Narrator: About one in four women delivers her baby via Caesarean section, or C-section as it is commonly known. Although vaginal delivery is the natural and preferred method for childbirth, a C-section may be performed for the safety of mother and baby.
Bruce Johnston, M.D.: Preoperatively, the process begins early during the prenatal care if the patient knows she's going to have an elective Caesarean section. We talk about what she is to expect — the anesthetic or analgesic she's going to receive, the fact that she'll have a Foley catheter in her bladder (to drain urine), and that once she comes into the room, there will be many people in the room, including her scrub nurse, the anesthesiologist, the pediatrician and then the core of people that will actually perform her Caesarean section. We try to advise her what to expect, what times — how long potentially we think on an average it will actually take to perform the Caesarean section — and we like not to forget the father. The father is an important caregiver and is a good hand-holder for people who are doing this under regional anesthesia.
Mother: That's tart!
Gurinder Vasdev, M.D.: That was Bicitra, which neutralizes the acid in the stomach, because pregnant women tend to have a little more acid in their stomach than normal. This is so that if she feels sick or nauseated during surgery, she's not bringing up acid.
Narrator: Eighty percent of women having a C-section use regional analgesic for pain control — either an epidural or a spinal block. The other 20 percent use general anesthesia. You'll be made comfortable in a special surgical delivery room and administered pain medication. This video shows a spinal block. Placing a spinal begins with cleaning a small area in your lower back with antiseptic solution.
Dr. Vasdev: We're doing a spinal anesthetic, and we're going to draw up the medication for the spinal anesthetic. For that, we use a combination of a local anesthetic called bupivacaine, some opiate medication called fentanyl, and morphine, and that gives you analgesia for almost 24 to 48 hours after the C-section so that you don't require any form of IV pain relief.
Narrator: During placement of your spinal, you'll either lie on your side or sit up, and round your back. First an anesthetic is injected to numb the area. You may feel a pinprick when the anesthetic is injected, but the spinal block shouldn't cause any discomfort. Then the analgesic is injected into the sac of fluid surrounding the spinal nerves, below the level of the spinal cord. A spinal block takes effect almost immediately.
The blue shading in this illustration shows the area of your body numbed by the anesthetic.
Dr. Johnston: The total time for a Caesarean section varies significantly for people who are having repeat Caesarean sections. Our primary Caesarean sections generally take approximately 30 minutes total.
Narrator: Once the anesthetic has taken effect, your abdomen will be prepped for delivery of your baby. Your doctor will make two incisions, one through your abdominal wall, and another into your uterus.
There are two types of abdominal incisions: vertical and horizontal. Vertical incisions are usually done only in an emergency, from just below your navel to just above the pubic bone.
Horizontal incisions are also called Pfannenstiel incisions, or more commonly, bikini incisions. The horizontal incision is made across the lower abdomen, near the pubic hairline. Bikini incisions are used in most C-sections because they typically heal well, the scar is not easily seen and they may cause less post-delivery discomfort. The initial incision is about 6 inches long and cuts through your skin, fat and muscle to get to the uterus, where your baby is. Your doctor uses a special knife that burns, or cauterizes, the tissues to help control bleeding.
Dr. Johnston: When we perform a Caesarean section, it's the matter of several little steps. Basically most patients cosmetically are most interested in having an incision that goes across the lower part of their abdomen. It's called a Pfannenstiel incision. And when we make that incision, we go down through the skin and subcutaneous layers. Then we get a layer of fascia, or connective tissue, that covers up the rectus abdominis muscles. That (the connective tissue) is incised and then gently separated so that we can actually enter the tummy cavity where the uterus is without cutting any muscles. Once we do that, we make a little flap up underneath the bladder and then make our incision below that. We make it at a location where, if later on she desired to have a vaginal birth after her Caesarean section, it would be a possibility. Usually in approximately five to 10 minutes we've got the baby delivered, and the rest of the time is suturing and repairing the regional incision site.
Narrator: Because your anesthetic blocks pain but not motion, you'll likely feel some tugging when your baby is pulled out, but it shouldn't hurt. Once the baby is delivered, your doctor will remove the placenta and begin to close the incisions. Internal stitches dissolve, and don't need to be removed.
Dr. Johnston: Of course, once we deliver the baby, the steps are done in reverse, except it takes longer to repair the incisions than it did originally to make them. So we do the steps just backward and repair the incision in the uterus. Then we sequentially repair the body wall, which is done in two or three steps, and then either suture or staple the skin edges. If they are stapled, the staples are removed before the patient goes home approximately 72 to 96 hours later.
