How a cesarean section is performed: stages of the operation

Making the decision to have a cesarean section, or C-section, is frequently very important for the mother’s and the baby’s safety. During this surgical procedure, the mother’s abdomen and uterus are cut open to deliver the baby. To ease their anxiety and get ready for the journey ahead, expectant parents should know what to anticipate during this procedure.

The mother is first given anesthesia, usually a spinal block or epidural, so that she can undergo a C-section while awake and pain-free. The surgical team makes an incision in the abdominal wall, usually just above the pubic area, once the anesthesia takes effect. By making this incision, the medical professionals can access the uterus and perform a second, safe incision to deliver the baby.

Following delivery, the infant’s airways will be cleared by the doctors, who will also assess any urgent medical needs. After the placenta is extracted, the wounds are expertly sutured. The actual procedure usually takes less than an hour, but recovery times can differ. It can be easier to adjust to parenthood if you are aware of the stages involved in the operation.

Hospitalization times and preparation

In contemporary obstetrics, 15% of all births are delivered by cesarean section, and in some areas, 20% of births are surgically delivered. As a point of comparison, the percentage of surgical births was only 3.3% in 1984. Experts typically link the rise in popularity of the procedure to the prevalence of IVF, a general decline in the birth rate, and an increase in the proportion of women who decide to consider having their first child only after 35 years of marriage.

Roughly 85–90% of laparotomy procedures are planned. Only for vital signs are emergency operations performed very infrequently.

The decision regarding the operation’s deadlines can be made at any point during the gestational period, even if the woman has a cesarean section. This is because of the factors that make independent birth unfeasible. The question of alternatives is not raised at all if the indications are absolute, meaning they are not authorized (narrow pelvis, more than two uterine scars, etc. D.). It is obvious that there isn’t another delivery method possible.

In other situations, the decision to have an operation is made only after 35 weeks of pregnancy if the reasons for the surgery (large fruit, pathological presentation of the fetus, and t. D.) are discovered later. At this point, the fetus’s dimensions, estimated weight, and specific location within the uterus become evident.

Many people are aware that infants born between 36 and 37 weeks are already highly viable. This is accurate, however there is a chance that a certain child will experience delayed lung tissue maturation, which could lead to the development of respiratory failure after birth. Therefore, the Ministry of Health advises having a planned operation after the 39th week of pregnancy in order to reduce needless risk. Nearly all children’s lung tissue has fully developed by this point.

Furthermore, it’s thought to be preferable to deliver the baby as near to the scheduled birth date as possible because the mother’s body will be under less stress and lactation will start almost on schedule, albeit a little later than with a physiological birth.

At 38 weeks, the antenatal clinic refers a patient to the maternity hospital if there are no signs that an earlier procedure is necessary. The woman should be admitted to the hospital a few days prior to the procedure so that she can start getting ready for the impending surgical birth. The postoperative period and the operation’s success, as well as its lack of complications, are primarily dependent on preparation.

The woman has the required testing done on the day she is admitted to the hospital. These consist of a routine blood test, a blood type and Rh factor test, a biochemical blood test, and occasionally a coagulogram to ascertain other hemostasis factors and the rate of blood clotting. In addition to a general urine test, a laboratory analysis of a vaginal smear is carried out.

The attending physician obtains a thorough and comprehensive obstetric history from his patient, including the number of births, abortions, miscarriages, frozen pregnancies, and previous reproductive organ surgeries, while the laboratory technicians perform these tests.

The baby’s health is also assessed. A uterine ultrasound is used to measure the placenta’s position in relation to the anterior wall of the uterus, as well as its size, which primarily consists of the head’s diameter. This information is used to estimate the baby’s weight. To ascertain the baby’s heart rate, level of motor activity, and overall health, a CTG is conducted.

An anesthesiologist meets with the woman about a day and a half prior to the procedure. In order to provide the woman with the best anesthesia, the doctor determines which types of anesthesia are appropriate for her and works with her to plan the dosage, duration, and side effects. Premedication is prescribed to the patient after she signs informed consent for spinal, epidural, or general anesthesia.

Eating is forbidden starting in the previous day’s evening. Eating and drinking are not allowed the morning of the surgery. After receiving an enema to clear her intestines, the woman gets her pubic region shaved and is dressed in a sterile shirt.

