La Caesarean is a surgical procedure that allows give birth to a woman by practicing a incision in the abdomen and uterus.

It is a technique used very frequently: depending on the country, on average, 15 to 30% of deliveries are done by cesarean section (sometimes more). In France and Quebec, about one in five women give birth by Caesarean section.

In general, doctors opt for cesarean section when conditions, in the mother or in the child, are not favorable for a natural childbirth. Caesarean section can be scheduled or performed on an emergency basis. The indications are not the same in these two situations.

In less than half of cases, the cesarean section is scheduled in advance (it is performed before the natural onset of labor). The reasons are various:

• abnormal presentation of the child (transverse or head office presentation)
• abnormal localization of the placenta  (placenta prævia)
• multiple pregnancy
• very high weight child (macrosome over 4,5 kg)
• problems during pregnancy (maternal preeclampsia, stunted growth of the child)
• history of cesarean section for a previous pregnancy (although a vaginal birth is possible in most cases)
• infection of mother with certain viruses like HIV (the cesarean does not contaminate the baby)
• certain obstetric history (uterine rupture, complicated shoulder dystocia, complicated uterine scars, etc.)
• mother’s decision for reasons of convenience (some doctors accept it, although the Haute Autorité de santé en France considers that the mother’s request is not an indication)

Caesarean section can also be performed urgently, during pregnancy or when the delivery does not go as planned, and vaginal labor becomes impossible or too risky for the mother and / or child:

• abnormal heart rhythms of the child (fetal distress)
• stopping cervical dilation despite medications
• hypoxia (= lack of oxygen) of mother or child
• failed forceps extraction
• maternal bleeding (placental abruption, suspicion of uterine rupture, etc.)
• risk of serious lesions of the pelvic floor with involvement of the urethral and anal sphincters, etc.
• preeclampsia attack, a disease that can occur during pregnancy and cause, among other things, severe hypertension.

Cesarean section is performed under anesthesia, most often loco-regional (epidural anesthesia) and more rarely under general anesthesia.

It consists of incising the abdominal wall and the uterus (= hysterotomy) to extract the baby and the placenta.

The incision is made horizontally just above the pubic hair and the child is withdrawn through this opening. In some cases, an instrumental aid (forceps, suction cup) is necessary to get the baby out.

When programmed, the patient will be asked, before the operation:

• remove jewelry and all traces of nail polish
• to shave the pubis (can be done by the medical team)
• to take a shower (with an iodized antiseptic)
• put on an outfit for the boulder (blouse and charlotte)

Once in the operating room, an infusion and a urinary catheter are placed and anesthesia is performed.

A sterile drape (sheet) is installed so that the woman cannot see the operation.

Depending on the medical team and the circumstances (emergency or not), the father or the accompanying person may be present in the operating room.

After the baby is extracted, the incision is sutured (or stapled) and the mother is placed under surveillance for about 2 hours to make sure there are no complications.

The urinary catheter and intravenous infusion are usually left in place for a few hours.

In some cases, it is possible for her to keep her baby with her, skin to skin, but more often than not, in most maternity hospitals, the baby is not given to her immediately.

Risks and complications of cesarean section

Like any surgical procedure, a cesarean section can involve risks.

The urinary catheter can cause minor urinary tract infections in the days following the operation (the most common complication).

Inflammatory reactions or a hematoma in the scar can sometimes appear. More rarely, bowel obstruction, severe bleeding, or infection of the uterus may occur. There is also a very low risk of phlebitis (= blood clot in a vein) or pulmonary embolism. Anticoagulant injections will usually be given to prevent this.

Usually, discharge from the maternity hospital takes place 4-7 days after childbirth. It is normal to feel pain and tightness in the scar: analgesic drugs may be prescribed for a few days.

As after a vaginal birth, vaginal blood loss, scanty, persists for a few weeks (about 4 to 6).

You should know that after a first cesarean section, it is often possible to give birth vaginally during subsequent pregnancies. This should be discussed with your doctor, depending on the indications for the cesarean section and the progress of the pregnancy.