105. Medical Procedures And Medications In Labour

A cesarean birth or c-section is the birth of your baby through an incision (cut) made into your abdomen and uterus. Some cesarean briths are planned; others are done iafter labour has begun.

In some cases, vaginal birth is not possible or would cause undue risk to the mother or baby. A cesarean birth may be necessary for several reasons:

• Fetal distress: This occurs when your baby is not tolerating the stress of labour. Signs of fetal distress may be noted in a change in the baby’s heart rate and/or if there is meconium in the amniotic fluid
• Cephalopelvic disproportion (CPD): This means that your baby is too large to pass safely through your pelvis
• Breech position: This is when your baby is lying buttocks (bottom) or feet first. Some women may be able to birth vaginally; however, there may be concerns for the safety of the baby, especially in a first pregnancy
• Complicated multiple births (twins or triplets): Where one or more of the babies are breech or lying sideways (transverse position)
• Vaginal bleeding: This may mean a problem with the placenta. Vaginal bleeding may occur if the placenta is below the baby and lies over part or all of the cervix (placenta previa) or if the placenta begins to separate from the wall of the uterus before the birth (abruptio placenta)
• Malpresentation: If the baby is lying in the transverse (sideways) position a cesarean birth is necessary as a vaginal birth is not possible. Other malpresentations may include brow or face presentation
• Active herpes: Virus infections will also require delivery by cesarean birth as the baby can become infected as it passes through the vagina
• Cord prolapse: Rarely, if membranes rupture in a gush, the cord can be carried along and become caught between the baby and your pelvis. If this occurs, every contraction compresses the cord and decreases the blood supply to the baby

The doctor will book your cesarean birth with the hospital. You will go to the hospital the same day your surgery is booked.

Have a late night snack the night before the surgery. You will likely be instructed to not eat or drink anything for at least 8 hours before your surgery, unless told otherwise by your anesthetist. In the morning, have a shower before coming to the hospital.

The nurses will get you ready for surgery by:

• Making sure that blood tests are done
• Taking your blood pressure, pulse, temperature, and fetal heart
• Inserting a catheter (thin, rubber tube) into your bladder to make sure that your bladder is always empty
• Starting an intravenous (IV)
• Putting support stockings on your lower legs to prevent blood pooling and clot formation

• Monitoring equipment will be used to check your blood pressure and heart rate
• You will lie down on the operating room table which will tilt a bit to the left (there are supports on the side to keep you from slipping)
• Your abdomen and thighs will be washed and covered with sterilized cloths, leaving only a small area on your abdomen exposed. The arm with the IV, or possibly both arms, will rest on an arm board away from your body with straps to help you hold them in place
• The order of these events will differ depending on whether you have a general or regional anesthetic (epidural or spinal)
• When you are completely anesthetized, the surgery will begin
• There are 2 types of incisions that the doctor may make on your abdomen and uterus
  • The most common is a low transverse and lower segment incision. This incision heals with little scarring and is in an area that is better able to withstand the stress of a future vaginal birth. The surgeon will make the first incision on your skin low on your abdomen, along the “bikini” line. The next incision will be on the lower segment of your uterus.
  • Less commonly used is the vertical or “classical” incision. A doctor may choose to do a ‘classical’ incision if it is a critical emergency, if the baby is very premature and the lower segment of the uterus is not developed, or the baby is in a position such that a lower segment incision is not safe. The “classical” incision is through the main part of the uterus and may be less likely to withstand the stress of a future vaginal birth.
• During the delivery of your baby you will feel pulling and tugging as the doctors help your baby to get in a position to be born. (It helps to do some nice slow deep breaths.)

It may seem like there are a lot of people in the operating room during a cesarean birth. Each person is there to do a certain job to ensure that the procedure goes well. There will be a group of professionals to care for you and another group to care for your baby once it’s born.

• The Anesthetist: Administers regional or general anesthesia and monitors its effectiveness, also monitors the vital signs of you and your baby during surgery
• The Doctors: An obstetrician will be in charge of performing your surgery, with another doctor assisting. It is possible that a third doctor or resident doctor may also assist
• The Nurses: There will be 2 or 3 nurses to assist the doctors and care for you
• The Baby Team: Can be made up of a combination of the following professionals depending on the circumstances of your baby’s birth:
  • A nurse from the special care nursery (SCN) or Neonatal Intensive Care Unit (NICU)
  • A pediatric resident and/or Neonatologist from NICU
  • A respiratory therapist to assist your baby if he/she needs it
• You and your support person!