The caesarean section: procedure and reasons

Primary and secondary cesarean section

In general, a caesarean section is divided into a primary and a secondary intervention. In the so-called primary caesarean section, the decision to have an operative delivery is made before the birth begins. The caesarean section is usually used to avert the foreseeable dangers of a vaginal birth. In the case of a secondary caesarean section, the decision is made during delivery for urgent medical reasons.

Reasons for planned caesarean section

Medical reasons for a planned caesarean section can be:

• serious illnesses in the mother (e.g. HIV, retinal detachments)
• previous uterine surgery
• Complicated fetal position that makes vaginal birth difficult or impossible (e.g. breech presentation )
• the child is too small or weak for a vaginal birth (e.g. because it has to be born earlier)
• previous preterm births
• Disproportion of child’s head and maternal pelvis
• Placenta previa
• malformations in the child
• threatened undersupply of the child

Reasons for an optional caesarean section

Another type of primary caesarean section, in addition to the planned caesarean section, is the desired caesarean section . There is no immediate medical indication for this procedure. As the name suggests, it is also carried out at the patient’s request, since she fears, for example, that she will not be able to go through the birth process or is afraid of the physical consequences of a vaginal birth.

Reasons for a caesarean section during childbirth

One speaks of a secondary caesarean section when the circumstances during the birth make a section delivery necessary because there is an acute danger for mother or child. You can find out more about this in our article on emergency c-sections .

There are absolute and relative reasons for having a caesarean. That is why it is all the more important that you have a detailed consultation with your doctor before you give birth, in which he describes the course of the operation to you and, above all, explains the risks of a caesarean section .

Caesarean section: preparation and procedure

If you have decided to give birth to your child by caesarean section, you should appear at the clinic on the day of the birth (usually around 38 weeks of pregnancy) a few hours before the start of the operation so that all the preparations can be made in peace.

• As a rule, an ultrasound examination and a CTG are carried out first to check the condition of your unborn child.
• This is followed by a shave of your genital area, as the doctor will later make the abdominal incision below the pubic hair line, so that the caesarean section scar is covered by hair or underwear after the operation.
• In most cases, a urinary catheter is placed so that the urinary bladder remains empty during childbirth and does not get in the way of the operation that follows. You will also be put on thrombosis stockings and a surgical shirt.
• After these preparations, you will be taken to the operating room, where the anesthetic will be administered. Today, caesarean sections are usually performed using regional anesthetic methods, such as spinal or epidural anesthesia ( PDA ). You remain conscious during the operation, but you don’t feel any pain, only tension and pressure. General anesthesia is usually only used in emergencies because it takes effect more quickly.
• Once the anesthetic takes effect, your abdomen will be disinfected in and around the surgical area. Your legs and the rest of your stomach will be covered with sterile towels. Finally, the view of the surgical area is blocked by a cloth that is hung vertically below your face over your upper body.

Procedure of the caesarean section OP

At the beginning of the delivery, the surgeon opens your abdomen with a horizontal incision about 12 centimeters long below the pubic hairline. The remaining layers of fat and tissue are then opened up. Originally, all of these layers were opened by incisions, but today the method of the so-called “gentle” caesarean section is used in many clinics.

Misgav-Ladach method

In this method, which is named after the Israeli hospital Misgav Ladach where it was invented, the individual layers of tissue are not cut through, but rather bluntly stretched and torn with the hands. This sounds very painful at first, but it is a lot gentler on the tissue than cutting through all the layers. In contrast to a cut, a tear seeks the path of least resistance and thus cuts fewer blood vessels. As a result, the patient loses less blood during the operation than with a conventional caesarean section and the wound can later heal faster. The duration of the operation is also reduced, since the individual layers of tissue usually do not have to be sewn up, but usually grow back together by themselves.

The delivery

After the skin incision, the surgeon stretches your abdominal wall by hand and pushes the abdominal muscles to the side. He also opens the underlying peritoneum by hand to prevent injuries to the intestines and bladder. The uterus is then opened in the lower third near the bladder, depending on the surgical method used, with a long incision or a small incision with subsequent tearing of the tissue. Your baby is removed from the uterus, which contracts immediately afterwards. If the delivery takes place under regional anesthesia and there are no complications , you can already hold your child at this point. The surgeon now removes the placenta that is coming offand checks that no remains of the placenta are left in the uterus. Finally, the individual abdominal layers are closed again by either all layers being sewn up individually or just your abdominal wall. The entire procedure takes about 20 to 30 minutes, and your baby will be delivered after just a few minutes. While the surgical team sews up your wounds, a midwife performs the initial examination of your newborn .

Aftercare after a cesarean section

After the operation, you will usually remain in the delivery room for about two to three hours, during which time your condition will be checked by a doctor. You cannot get up during this time, but your baby is with you after a complication-free birth and you can hold it in your arms. Your partner or another accompanying person can also keep you company. If the Misgav-Ladach method was used on you, the inserted urinary catheter can be removed after just a few hours, otherwise it usually remains in place until the next day.

After a caesarean section, you should expect to stay in the hospital for four to six days. The length of your stay depends primarily on how well the wounds resulting from the operation heal. Because even if certain birth injuries, such as a perineal tear , can be prevented by a caesarean section, you should also consider that a section delivery deliberately causes a serious wound that extends through several layers of tissue. You should therefore not make a decision for or against a caesarean section lightly. Consider all the pros and cons of the method and discuss the options with your partner or a midwife who can help you make a decision.