The dynamics of a cesarean section

Before a cesarean section is performed, the health expert will explain why he believes a cesarean section is necessary and the patient is in most cases asked to sign a consent form.

Saturday, November 03, 2012
Dr.Joseph Kamugisha

Before a cesarean section is performed, the health expert will explain why he believes a cesarean section is necessary and the patient is in most cases asked to sign a consent form. Under such conditions, it is advisable to have both partners’ available for the consent and can stay together during most of the preparations for delivery. However, there are rare circumstances where the cesarean section is such an emergency that there’s no time for the husband to be called on or not allowed in the operating room.Before the patient enters operating room, she is cleaned and dressed with sterile hospital dressings. Normally nurses shave the top section of the patient pubic hair before she is moved into an operating room.A catheter is then inserted into the female urethra to drain urine during the procedure. This is done especially to protect the bladder during delivery procedures. The urinary bladder is one of the closest neighbors of the uterus.Since cesarean section is a major surgical procedure, anesthesia is an obligation. Anesthesia is the act of drug administration into the patient body system to prevent or minimize pain brought about by a given surgical procedure. Anesthesiologists are doctors or nurses trained to carry out anesthesia procedures and will then come by review of various options to manage pain.Today general anesthesia is not considered in most of c-section procedures except in the most extreme emergency situations or if the patient cannot have regional pain relief like an epidural or spinal block for some reason.An epidural or spinal block is the one which is given to numb the lower half of the body but leave a patient awake and alert for the birth or delivery of her baby. The lower half of the body involves the abdomen and legs. The drug for use is injected through the spine just between the vertebral spaces of the low back.The patient is always administered with an antacid medication such as cimetidine before surgery as a precautionary measure. This is because in cases of emergency, the patient might need general anesthesia that puts her at risk for vomiting while she is unconscious and thereby inhaling stomach contents into the lungs. The antacid neutralizes the stomach acid so that it does not damage the lung tissue in such circumstances.The patient is also administered with antibiotics through the intra-venous, IV line to help prevent infection after the operation. Some health experts have previously administered antibiotics after surgery, but the newest recommendations require giving them before surgery is performed.After all anesthesia procedures are done, there is an obstacle raised above the waist to refrain the patient from seeing the incision being made by the doctor.At deliveryThe mother’s belly is swabbed with an antiseptic, and the doctor will most likely make a small, horizontal incision in the skin above the pubic bone. The doctor will then cut through the underlying tissue, slowly working his way down into the abdomen in order to reach the uterus. When abdominal muscles are reached, they are separated manually rather than cutting through them. This is done to minimize trauma to the muscular tissue. The separation of the muscle exposes the underneath peritoneal linings that are also separated manually to reach the uterus. The uterus is pulled manually and gently onto the outer skin surface of the abdominal wall.At the uterus, a horizontal cut in the lower section is made. In a normal position of the baby with head presentation, the baby’s head is gently pulled or delivered from the mother’s uterus followed by other parts of the body. The umbilical cord that serves as a link between the fetus and mother during pregnancy is clamped at its middle length to limit blood circulation before its cut. After the umbilical cord is cut, the new baby is cleaned and airway checked. This is a point where mothers are able to see their newly born babies during a cesarean delivery procedure.The placenta is then delivered and the uterus is cleaned by sterile gauze to remove clots of blood. The uterus is closed or sutured in two planes or layers before it is pushed back into its abdominal position. In rare circumstances, the doctor will opt for a vertical or classical uterine incision. The disadvantage with this incision is that the mother will not be able to deliver vaginally or normally with the next pregnancy.Stitches are made to muscle layers until the final closure of the abdomen. Stitches used for closure of the uterus and abdominal muscle layers will normally dissolve in the body.