Caesarean section (C-section) procedure

Let us first of all understand what is C-Section (Caesarean section) procedure:

It is a surgical procedure, adopted by Doctor for the delivery of a baby through a surgical incision in the mother’s abdomen and uterus. In certain situations, a C-section is scheduled in advance. In others, it’s done in response to an unforeseen complication.

Normally, the delivery (birth of a baby) occurs through Vagina which is the natural method of birth for all mammals including Human beings. The average length of a stay in hospital for a normal vaginal delivery is 36–48 hours or,  it may be extended upto 60 hrs in case of episiotomy in which, a surgical cut in the muscular area between the vagina and the anus (the area called the perineum) is made just before delivery to enlarge your vaginal opening. The stay in hospital in cases where C-Section procedure is carried out, may further be extended upto 108 hours.

Different types of normal vaginal deliveries have different terms:

• Spontaneous Vaginal Delivery (SVD) occurs without the use of drugs or techniques to induce labour, and the mother delivers her baby in natural way without use of Forceps, Vacuum extractor or, a C-Section procedure.
• Assisted Vaginal Delivery (AVD) occurs with or without the use of drugs or techniques to induce labour, and requires the use of special instruments like forceps or a vacuum extractor to deliver her baby.
• Induced Vaginal Delivery (IVD) occurs by involving Labour pain, initiated and induced with the help of drugs or, manual techniques to deliver baby.

All above deliveries are called Normal Vaginal Delivery (NVD) in which episiotomy may or, may not take place and such deliveries are different with a delivery by cesarean section.

The Caesarean Section procedure is an unnatural method of delivering the baby. That is why, the doctors normally recommend and advise to opt for this procedure  only when the risk factor in vaginal delivery is expected to be very high for mother &/or, baby.

The C-sections are also carried out for personal and social reasons.  

There are following probable complications and other risk factors, associated with vaginal delivery which warrant to opt for C-Section procedure:

• Breech or, Transverse positions (Abnormal position of baby in womb).
• Prolonged labour or, failure to progress (Dystocia).
• Fetal distress.
• Cord prolapse (when the umbilical cord comes out of the uterus with or before fetus).
• Risk of Uterine rupture.
• Hypertension or, Tachycardia in the mother or baby after Amniotic rupture (Preeclampsia).
• Complications related with problems in Placenta_abruption, accreta etc.
• Failure of AVD is conducive to adopt C-section procedure.
• If the weight of baby is more than 4 kg (Macrosomia).
• Complication of pregnancy in which, sometimes, the blood vessels of baby cross or run near the internal opening of the uterus (Vasa previa).

The prevalence of caesarean section procedure is higher than needed in many countries and physicians are encouraged to actively discourage C-section procedure. The rate of caesarean higher than 10-15% is not associated in any way with the reductions in mortality rate of maternal or infant.

Some of the efforts made in this direction is to emphasize the patient that a long latent phase of labour should not be treated as abnormal and it is not a sole justification to go for C-section.

Active labour starts from a cervical dilatation of 4 cm to 6 cm and allow at least 2 hours of pushing for women who have previously given birth and 3 hours of pushing for women who have not previously given birth. The physical exercise during pregnancy also decreases the risk of C-section procedure. The risk of death during caesarean section procedure is 13 per 1 lakh.

Women who undergo Caesarean section procedure may face the problems during pregnancy in later stage and hence, it is recommended that women who want larger families should not  go for elective caesarean procedure unless there are medical indications to do so.

A resuscitative hysterectomy, also known as a peri-mortem caesarean delivery, is an emergency caesarean delivery carried out where maternal cardiac arrest has occurred.

Aortocaval compression (it is the compression of the abdominal aorta and inferior  vena cava by the gravid uterus when a pregnant woman lies on her back i.e. in the position of supine), generated by the gravid uterus, is removed to assist in resuscitation of the mother. Here, unlike other forms of caesarean section, the welfare of the fetus is a secondary priority and the procedure may be performed even prior to the limit of  fetal viability if it is necessarily required for the survival of mother.

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