesarean section is a feared complication during childbirth, while other pregnant women explicitly want a cesarean section. But what is actually done during a cesarean section, how dangerous is it and how long does it take to heal afterwards? You can find answers to all these questions in this article.
When is a cesarean section necessary?
In gynecology, there are several categories into which a cesarean section can be divided. First, there is a distinction between a primary and secondary cesarean section. The primary cesarean section is performed before labor has begun to promote birth. The secondary cesarean, on the other hand, is performed in case of complications that occur during labor. The expectant mother is already in labor at this time. In addition, a cesarean section can proceed in a planned manner or be an emergency. There are different reasons for all these scenarios. Reasons for a planned cesarean section include:
- Placental or uterine malformations.
- Pre-existing conditions of the mother
- Malformations of the child
- On request
- A previous cesarean section
- Birth arrest
By the way, in the case of an elective cesarean section without medical necessity, the costs are not covered by public health insurance. Reasons for an emergency cesarean section:
- Heavy vaginal bleeding
- Undersupply of the newborn (for example, drop in heart tones)
- Suspicion of uterine rupture
- Umbilical cord prolapse
Depending on whether the emergency cesarean section, before or after the onset of labor must be performed, it is a primary or secondary emergency cesarean section.
What is the procedure for a cesarean section?
Unless it is an emergency situation, preparation for a cesarean section begins approximately two hours before surgery. Even before entering the operating room, the expectant mother is informed about possible risks, given thrombosis stockings and, if necessary, has her genital area shaved. A CTG (cardiotocography) is also performed to check the baby’s heart tones one last time. In the operating room, the expectant mother will receive an epidural (PDA for short) or anesthesia. An epidural is injected close to the spinal cord. The great advantage here is that the mother is awake during the operation and only feels the lower half of her body not at all or very little. As soon as her child is born, she can therefore receive it. So-called intubation anesthesia, in which the woman giving birth is not conscious, is chosen mainly for emergency cesarean sections. However, it can also be used under certain circumstances during a planned cesarean section, for example, if the expectant mother is very afraid of the procedure, although this is rather rare. In addition, the mother is given a urinary catheter to keep the bladder empty during the operation. This reduces the risk of urinary bladder injury. The mother is also given antibiotic prophylaxis to prevent infection.
Emergency cesarean section procedure
Emergency cesarean section differs from normal cesarean section not only in terms of anesthesia, but also in the procedure. Namely, the most important goal here is to keep the time between the decision to perform the cesarean section and the delivery of the baby as short as possible, in the best case at less than 20 minutes. Accordingly, much of what is standard in a normal cesarean section is dispensed with. These include, for example, the application of thrombosis stockings or shaving.
What is done during a cesarean section?
The surgery itself begins with a small incision in the skin horizontally above the pubic bone. The incision is about eight to 15 centimeters long. Then, the individual abdominal muscle layers are carefully exposed and cut through until the doctor reaches the uterus and opens it with a cross-section as well. If the amniotic sac has not yet broken, this is also cut open and the baby can be removed from the mother’s abdomen.
How long does a cesarean section usually take?
A cesarean section is not a particularly long surgery. It takes about an hour. On average, only about 15 minutes pass until the baby is born, and in the case of an emergency C-section, it is sometimes as little as five minutes. After the baby is born, you have to wait for the placenta to detach.This process is accelerated by the drug oxytocin. In the meantime, a midwife and, if necessary, a pediatrician take care of the newborn’s first aid. It then takes about half an hour for the uterus and the individual abdominal muscle layers of the new mother to be sutured back together.
How dangerous is cesarean section?
The cesarean section rate in Germany today is circa 30 percent. Through an incisional delivery, many lives, both of mother and child, can be saved annually. But of course, a cesarean section also has some risks and disadvantages, which is why the decision to have a cesarean section should not be made lightly. The risks of a cesarean birth include, above all, wound healing disorders and infections at the cesarean scar. In addition, the tissues surrounding the uterus may be injured during surgery, especially the urinary bladder. There is also an increased risk of thrombosis compared to vaginal delivery. Many pregnant women also fear that after cesarean surgery, vaginal delivery will no longer be possible for the next child. This is only partially true. In general, a vaginal delivery is possible after a cesarean section, even after an emergency cesarean section. Only in the case of a longitudinal uterine incision, vaginal delivery is no longer possible afterwards. This is an incision technique in which the uterus is opened longitudinally instead of in cross-section, and it must be used very rarely.
