Table of contents:
- Indications for Caesarean section
- Caesarean Operation Warning
- Before C-section
- C-section Procedure
- After C-section
- Complications of Caesarean section
C-section is a medical procedure that aims to remove the baby through an incision in the mother's abdomen and uterus, usually made transversely just below the waist line
In many cases, cesarean section is performed under epidural anesthesia or spinal anesthesia where the mother can remain conscious during the operation process. The majority of mothers who undergo a cesarean delivery process can go home from the hospital 3 to 5 days after the surgical procedure. However, to fully recover, regular home care and regular check-ups with a gynecologist are required for a period of approximately one month.
Indications for Caesarean section
C-section can be done if the mother wants to give birth by surgery (elective) or as an emergency measure when the doctor feels the mother's pregnancy is too risky to be born normally. Doctors may consider cesarean section in several conditions such as:
- The fetus does not get enough oxygen and nutrients, so it must be delivered as soon as possible.
- The mother has an infection, such as a genital herpes infection or HIV.
- The labor did not go well or the mother experienced excessive vaginal bleeding.
- Mother experiencing pregnancy with high blood pressure (preeclampsia).
- The mother has a placenta that is too low (placenta previa).
- The position of the fetus in the uterus is not normal and the doctor cannot correct its position.
- Obstruction of the birth canal, for example due to a narrow pelvis.
- The umbilical cord exits through the cervix before the fetus or the umbilical cord is compressed by the uterus during contractions.
- Undergoing a cesarean section in previous deliveries.
- Mother is carrying more than one fetus at the same time (twins).
Caesarean Operation Warning
If you are planning to have a cesarean delivery, consult an anesthesiologist about your medical history. This is to avoid the negative effects that may arise due to the administration of anesthesia during a cesarean section.
For mothers who are planning a vaginal delivery, it never hurts to discuss with the doctor about the possibility of a cesarean section. This is in preparation if you have to have a caesarean section unexpectedly.
However, please note that caesarean section can cause a population imbalance between good bacteria and bad bacteria in the baby's intestines. This should be obtained from the baby's contact with good bacteria from the mother's vagina during the normal delivery process.
The above conditions can cause imperfect formation of the baby's natural immune system. As a result, babies are more at risk for diseases related to the immune system, such as allergies, asthma, eczema, and even autoimmune diseases, such as type 1 diabetes and colitis.
Even so, there are several ways that are thought to reduce a child's risk of this immune-related disease. One of them is by giving breast milk (ASI), especially in the first 6 months of life.
ASI is the most complete and most appropriate source of nutrition for babies. In addition to containing various kinds of nutrients, breast milk also naturally contains synbiotics, which are a combination of probiotics (good bacteria for the digestive tract) and prebiotics (nutrients that help the development of probiotics).
The synbiotic content in breast milk can help the growth of good bacteria and suppress the growth of bad bacteria in the baby's intestines. By achieving this balance, a strong natural immune system can be formed and protect the baby from various diseases.
You can consult with your pediatrician regarding the proper nutritional needs for your baby.
Some of the tests that the doctor may do before a cesarean section are:
- Blood test. The patient will be advised to undergo a blood test, so that the doctor can determine your hemoglobin level and blood type. Blood type tests need to be done in preparation for transfusion if needed.
- Amniocentesis. This test may be recommended if you are going to have a cesarean section before 39 weeks of pregnancy. The doctor will check the maturity of the fetal lungs by examining a sample of amniotic fluid in the laboratory.
Patients are required to fast for several hours before the operation. Your doctor or nurse will tell you how much time you need to fast. The doctor will also prescribe some medicines to the patient before undergoing a cesarean section such as:
- Antiemetic (to prevent nausea)
- Antacids (to reduce the patient's stomach acid levels)
The doctor can also ask the patient to clean the whole body with antiseptic soap before the cesarean section is performed. This aims to reduce the risk of infection. Patients are also asked not to shave pubic hair, because it can increase the risk of infection at the surgical site.
The initial preparation that the doctor will do to the patient in the operating room is to give anesthesia and empty the bladder. This is usually done by means of a catheter.
The anesthesia given is generally epidural or spinal anesthesia which will only numb the lower body, but keep the patient awake. But keep in mind, for some conditions, the doctor may give you general anesthesia, in which you will fall asleep during the process. Talk to your doctor about the type of surgery that best suits your condition.
