When a cesarean section is the only saviour

If you are pregnant, chances are good that you will be able to deliver your baby through the birth canal. But there are cases when a C-section is needed for the safety of the mother or baby, writes Dr Kizito Lubano

A Cesarean section is the delivery of a baby through a cut (incision) in the mother’s belly and uterus. It is often called a C-section. In most cases, a woman can be awake during the birth and be with her newborn soon afterward.

So even if you plan on a vaginal birth, it’s a good idea to learn about C-section, in case the unexpected happens.

When a C-section is needed

A C-section may be planned or unplanned. In most cases, doctors do C-sections because of problems that arise during labour. Reasons you might need an unplanned C-section include:

•     Labor is slow and hard or stops completely.

•     The baby shows signs of distress, such as a very fast or slow heart rate, or passes meconium (baby’s stomach contents).

•     A problem with the placenta or umbilical cord puts the baby at risk.

•     The baby is too big to be delivered through the vagina.

These reasons fall under categories known as 4Ps- Power (uterine contractions); P-Passage (Birth canal); P-Passenger (baby); and P-Psyche (maternal motivation).

When doctors know about a problem ahead of time, they may schedule a C-section. Reasons you might have a planned C-section include:

•     The baby is not in a head-down position close to your due date.

•     You have a problem such as heart disease that could be made worse by the stress of labour.

•     You have an infection that you could pass to the baby during a vaginal birth.

•     You are carrying more than one baby (multiple pregnancy).

•     You had a C-section before, and you have the same problems this time or your doctor thinks labour might cause your scar to tear (uterine rupture).

In some cases, a woman who had a C-section in the past may be able to deliver her next baby through the birth canal. This is called vaginal birth after cesarean. If you have had a previous C-section, ask your doctor if this might be an option this time.

In the past 40 years, the rate of cesarean deliveries has jumped from about one out of 20 births to about one out of four births. This trend has caused experts to worry that C-section is being done more often than it is needed. Because of the risks, experts feel that C-section should only be done for medical reasons.

Risks of C-section

Most mothers and babies do well after C-section. But it is a major surgery, so it carries more risk than a normal vaginal delivery. Some possible risks of C-section include:

•     Infection of the incision or the uterus.

•     Heavy blood loss.

•     Blood clots in the mother’s legs or lungs.

•     Injury to the mother or baby.

•     Problems from the anesthesia, such as nausea, vomiting, and severe headache.

•     Breathing problems in the baby if it was delivered before its due date.

If a woman with a C-section scar gets pregnant again, she has a small risk of the scar tearing open during labour (uterine rupture).

She also has a slightly higher risk to develop a problem with the placenta called placenta previa.

How a C-section is done

Before a C-section, a needle called an IV is put in one of the mother’s veins to give fluids and medicine during the surgery. She will then get medicine to numb her belly and legs. Fast-acting general anesthesia, which makes the mother sleep during the surgery, is only used in an emergency.

Once the anesthesia is working, the doctor makes the incision. Usually it is made low across the belly, just above the pubic hair-line. This is called a bikini cut.

Sometimes the incision is made from the navel down to the pubic area.  After lifting the baby out, the doctor removes the placenta and closes the incision with stitches.