Caesarean section is a medical procedure that aims to remove the baby through an incision in the mother's abdomen and uterus, usually made across just below the waist line.
In most cases, cesarean section is performed under epidural anesthesia or spinal anesthesia where the mother can remain conscious during the operation. The majority of mothers who undergo a caesarean section can go home from the hospital 3 to 5 days after the surgical procedure. However, to fully recover, regular home care and regular check-ups with a gynecologist are required for a period of approximately one month.
Indications for Caesarean section
Caesarean section can be done if the mother wants to give birth by surgery (elective) or as an emergency measure when the doctor feels the mother's pregnancy is too risky to be delivered normally. Your doctor may consider a cesarean section in several conditions, such as:
- The fetus does not get enough oxygen and nutrients, so it must be delivered as soon as possible.
- Mother has an infection, such as a genital herpes infection or HIV.
- Labor did not go well or the mother experienced excessive vaginal bleeding.
- Mother experiencing pregnancy with high blood pressure (preeclampsia).
- The mother has a too low position of the placenta (placenta previa).
- The position of the fetus in the uterus is not normal and doctors cannot correct its position.
- Obstruction of the birth canal, for example due to a narrow pelvis.
- The umbilical cord exits through the cervix before the fetus or the umbilical cord is compressed by the uterus during contractions.
- Had a cesarean section in previous deliveries.
- Mother carries more than one fetus at the same time (twins).
Caesarean Operation Warning
If you are planning to have a cesarean delivery, consult an anesthesiologist about your medical history. This is to avoid the occurrence of negative effects that may arise due to the administration of anesthesia during a cesarean section.
For mothers who are planning a vaginal delivery, it never hurts to discuss with the doctor about the possibility of a cesarean section. This is in preparation if you have to have a caesarean section unexpectedly.
However, please note that caesarean section can cause a population imbalance between good bacteria and bad bacteria in the baby's intestines. This should be obtained from the baby's contact with good bacteria from the mother's vagina during the normal delivery process.
The above conditions can cause imperfect formation of the baby's natural immune system. As a result, babies are more at risk for diseases related to the immune system, such as allergies, asthma, eczema, and even autoimmune diseases, such as type 1 diabetes and colitis.
Even so, there are several ways that are thought to reduce a child's risk of this immune-related disease. One of them is by giving breast milk (ASI), especially in the first 6 months of life.
Breast milk is the most complete and most appropriate source of nutrition for babies. In addition to containing various kinds of nutrients, breast milk also naturally contains synbiotics, which are a combination of probiotics (bacteria that are good for the digestive tract) and prebiotics (nutrients that help the development of probiotics).
The synbiotic content in breast milk can help the growth of good bacteria and suppress the growth of bad bacteria in the baby's intestines. By achieving this balance, a strong natural immune system can be formed and protect the baby from various diseases.
You can consult with your pediatrician regarding the proper nutritional needs for the baby.
Before Caesarean
Some of the tests your doctor may do before a cesarean section are:
- Blood test. The patient will be advised to undergo a blood test, so that the doctor can determine your hemoglobin level and blood type. Blood type tests need to be done in preparation for transfusion if needed.
- Amniocentesis. This test may be recommended if you are going to have a C-section at 39 weeks of pregnancy. The doctor will check the maturity of the fetal lungs by examining a sample of amniotic fluid in the laboratory.
The patient is required to fast for several hours before the operation. The doctor or nurse will tell you how much time you need to fast. The doctor will also prescribe some medicines to the patient before undergoing a cesarean section such as:
- Antibiotics
- Antiemetic (to prevent nausea)
- Antacids (to reduce the patient's stomach acid levels)
Doctors can also ask the patient to clean the entire body with antiseptic soap before the cesarean section is performed. This aims to reduce the risk of infection. Patients were also asked not to shave their pubic hair, as this could increase the risk of infection at the surgical site.
Caesarean Operation Procedure
The initial preparation that the doctor will do for the patient in the operating room is to give anesthesia and empty the bladder. This is usually done by means of a catheter.
Anesthesia given is generally epidural or spinal anesthesia which will only numb the lower body, but the patient remains awake. But keep in mind, for some conditions, the doctor may give you general anesthesia, in which you will fall asleep during the process. Consult with your doctor about the type of surgery that best suits your condition.
