About a month ago we explained what a normal birth is like, with the intention of offering some information to pregnant women to know what to expect and, more or less, what happens when a woman goes into labor.
As everything does not always go as a wait, and as the last thing that nobody wants to happen is that the mother or the baby are at vital risk, some of the deliveries, those that are complicated, usually end up in caesarean section. Caesarean section is not something that a woman can choose in a public hospital, because it is a surgical intervention that also carries risks, but I think it is also interesting to talk a little about it to know what it is and what happens when a woman has a cesarean delivery.
Are many deliveries ending in caesarean section?
The first doubt that a woman may have is to know what is the probability that her birth will end in a caesarean section. Well, it's hard to say, because every body and every birth is different, but it can be interesting to know how many caesarean sections are performed in a hospital to know what to expect.
According to WHO, the number of logical or advisable caesarean sections is estimated at 15-20% of all deliveries. Public hospitals in Spain have been around 21-23% for years, while private hospitals are going to 30% or so.
What is a caesarean section?
The caesarean section consists of a surgical intervention in which an incision is made in the mother's abdomen and uterus to remove the baby for that wound. It is carried out when the gynecologist considers that there is some risk to the health of the baby and / or the mother in case of giving birth vaginally.
This, of course, is the theory. In practice, the probability of having a C-section changes (in Puerto Rico around 50% and in Italy 40%) and this means that the reasons can become very varied, or directly lie. It is not to scare or generalize, but according to what places children are barely born on the weekend and this shows that childbirth is controlled and medicalized in excess and that some deliveries will probably end up in caesarean section for the convenience of the gynecologist, who prefers to work during the week that Saturday or Sunday.
It is usually done with the mother awake, but with controlled anesthesia from the thoracic area to the feet, through epidural anesthesia. In Spain it is rare that they let the father in (some hospitals do allow it), but in other countries it is the most common. I had to stay out in the birth of my first child, Jon, who came by caesarean section, and I would have sincerely liked to be present. However, it is no longer just for me, for the father, but more for the mother. This is a time when you may need support and the couple's company can help you a lot.
Indications for a cesarean section
The indications to make a cesarean section or not are a bit variable. In some aspects all hospital protocols coincide in the convenience of caesarean section. In others, on the other hand, there are hospitals that have a cesarean section and others do not, leaving the decision at the discretion of the professional. I speak for example of the breech presentations, since in Canada they have long considered that it is not a reason to do caesarean section and in other hospitals they will say not to mention the toupee, caesarean section and ready.
So the decision to perform a C-section depends on several factors, the gynecologist being the most important (because some will do more C-sections than others), the place where you are going to give birth (at a home, in a certain hospital, in a country where Caesarean section rates are very high, ...), medical history, etc.
To number them a little, some of the reasons that lead professionals to perform a caesarean section They are as follows:
- The baby has an abnormal heart rate.
- That the baby comes with a position that hinders vaginal delivery, as a cross or with the feet in front (as I have said depends on the country, the hospital and the professional).
- That there is a problem in the development of the baby, such as hydrocephalus or spina bifida.
- That it is a multiple pregnancy (triplets and sometimes twins), which again will depend on each professional and each birth.
- That the mother has an active infection of genital herpes.
- That the mother has HIV.
- That the mother has ever been intervened in the uterus (it depends, because a previous cesarean is also a uterine intervention and that there is a previous cesarean is no longer an indication of a new cesarean).
- That the mother has a serious illness such as heart disease, preeclampsia or eclampsia.
- That the baby's head is too large to pass through the mother's pelvis (they call it cephalopelvic disproportion and it is a topic that creates controversy because it is very difficult for a woman to get a baby that can not give birth later).
- Let the labor be prolonged too much or stop.
- That the baby is very large (that as the cephalopelvic disproportion is a controversial issue).
- That there is a placenta previa, which is when the placenta covers part or all of the opening to the cervix.
- Let there be a placental abruption.
- That a cord prolapse occurs, when the cord goes out through the opening of the birth canal before the baby.
What happens after caesarean section?
What usually happens after a caesarean section is to teach the mother to her baby for a moment and then appreciate it, since some children, due to anesthesia, are born a little sleepy and may need help breathing. What happens next depends a little on how each hospital works. There are centers where they leave the baby in the nursery while the mother has just recovered in the resuscitation room. Other hospitals leave the baby with dad while those hours pass.
The most modern, the ones that I like do the most logical, they leave the baby in resuscitation with the mother and the father. Giving birth by caesarean section can be a bit hard for some mothers, who see their expectations broken (something that will have to be exceeded over time), and a good way to help them minimize the bad feeling about what happened is to allow the baby be with the mother right away, in skin-to-skin contact, as if she had come vaginally.
That way you can be breastfed before and there will be less risk that breastfeeding will end up failing. In this way, the myth that says that milk takes longer to rise when you have a caesarean section can be demolished, since the difference does not come from the way of giving birth, but of the time between the placenta leaves and the baby is taken to the chest. The more time passes, the longer it takes to raise the milk and the greater the difficulty.
It is possible for the baby to spend a few hours pouring amniotic fluid through the mouth. It is normal and you have to watch a little that you can not drown with him, helping him to remove it with a little gas when we see it bubble. When a baby is born vaginally, the chest is "squeezed" and removes virtually all of the fluid left in his lungs. At birth by caesarean section this does not happen and it must be he who is taking it out.
Risks of caesarean section
Giving birth by caesarean section is relatively safe, but carries more risks than giving birth vaginally, and therefore the recommendation is that they be used only if strictly necessary.
Again, to list a little the most common risks:
- Infection of the bladder or uterus, since it is a surgical intervention with wound and rupture of the uterus, which should heal.
- Injury of the urinary tract.
- Injury to the baby (we have already seen here a wound made during caesarean section).
- Increased risk of placenta previa in future pregnancies.
- Increased risk of placenta attached in future pregnancies (the placenta has trouble separating after the next delivery).
- Increased risk of uterine rupture.
- Increased risk of bleeding as a result of the three previous situations.
- Bleeding hemorrhage in the intervention area.
- That blood clots occur that reach the pelvic veins or legs.
- Wound infection.
It is for all these reasons that a normal natural birth is always preferable and the reason that gynecologists are increasingly reluctant to practice a C-section. This does not always happen, of course, because in private healthcare they are more lax, and especially when it comes to people with money or celebrities, who have the possibility to choose how to give birth (although many think that it should not be so).
