Friday, November 27, 2020

Preparing for: Cesarean Delivery (C-Section)

Medika's Patient Information Series for preparing for Procedures

Our Preparing for series allows a patient to properly prepare themselves for a procedure. Answers about how long the procedure will last, what’s involved, what to expect, and even advice on packing your bag, While your surgeon preps, we’ll make sure you’re ready.

What is a cesarean section?

When the baby is delivered through an incision in the abdomen and uterus, it is called a cesarean section or C-section. Most women will have a horizontal lower abdominal incision. Sometimes surgeons make a vertical incision if a woman has an extensive past surgical history or large uterine fibroid or if there is an emergency. 

Some women will choose to have a permanent contraception surgery, or tubal ligation, with their c-section.

Why do some women need a cesarean delivery?

Some women with a history of a prior c-section will have a scheduled cesarean delivery. Some women require cesarean delivery during labor. The most common reasons for a cesarean birth during labor are unsuccessful labor and fetal distress. Sometimes during labor, the contractions fail to open the cervix enough for the baby to pass through the birth canal.

Fetal distress means that the baby’s heart rhythm is abnormal and indicates that the baby’s health is in danger. Delivery via cesarean section may be the fastest way to remove the baby from the stress of labor and also the fastest way for the medical team to evaluate the baby. 

Other common reasons for a scheduled cesarean delivery include:

  1. Breech or fetal malpresentation (not head down) 
  2. Twin pregnancy
  3. Prior uterine surgery (myomectomy)
  4. Placenta disorders like placenta previa  

What are the possible complications of cesarean delivery?

Most women will have an uncomplicated C-section. A small percentage of women may develop complications and these are usually easily treated. Potential complications include bleeding, infection, injury to the bowel or bladder, blood clots in legs or lungs, and reactions to anesthesia.

For most women, vaginal delivery carries less risk of heavy bleeding, infection, and injury to abdominal organs compared to c-section. Vaginal delivery is also associated with less risk of postoperative complications and shorter recovery times compared to cesarean delivery. However, some women may not be candidates for vaginal delivery and some women may develop unavoidable indications for cesarean delivery during labor. You and your doctor will determine which approach is most suitable for you.

How long will I be in the hospital?

Most women will need to stay 48-72 hours after cesarean delivery. Various factors, such as the reason for C-section, surgical complexity and postoperative recovery course help determine the surgical plan.

Can my family visit me?

A trusted family member should drive you to and from the hospital. Families are welcome to stay with you before and after surgery. Hospital visitor policies for overnight stays vary with the ongoing COVID-19 pandemic.

Does my procedure require an anesthetic?

Most women receive regional anesthesia for cesarean delivery. This can be an epidural and/or a spinal block. During regional anesthesia, only the lower half of the body is numbed and the patient is awake during the procedure. This technique allows the mom to be awake during delivery and enjoy the experience of seeing their newborn baby.  To place a regional block, a tiny incision is made in the lower back. For an epidural, a small tube is placed to deliver medication through the tube when needed. For a spinal block, the drug is injected directly into the spinal fluid. 

Rarely, general anesthesia is needed for cesarean delivery. This means that the patient will not be awake during the delivery. General anesthesia is used only if the regional block does not work or if there is an emergency without enough time to administer a regional block.  

Beautiful woman holding a newborn baby in her arms

How should I prepare?

For scheduled cesarean sections, at your final OB appointment, the doctor will review your specific instructions. You should also confirm the date, time, and location of the surgery. We will need to carefully review your medications and plan when the last dose should be taken prior to the surgery and when to resume medications. This is particularly important for patients taking aspirin, blood pressure medicines, and diabetes medicines. 

Your doctor should review all medication and food allergies. We remind patients to avoid alcohol 24 hours before the surgery. We also instruct patients to refrain from eating or drinking at least 8 hours prior to the surgery time. 

Please keep in mind that the hospital will perform a car seat check prior to discharge (it needs to be purchased prior to discharge). Also if you are planning on cord blood banking, please bring your kit with you to the hospital. 

The hospital will supply almost everything you and your baby will need for your stay, including gowns, pads, underwear, baby clothing, diapers, breast pumps, formula, and bottles. However, you will need to bring clothes and supplies for your trip home. Some women also prefer to bring some of their own things to be more comfortable, such as their toothbrush, comfortable clothing, and lotion.   

What happens after I check-in at the hospital?

After checking in on Labor & Delivery, you will change into a surgical gown and store your belongings. You will meet the nursing team who will provide care during your surgery. They will review your medical history. The surgical consent form is reviewed, signed, or updated with any changes. An IV will be placed at this time. 

The anesthesia team will also interview you and answer questions. Typically your surgeon will review any last-minute questions.

What happens in the operating room?

After the preoperative evaluation, the team will guide you to the operating room. You will move from the mobile bed to the operating table. Monitors will be attached to various parts of your body to measure your pulse, oxygen level, and blood pressure. Then the anesthesiologist will place the regional block. 

