Cesarean Section

By: Bradley G. Goldberg, M.D.

Cesarean Section is the delivery of a baby by an abdominal incision performed on the mother. It is the most common major surgery performed in the United States at a frequency of about one million per year. The name “Cesarean” is likely traced back to ancient Rome (the time of Cesar) when the operation was performed after a maternal death to separate the mother and baby so they could be buried separately.

Obviously, modern medicine has several other indications for this procedure. These include a baby that is not able to tolerate the stress of labor, previous cesarean section in a woman who does not wish to take the risk of vaginal birth after cesarean (VBAC), inadequate progress during labor, breech babies, multiple births - especially triplets or more, and several other conditions that would render a vaginal delivery too risky.

Recent statistics indicate that 25% of all deliveries in this country are by cesarean section. This is the highest rate in recent history, and most experts agree that this number will continue to increase for the foreseeable future.

There are several reasons why the rate is increasing. One is that fewer VBAC’s (Vaginal Birth after Cesarean) are being done. Another reason for the increase rate is that as technology advances, we are better able to detect conditions of the fetus that may be more amenable to cesarean delivery. Another notable reason is the current legal climate.

Most cesarean sections can be performed under spinal or epidural anesthesia. This is the preferred method of anesthesia since it is excellent for pain relief both during and after the operation. In addition the patient is able to avoid “general anesthesia” which is being put to sleep. The advantages to being awake during the cesarean are that the mother can immediately see her new baby, and that she may have a support person present in the room with her to share the experience, which is not usually allowed when general anesthesia is used. Also, by avoiding general anesthesia the baby is more vigorous when born, and less prone to some respiratory problems.

Most C-sections these days are performed using a “Pfannenstiel” incision, which is sometimes informally referred to as the “bikini” incision. This is a much more cosmetic incision than a vertical or “up & down” incision, and it also heals better. However, there are still some indications for the vertical incision.

The average hospital stay after a cesarean section is two to three days. Some discomfort is to be expected after any abdominal operation and cesarean is no exception. However, most people are not in severe pain after the procedure, since the spinal anesthesia will last for up to 18 hours. After that, there are several adequate choices for pain relief from intravenous medications to oral. Most women do quite well after the procedure and are anxious to go home by the second day and bond with their new family.
 

Copyright © 2003 Coffee Women's Center, All Rights Reserved.