It’s advised to use compression stockings or an elastic bandage on the legs to prevent thromboembolism, which is a potential but uncomfortable side effect of the procedure.

Following the preoperative procedures, the female patient is brought to the operating room. Everything is prepared for the planned operation there. She actually starts the first part of the procedure, which is pain relief, while the anesthesiologist and surgical team are already waiting for her.

Anaesthesia

Since the procedure is abdominal and takes anywhere from 25 to 45 minutes, or even longer, pain relief is required. Pain relief that is sufficient is the first step. It establishes the level of comfort the patient will experience and the surgeon’s level of ease of operation.

In the event that epidural anesthesia is chosen, the actual procedure will start a little later because it takes roughly 15 to 20 minutes from the time pain is relieved until the desired result is obtained. The patient is either positioned on the operating table with her head and shoulders bent forward and her back rounded, or she is placed on her side with her legs tucked in (fetal position).

After applying an antiseptic to the lumbar spine, the anesthesiologist does a lumbar puncture. During this procedure, a test dose of anesthetic is injected into the epidural space of the spine through a catheter that has been inserted and made punctured between the vertebrae using a thin, special needle. If nothing strange occurs after three minutes, the main anesthetic dose is given. After fifteen minutes, the woman stops feeling in her lower abdomen and legs and starts to experience tingling and numbness in that area of her body.

The anesthesiologist speaks with the patient and continuously checks on her blood pressure, heart rate, and overall health. He tests the patient’s motor and sensory sensitivity before instructing the surgical team on whether or not the patient is ready for surgery. The laboring woman is placed in front of a screen so she won’t have to think about what’s happening while the doctors perform the actual procedure. Due to the medications obstructing the passage of nerve impulses from the nerve endings to the brain, the woman is aware but does not experience pain.

The time for general anesthesia is shorter. After fixing her hands and placing the catheter into Vienna, the woman is placed on the operating table and given anesthetics along the way. The anesthesiologist quickly places an intubation tube in the trachea and attaches the patient to a ventilator once the patient nods off, which takes only a few seconds. The physician may adjust the medication dosages while the procedure is being performed. While the laboring woman is unconscious and fast asleep, doctors can start the procedure.

When a vaginal birth is neither safe nor feasible, a cesarean section, or C-section, is a surgical procedure used to deliver the baby. There are multiple distinct phases to the procedure: initially, the mother receives anesthesia, typically through a spinal or epidural block. To carefully remove the baby, a horizontal incision is then made in the uterus and lower abdomen. The placenta is removed along with the baby after delivery, and the wounds are stitched up carefully. This procedure helps to effectively manage a variety of birth complications while guaranteeing the safety of both mother and child.

Step-by-step progress of operative labor

It should be mentioned that there are numerous ways to carry out the procedure. Depending on the case, circumstances, anamnesis, indications, and individual preferences, the surgeon selects a particular one. There are techniques that involve cutting every layer and then suturing it, techniques that reduce tissue dissection, and techniques that just involve moving muscle tissue to the side by hand. It is possible for the incision to be horizontal or vertical.

The best option is thought to be a low horizontal incision in the lower uterine segment because these sutures heal more readily, make it possible to carry a subsequent pregnancy to term without difficulty, and even allow the woman to give birth to a second child naturally, provided she chooses to do so and there are no medical reasons not to.

Regardless of the delivery method the physician selects, the procedure will consist of the primary phases, which we will go over in greater detail.

Laparotomy

The anterior abdominal wall is cut, the abdomen is cleaned with an antiseptic, and it is wrapped in sterile cloth to keep it separate from the rest of the body. An incision is made four centimeters below the navel and brought to a point four centimeters above the pubic symphysis in a lower midline laparotomy via vertical cutting. A horizontal cut, also known as a Pfannenstiel laparotomy, involves making an arcuate incision that is 12 to 15 centimeters long, or longer if needed, along the skin fold above the pubis.

It is also possible to do a Joel-Cohen laparotomy, in which the incision is made just above the peripubic fold but horizontally below the navel. If necessary, an incision of this kind can be extended with specialty scissors.

To avoid inadvertently hurting the bladder, the muscles are gently moved aside and it is temporarily repositioned to the side. The uterine wall is the only barrier separating the doctor and the child.