The following is the sequence of caesarean section procedures that are generally performed by doctors:
- The patient will be lying on the operating table with the head slightly elevated.
- After that the doctor will make an incision of 10 to 20 centimeters in the patient's abdomen and uterus. Usually the incision is made horizontally slightly below the waist line. However, if it feels more appropriate, the doctor can also make a vertical incision below the navel.
- The patient's baby will be removed through the incision made. This process usually takes 5 to 10 minutes. During this process, the patient will feel a slight tug.
- If everything is normal, generally the doctor will show and give the baby to the patient shortly after being removed from the stomach.
- The doctor will then remove the placenta from the uterus, and give an injection of the hormone oxytocin to stimulate uterine contractions so that the bleeding will decrease and eventually stop completely.
- The doctor will close the incision in the uterus and abdomen with stitches. The entire C-section procedure will generally take 40 to 50 minutes.
Patients will be transferred from the operating room to the treatment room when all caesarean section procedures have been performed and the patient's condition is normal. The doctor will prescribe pain medication to reduce pain at the incision site. Patients will be advised to get up and walk shortly after returning to the treatment room.
There will be normal bleeding that comes out of the vagina in the first few days after a cesarean section.This blood is called lochia. In the first three days, lochia can be sufficient and bright red in color, and the color will slowly turn brown, until finally yellow to white.
However, what you need to watch out for is if there is a lot of blood that you have to change pads more than twice in 1 hour for at least two consecutive hours. Also, lochia is considered abnormal if it is still red in color and there are still very large numbers on the 4th day after the C-section, or if your lochia smells bad and you have a fever.
Doctors will also carry out treatment to prevent blood clots from occurring. Treatments that can be given include compression stockings or injection of anticoagulant drugs.
In addition, patients will be given counseling assistance to breastfeed their babies. The catheter will be removed when the patient is able to walk or about 12 to 18 hours after the C-section is complete.
When leaving the hospital the doctor will recommend several things the patient should do during the recovery period at home, namely:
- Support the belly with a pillow while breastfeeding.
- Avoid lifting anything heavier than a baby and get plenty of rest.
- Drink plenty of fluids to replace fluids lost during cesarean section and breastfeeding and prevent constipation.
- Avoid having sex until the time permitted by the doctor. Usually the patient is prohibited from having sex four to six weeks after the cesarean section.
- Take painkillers according to the doctor's prescription.
The following steps can also be taken by the patient for the incision, namely cleaning and drying the wound slowly every day, being aware of signs of infection at the incision site, and wearing loose clothing made of comfortable material.
Immediately consult a doctor if the patient feels any of the following:
- Swelling or pain in the lower leg.
- Severe pain.
- Pain when urinating.
- Urine leak.
- The appearance of pus or smelly fluid from the incision wound.
- The incision becomes red, painful, and swollen.
- Coughing or shortness of breath.
- A lot of vaginal bleeding. You need to be careful if you have to change pads more than twice an hour for at least two hours in a row.
Complications of Caesarean section
Caesar is one of the major surgeries that has several risks for both mother and baby. Some of the risks that can develop in babies born by caesarean section are:
- Surgery injuries. Although it is rare, incisions in the baby's skin can occur during the surgical process.
- Respiratory problems. Babies born by cesarean section are at increased risk of abnormally fast breathing during the first few days after birth.
While some of the risks that can befall mothers who undergo caesarean section are as follows:
- Bleeding that is getting worse. Cesarean patients will usually experience more severe bleeding during a cesarean section when compared to a normal delivery process.
- Injury from surgery. This can happen to the organs around the uterus.
- Blood clots. Cesarean patients may experience blood clots in the veins, especially in the legs or pelvic organs.
- Increased risk of complications in subsequent pregnancies. Although rare, cesarean section can increase the risk of problems in subsequent pregnancies, such as the stitches in the uterus open, the placenta attaches to the uterus, and fetal death in utero.
- Wound infection. This will be more risky in the process of delivery by caesarean section than normal.
- Side effects of anesthetic drugs. Although it is rare, caesarean patients may experience negative effects of anesthesia such as severe headaches.
- Infection and inflammation of the uterine membrane lining. This can cause fever, foul-smelling vaginal discharge, and painful urination.