The following is a sequence of caesarean section procedures that doctors generally perform:
- The patient will lie on the operating table with the head slightly elevated.
- After that the doctor will make a 10 to 20 cm incision in the patient's abdomen and uterus. Usually the incision is made horizontally slightly below the waist line. But if it feels more appropriate, the doctor can also make a vertical incision below the navel.
- The patient's baby will be removed through the incision made. This process usually takes 5 to 10 minutes. In this process, the patient will feel a slight tug.
- If everything is normal, usually the doctor will show and give the baby to the patient shortly after being removed from the stomach.
- The doctor will then remove the placenta from the uterus, and give an injection of the hormone oxytocin to stimulate uterine contractions so that the bleeding will decrease and eventually stop completely.
- The doctor will close the incision in the uterus and abdomen with stitches. The entire C-section procedure will generally take 40 to 50 minutes.
After Caesarean
The patient will be transferred from the operating room to the treatment room when all caesarean section procedures have been performed and the patient's condition is normal. The doctor will prescribe pain medication to reduce pain at the incision site. The patient will be advised to get up and walk shortly after returning to the treatment room.
There will be normal bleeding from the vagina in the first few days after a cesarean section. This blood is called lochia. In the first three days, lochia can be sufficient and bright red in color, and the color will slowly turn brown, until finally yellow to white.
However, what you need to watch out for is if the blood that comes out is a lot to the point that you have to change the pads more than twice in 1 hour for at least two consecutive hours. Also, lochia is considered abnormal if it is still red and in large numbers on the 4th day after the C-section, or if your lochia smells bad and you have a fever.
The doctor will also carry out treatment to prevent blood clots from occurring. Treatments that can be given include: compression stockings or by injection of anticoagulant drugs.
In addition, patients will be given counseling assistance to breastfeed their babies. The catheter will be removed when the patient is able to walk or about 12 to 18 hours after the C-section is complete.
When leaving the hospital the doctor will recommend several things the patient should do during the recovery period at home, namely:
- Support the abdomen with a pillow while breastfeeding.
- Avoid lifting anything heavier than the baby and get plenty of rest.
- Drink plenty of fluids to replace fluids lost during cesarean section and breastfeeding and prevent constipation.
- Avoid having sex until the time permitted by the doctor. Usually the patient is prohibited from having sex four to six weeks after the cesarean section.
- Take pain relievers according to the doctor's prescription.
The following steps can also be taken by the patient for the incision, namely cleaning and drying the wound slowly every day, watching for signs of infection at the incision site, and wearing loose clothing made of comfortable material.
Immediately consult a doctor if the patient feels any of the following:
- Swelling or pain in the lower leg.
- Severe pain.
- Pain when urinating.
- Urine leakage.
- The appearance of pus or foul-smelling fluid from the incision.
- The incision wound becomes red, painful, and swollen.
- Coughing or shortness of breath.
- Profuse vaginal bleeding. You need to be careful if you have to change pads more than twice an hour for at least two hours in a row.
C-section complications
Caesarean is one of the major surgery that has several risks for mother and baby. Some of the risks that can develop in babies born by cesarean section are:
- Surgical injury. Although rare, incisions in the baby's skin can occur during the surgical process.
- Disturbance everpasan. Babies born by caesarean section are more at risk for abnormally faster breathing during the first few days after birth.
While some of the risks that can befall mothers who undergo caesarean section are as follows:
- Bleeding getting worse. Cesarean patients will usually experience more severe bleeding during a cesarean section when compared to a normal delivery process.
- Injury due to surgery. This can occur in the organs around the uterus.
- Blood clotting. Cesarean patients can experience blood clots in the veins, especially in the legs or pelvic organs.
- Increased risk of complications in the next pregnancy process. Although rare, cesarean section can increase the risk of problems for future pregnancies, such as the stitches in the uterus open, the placenta attaches to the uterus, and the death of the fetus in the womb.
- Wound infection. This will be more risky in the process of delivery by caesarean section than normal.
- Anesthetic side effects. Although rare, cesarean patients may experience negative effects of anesthesia such as severe headaches.
- Infection and inflammation of the uterine membrane lining. This can cause fever, foul-smelling vaginal discharge, and painful urination.