This is an operation to remove the baby from the uterus through an incision in the abdominal wall, thus short-circuiting the normal delivery process through thecanal.
In some situations the Caesarean is an ‘elective’ operation, that is, known about and planned in advance with the consent of all concerned. Elective Caesareans are performed if it is known that a normal delivery would be dangerous or impossible, for example:
- in severe placenta praevia in which the placenta obstructs the baby’s exit through the cervix,
- disproportion, in which the baby is too big in relation to the mother’s pelvis,
- certain cases of severe ,
- presence of some maternal disorder such as diabetes, •
- in some breech presentations,
- when the baby’s condition is deteriorating.
In these situations a Caesarean is usually planned and then carried out without waiting for labour to start. Occasionally a ‘trial of labour’ is advised, which means the mother is allowed to go into labour normally and a close check is kept on progress; if at any time there are problems the arrangements for a Caesarean are already made and the operation is quickly carried out.
In other situations labour begins but an emergency arises which means immediate delivery is vital. Often the labour is still in the first stage when this happens and the cervix is not fully dilated, socannot be used. Therefore a Caesarean is the best option. Common reasons for this include:
- foetal distress as shown by foetal monitoring,
- bleeding during labour, causing loss of blood supply to the baby,
- trapped or constricted umbilical cord,
- unsuspected disproportion, for example caused by a brow presentation.
Caesarean techniques have come a long way since the time of Roman emperor Julius Caesar, after whom the procedure is named and who was reputedly born in this way. The modern Caesarean is carried out by making a small cut low down and across the mother’s abdomen, just above the pubic area, the so-called ‘bikini cut’.
The skin is incised, then the tissues below until the uterus is reached. An incision is made in the lower part of the uterus, the membrane around the baby is ruptured and the amniotic fluid sucked out.
The baby’s head is carefully delivered, followed by its body and the placenta.
The area is then repaired and stitched. In an emergency the whole procedure can be performed very quickly, only a few minutes from start to delivery. Two methods of anaesthesia are available for a Caesarean.
In an emergency a general anaesthetic is used, although this can affect the baby’s breathing when it is born.
If there is more time, doctors and mothers alike usually prefer epidural anaesthesia in which a local anaesthetic is injected into the fluid around the spinal cord in the lower back, numbing only the lower part of the mother’s body and legs.
With an epidural the mother remains conscious and can see and hold her baby as soon as it is born. Following a Caesarean, the mother is usually in hospital for a week or so. Recovery is generally uncomplicated and the uterus returns to its normal size and shape in about ten weeks. In some countries – notably the United States – once a woman has had a Caesarean it is highly likely that any further babies will be born in this way: ‘Once a Caesarean, always a Caesarean’.
In most countries however, if a mother has had a Caesarean then normal labours are encouraged in future pregnancies provided the original problems were unique to that. In most cases the incision heals well enough to stand the strain of a normal labour subsequently.