After the anesthesiologist has confirmed the regional block is functioning appropriately, the OR team will lay you down and adjust your position. The anesthesiologist will administer IV antibiotics through your IV. The OR nursing team will then apply an antibacterial fluid to your abdomen, trim the pubic hair if needed, and cover your body with drapes. In addition, a tube called a foley catheter will be placed in your bladder to drain urine. 

The team then performs a “surgical time-out.” A surgical safety check-list is read aloud, requiring all surgical team members to be present and attentive. One family member is allowed to be with you during the procedure and is called to your side at this time. 

The OB/Gyn begins by making a skin incision in the lower abdomen. It is typically horizontal, but sometimes a vertical incision is needed if there is an extensive surgical history, a known pelvic mass such as a large fibroid, or if there is an emergency. 

The abdominal muscles are separated and the uterus is visualized. An incision is then made in the uterine wall. This incision is also typically horizontal. The baby is delivered through these incisions and the umbilical cord is clamped and cut. The baby is given to a special team of nurses for immediate evaluation. After the baby is evaluated, the baby will be brought to the mother. 

The placenta is then removed and the uterus is sewed closed with stitches that will dissolve as the uterus heals over the next few weeks. The surgeons then confirm there is no active bleeding. If permanent birth control is planned, it is performed at this time. Finally, the abdomen and pelvis are washed in a warm saltwater solution and all the abdominal wall layers are closed. The skin is closed with dissolvable sutures or staples.

Once the procedure is complete, the surgical team completes a post-procedure review. All instruments and equipment are counted and verified. When finished, the team will transfer the patient to the recovery room.

What happens in the recovery room and postpartum ward?

The recovery room is equipped to monitor patients’ blood pressure, heart rate, and bleeding after surgery. In the recovery room, we encourage mothers to begin breastfeeding. 

You will remain in the recovery room for observation for 1-2 hours. Afterward, you will be moved to a hospital room in the postpartum ward.

Immediately after the C-section, you will need to stay in bed until the regional block wears off and you are able to use your legs.  You will need someone to assist the first few times you move out of bed.  Because the lower half of the body is still numb, the bladder catheter is usually removed the next morning. 

As soon as possible, your nurses will encourage you to move around as much as you can. You may be encouraged to get out of bed and walk after your operation. Walking helps reduce the risk of blood clots. You may feel tired and weak at first. The sooner you resume activity, the sooner your body’s functions can get back to normal. 

Your incision may be sore for the first few weeks. The nursing team will give pain medicine as needed to help keep you comfortable. 

If you want to breast-feed, the lactation consultant will typically visit to provide guidance and support. The neonatal team will be monitoring the baby’s health for the first few days of life. 

What preparations should I make for aftercare at home?

You should speak with your physician regarding the resumption of exercise and sexual activity. Your doctor will also review wound care instructions. We generally recommend avoiding strenuous activity, heavy lifting, and sexual intercourse for 6 weeks after cesarean delivery. Also please avoid inserting anything into the vagina (no sex, tampons, or douching) until cleared by your doctor. 

Some mild cramping and light bleeding are expected after c-sections. You may have more cramping if you are breast-feeding.

Most women can return to basic activities in one to two weeks. Generally, we recommend patients stick to light activity only for the first 4–6 weeks. Light exercise helps your body heal and prevents some postoperative complications. Be sure to get plenty of rest, but you also need to move around as often as you can. Take short walks and gradually increase the distance you walk every day. 

You may resume a regular diet on the day of surgery. It may be helpful to prepare some meals and do your grocery store shopping and laundry before surgery. If you are breast-feeding, it is recommended to continue the prenatal vitamins to ensure good nutrition for you and your baby.

You will be given instructions to help control postoperative pain during healing. Some pain is expected for the first few weeks after the surgery. You may also have light bleeding and vaginal discharge for a few weeks. Sanitary pads can be used after the surgery. Constipation is common after cesarean deliveries. Try a stool softener and fiber supplement. Some women have temporary problems with emptying the bladder. 

Your doctor will schedule a postpartum visit 4–6 weeks after the procedure. We also schedule a wound check 1-2 weeks after delivery. At this time, the incision is inspected for appropriate healing. We also review your contraception options and evaluate for postpartum depression

After your postpartum visit, we recommend continuing your annual routine gynecologic exams.

DANGER SIGNALS

Call your doctor or report to the ER if you experience:

  • Pain not controlled with prescribed medication
  • Fever > 101
  • Severe nausea and vomiting
  • Calf or leg pain
  • Shortness of breath
  • Heavy vaginal bleeding
  • Foul-smelling vaginal discharge
  • Abdominal pain not controlled by pain medication
  • Inability to pass gas or have a bowel movement

This article was contributed by MacArthur Medical Center’s Dr. Reshma Patel

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Medika Life has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your health care provider(s). We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by Medika Life

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MacArthur Medical Center

MacArthur Medical Center's specialize in Midwifery, Pediatrics, Breast Surgery, Family Medicine and Urogynecology

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972-256-3700

info@macarthurmc.com

3501 N. MacArthur Blvd, Ste 500 Irving, TX 75062

Medika would like to thank MacArthur Medical Center for providing this Patient Information page.