Synonyms
Incisional binding, Sectio caesaera
- Birth mechanical indication: These are usually birth-impossible positions such as transverse position, disproportion between head and pelvis, a child that is clearly too large (macrosomia, > 4500g) or a head that is too large. A final pelvic position of the child can also be an indication for a Caesarean section.
- Childhood indication: pathological CTG findings (pathological findings of contractions), umbilical cord prolapse (incarceration of the umbilical cord due to a prolapse in the vagina, which results in an undersupply of oxygen to the child) Premature placental abruption, rhesus incompatibility, diabetes mellitus, infantile malformations or infections are reasons to prefer Caesarean section to natural birth. Among the infections that can be transmitted during birth are HIV, rubella and genital herpes.
- Maternal indication: These are usually severe states of exhaustion or general illness.
- Mixed indication: imminent eclampsia, a placenta praevia (placenta lies before the cervix) or an imminent uterine rupture are further reasons for a caesarean section.
In principle, a distinction is made between a primary and secondary caesarean section.
The main difference is the progress of birth at the time of the caesarean section. A primary caesarean section is planned and takes place before the birth begins. This means that the amniotic sac has not yet burst at the time of the operation and that no effective labour has yet begun.
The reason for a primary Caesarean section is not only the patient’s wish. Other indications for a primary Caesarean section may include unbirth-impossible positions, complications during pregnancy or a risk to mother and child under a natural birth. The third distinction is the emergency C-section.
This can be primary or secondary. This is merely a description of the urgency of a Caesarean section. Indications for such an emergency procedure are steady declining fetal heart sounds, eclampsia, HELLP syndrome, early placental abruption, or a ruptured uterus.
An emergency C-section should normally result in the birth of the child within 10 minutes.
- Primary Caesarean section:
The caesarean section can be performed under regional or general anesthesia. The regional anesthesia is an epidural or spinal anesthesia near the spinal cord.
The choice of the anaesthetic procedure depends on the planning of the operation and the mother’s ability to cope with stress. Since regional anesthesia takes a few minutes to take effect and requires a certain amount of patient cooperation, emergency C-sections are usually performed under general anesthesia. This allows the operation to be performed much more quickly, thus reducing the risk for mother and child.
The mortality rate due to a caesarean section is 1 in 25,000, so it is very rare. The current data indicate that general anesthesia carries a higher risk than regional anesthesia. However, the benefits for mother and child clearly outweigh the risks of an emergency C-section.
The advantage of regional anesthesia is that the father is usually allowed to go into the operation and the mother can see her child immediately after birth. More about anaesthesiaThanks to the latest techniques and surgical procedures, it is now possible to perform a caesarean section very gently and with the least possible complications. In most cases, the abdominal wall is opened through a deep incision in the lower abdomen (so-called acetabular stem incision).
After pushing the bladder away, the uterus is opened in the lower uterine segment. At this point there is enough connective tissue to allow for good healing. The uterus is then bluntly dilated without a further incision and the child is developed by hand or with a suction cup.
This procedure enables the best possible and fast wound healing with hardly any wound healing disturbances or other complications. Usually only a few minutes pass from the beginning of the operation until the birth of the child. Most of the time is often taken up by the subsequent closing of the wound.
Once the child has developed, the placenta is manually released and completely removed by hand before the uterus and abdominal wall are closed with sutures. The risks and complications of Caesarean section are very low nowadays. These are mainly wound infections, wound healing disorders and scar adhesions.It can also lead to damage of neighbouring organs.
The urinary bladder, but also the ureter and the intestine are affected. In addition, patients can lose a lot of blood if complications occur. There are hardly any risks for the child.
It is possible that the children may suffer minor abrasions, cuts or fractures due to the caesarean section. However, this is very rare. The children may also have a not fully functioning intestinal flora at the beginning.
The reason for this is that children born naturally swallow the vaginal secretions of the mother, which allows their intestinal flora to mature better. A somewhat more common problem is the adaptation of mother and child. Caesarean section children therefore more often have breastfeeding problems at the beginning because the bonding phase after a Caesarean section can be insufficient.
Late consequences can be uterine ruptures during another pregnancy, as the scar tissue is more brittle. In the past, the rule was that after a Caesarean section, all subsequent children must also be born by Caesarean section. The reason for this was the fear of a uterus rupture at the scar.
The tissue at this point is no longer so resilient and can tear more easily. In the meantime, however, it has been proven that a previous Caesarean section is not a compelling indication for a further surgical intervention for birth. However, this is only the case if there are no other indications or complications.
However, the frequency of uterine ruptures does not increase after a previous caesarean section. Nowadays, Caesarean section is a safe way of giving birth, provided that there is a corresponding indication. By means of a Caesarean section, dangers for both the mother and the child can be avoided or kept low.
However, a caesarean section should not become the rule, as it is not a natural birth. This can lead to bonding problems between mother and child after a Caesarean section. Breastfeeding is also often more problematic after a Caesarean section birth than after a natural birth.
For these reasons, some hospitals do not perform desired Cesarean sections. When deciding for or against a Caesarean section, it should not be forgotten that it is an operation that can entail corresponding risks. Nevertheless, there are indications that make a natural birth impossible. In such cases, a Caesarean section is a very good and largely risk-free way to spare or even save mother and child.
