C-sections 101

D-day surprises
With a childbirth class under your belt and a neatly typed birth plan tucked in your bag, you may be surprised to arrive at the hospital on the big day only to find that Mother Nature has a different scheme up her sleeve. It’s a good idea to be prepped to roll with the punches in case the unexpected occurs. The following scenarios may result in your doctor advising you to have an unplanned C-section:

• Stalled labor and failed attempts to get things moving again
  Baby’s heart rate indicates he cannot withstand induction or continued labor
• Prolapsed umbilical cord (when the umbilical cord slips through the cervix, it may cut off the oxygen supply to your baby)
• Placental abruption (when the placenta separates from the uterine wall, your baby will be deprived of oxygen if not delivered immediately)

Calculated cesareans
Although the business of childbirth isn’t an exact science, there are several instances in which your doctor will make plans to deliver via C-section well before the contractions begin. Medical reasons to book an OR in advance may include:

• Maternal obesity
• Multiple births (three or more babies require a C-section, as do some twins)
• Maternal conditions such as heart disease, HIV, active genital herpes outbreak, preeclampsia or diabetes that make labor or vaginal delivery too risky
• Breech (bottom down) or transverse (sideways) positioning of the baby
• Multiple previous cesareans or a previous C-section with a classical vertical uterine incision
• Cephalopelvic disproportion (baby’s head is too large to fit through the mother’s pelvis)
• Macrosomia (a very large baby)
• Placenta previa (the placenta is so low in the uterus that it blocks the cervical opening)

The play-by-play
Whether you’re scheduled for a C-section or not, arriving at the hospital prepared for every potential birthing possibility will make for a calmer, more enjoyable delivery. Here’s what to expect when giving birth via cesarean:

• After checking in at the hospital and signing consent forms, an IV will be started for easy administration of medication at any point during the delivery.
• You will most likely be given regional anesthesia in the form of an epidural or spinal block. This will numb the lower half of your body but allow you to remain awake during the birth. (Rare emergency cases require general anesthesia, in which case you would be put to sleep for the birth.)
• The top section of your pubic hair will be shaved and a catheter will be inserted into your bladder.
• Once in the operating room, your abdomen will be washed down with antiseptic solution and sterile drapes will be positioned around the exposed area. A screen will be set up near your shoulders so you don’t have to see the incision being made. (If you wish, you can ask for the screen to be partially lowered so you can watch the birth.)
• While your partner, outfitted in sterile garb, sits by your head and holds your hand, the doctor will make a horizontal incision in the skin just above your pubic bone.
• Slowly cutting through the tissue, the doctor will work down to the uterus. When the doctor has reached the abdominal muscles, she will gently spread them apart with her hands.
• Upon reaching the uterus, the doctor will carefully make an incision. Usually this will be a horizontal low transverse incision, but in some cases (such as a premature birth), the doctor will opt for a classical vertical uterine incision.
• Finally, the doctor will reach in and ease baby out. You will get your first glimpse of your new arrival as her nose and mouth are suctioned and the cord is clamped and cut.

As baby is being examined and bathed nearby, the doctor will remove the placenta and begin to stitch you back up. You will be able to enjoy baby up close as your partner holds her right by your head. More physical bonding and cuddling time will have to wait until you are taken to the recovery room, where you can nurse your newborn for the first time.