What are the risks to the baby?
For the newborn, there is also the risk of what is called “wet lungs.” Because the baby is not constricted in the birth canal, less fluid is forced out of the lungs. In general, the infant may experience mild adjustment problems in the first few hours of life after a cesarean section. These are probably caused by the fact that C-section babies are born much faster and also with less stress than is usually the case with a natural birth. Newborns born by cesarean section therefore often take a little longer to become as lively and alert as children born naturally. In addition, there is evidence that children born by cesarean section are more likely to suffer from allergies and other autoimmune diseases.
What comes after a cesarean section?
The postpartum period after cesarean delivery is a little different than after vaginal delivery. First, the mother classically stays in the hospital longer. Usually, it’s about five to seven days compared to three to five days after a vaginal delivery. Most women are more exhausted after a C-section than after a natural birth. One of the reasons for this is that the body does not release as many hormones that keep the new mother alert and euphoric. In addition, the surgical wound must be monitored and wound healing must be supported. A cesarean scar is a small wound in the bikini area about two transverse fingers above the pubic bone that is simply covered with a small band-aid for the first few days after birth.
Pain after cesarean section
Pain in the area of the surgical scar is perfectly normal for the first few days. After about five days, stitches can then be removed from the scar. It takes a total of about eight to twelve days for the stitches to heal. To care for the scar, there are various ointments that support wound healing and help with involution. Many women are initially ashamed of their fresh scar and their belly after cesarean section and pregnancy, but usually only a very small scar remains in the long run.
How long does lochia persist after cesarean section?
Also after a cesarean section, the so-called lochia, also called lochia, presents itself. This is wound secretion secreted by the uterus. In most cases, lochia is less pronounced after a cesarean section than after a vaginal delivery. It lasts for about three to four weeks.
At what point is exercise possible after a cesarean section?
As with vaginal delivery, the woman’s pelvic floor suffers from the strain during pregnancy, even if the heavy strain from the delivery itself is eliminated. Postnatal gymnastics is therefore also highly recommended in this case. This can usually be started six to eight weeks after the birth. With more strenuous sports, such as jogging, it may be necessary to wait even longer.This depends entirely on the individual wound healing of each woman. It is best to discuss with the attending physician whether the time is ripe to resume sports. In addition, every woman should listen to her own body and only increase athletic training slowly. As soon as she feels pain in her abdomen, she should stop the activity in question. The new mother should also be careful and mindful of herself in everyday life. During the first six weeks, she had better not do any heavy lifting or engage in other household activities
When can you start showering and bathing after cesarean section?
The goal after cesarean surgery is to get the new mother mobilized as soon as possible. In these first hours, mobilization primarily means light exercise: So, for example, getting up, stretching your legs a bit and cleaning and refreshing yourself at the sink. This can usually be done as early as six to eight hours after the operation and accelerates recovery. A short time later, from about the third day, showering is also possible again. It is recommended to ask for a waterproof plaster for this purpose at the ward. The surgical scar should not come into contact with water and soaps. Women should not bathe again until the postpartum flow has dried up to prevent germs from entering the uterus.
At what point can you breastfeed after cesarean section?
Breastfeeding is not a problem even immediately after a cesarean section. On the contrary, breastfeeding actually tends to support the bond between mother and newborn. Many mothers, especially after an emergency cesarean section, are disappointed that their birth experience did not go as they had hoped. They feel they did not form as strong a bond with their newborn as a result. Breastfeeding can help against this. If the mother wishes to breastfeed the baby, the baby should be put to the breast regularly from the beginning. This allows a rhythm to develop quickly between mother and baby. Another advantage of breastfeeding is that the mother’s body releases many hormones during this process, which strengthen the bond with the child and promote uterine involution.
When does my period start after a cesarean section?
The time until the first menstrual period after pregnancy varies greatly. After the postpartum flow dries up, menstruation can generally resume and pregnancy is possible again. If a woman breastfeeds, the onset of her period can be significantly delayed by the hormones that are released. However, even breastfeeding does not provide complete contraception. It is recommended that women wait one year to become pregnant again after a cesarean section. This ensures that the uterus and abdomen around the cesarean surgery scar can heal completely. Accordingly, couples should resume contraception six to eight weeks after a C-section.