Dissection of the uterus

Additionally, there are various methods for dissecting the reproductive organ. In case the surgeon has a strong preference for conventional methods, he has the option to create an incision either horizontally along the uterine body or vertically along the midline using the Sanger method. Fritsch suggests creating a pubic incision, which spans the entire uterus from one end to the other.

An incision made in the lower segment of the female reproductive organ is thought to be the most gentle and first-choice procedure. According to Rusakov, it can be transverse; Selheim claims it can be crescent or vertical.

The amniotic sac is opened by the doctor using either his hand or a surgical tool. It is thought that the best course of action in the event of an early birth is to keep the fetal membranes intact. This will make the newborn feel more comfortable and facilitate an easier transition.

Extraction of the fetus

The moment of greatest importance arrives. Doctors are concerned whether a child is born naturally or through surgical intervention because there is a small but still a chance that the fetus could be harmed during a CS. The surgeon inserts four fingers from his right hand into the uterus in order to lower these risks. When a baby is found with its head down, the medical professional’s hand moves toward the occipital region. Gently release one side of the head from the uterus and take the shoulders in turn. The child is extracted by the leg or inguinal bend if he is in the pelvic presentation. Grab the infant by the leg if it is lying across.

The fetal cord is severed. The infant is brought to the children’s department’s pediatrician, neonatologist, or nurse for various procedures such as weighing, placing clothespins on the umbilical cord, and other treatments. When a woman gives birth, her chest can be used to determine her child’s gender, height, and weight if she doesn’t get enough sleep. The meeting of the mother and child during a surgical birth under general anesthesia is postponed until after the woman awakens from the anesthesia.

Placenta extraction

Their hands are not connected to the placenta. It might be required to remove a portion of the myometrium and endometrium if it has grown in. When there is total ingrowth, the uterus is extracted whole. Along with making sure nothing is left inside, the surgeon examines the uterine cavity and determines whether the cervix’s cervical canal is passable. If not, the canal is manually expanded. This is required in order to allow lochia, or postpartum discharge, to freely exit the uterus cavity during the postpartum phase without creating inflammation and stagnation.

Suturing the uterus

The uterine margins are cut, and a single-row or double-row suture is placed there. Ideally, a double-row suture should be used. Even though applying it takes a little longer, it is more resilient. Every surgeon uses sutures in a different way.

The most important thing is to join the wound’s edges as precisely as possible. After that, the uterine scar will be level, consistent, and uniform, and it won’t affect the ability to conceive again.

Suturing the abdominal wall

Usually, a continuous suture is used, or separate silk or vicryl threads are used to suture the aponeurosis. The skin is sutured with separate sutures or staples. Occasionally, a very neat cosmetic suture is used to suture the skin.

Early postoperative period

After being moved to the intensive care unit, the woman is watched over for five to six hours. Everything matters: the uterus’s contractions, the recovery from anesthesia, and the return of sensitivity. Painkillers are used for two to three days to block pain following the return of sensitivity. In addition to taking temperature and blood pressure readings, contraction medications are given.

After six hours, if everything goes according to plan, the patient is moved to a general ward, where she will soon be able to sit and stand. She is given the baby.

Stage	Description
Preparation	The patient is given anesthesia, and the abdominal area is cleaned and prepped for surgery.
Incision	A small cut is made in the lower abdomen and uterus to access the baby.
Delivery	The baby is carefully lifted out of the uterus and handed to the medical team for immediate care.
Placenta Removal	The placenta is removed from the uterus, and the area is cleaned to prevent infection.
Stitching	The uterus and abdominal layers are stitched back together, and a bandage is applied.

For expectant parents, knowing the phases of a cesarean section can help demystify the procedure. The goal of this meticulously planned operation is to guarantee the safety of both mother and child. Every stage, from the first cut to the baby’s delivery, is meticulously planned to address any possible outcomes.

Once the incision is made, the placenta is removed and the incision is carefully closed after the baby is gently delivered. After surgery, attention turns to recovery, during which medical professionals keep an eye on the mother and child to make sure everything goes smoothly. Despite its complexity, the entire procedure is carried out with the highest care and skill to ensure the best results for the mother and the child.

Video on the topic

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