Medical procedures explained: Cesarean Sections Have Pros And Cons

Just one cesarean section was done in 101 B.C., according to
legend, and it brought Roman dictator Julius Caesar into the
By Kelly Savio Staff Writer

Just one cesarean section was done in 101 B.C., according to legend, and it brought Roman dictator Julius Caesar into the world.

In 2003, doctors performed 684,484 cesareans, according to the National Center for Health Statistics, and the popularity of the procedure continues to grow.

The Surgery

A cesarean, also called a C-section, is when a pregnant woman delivers her baby through an incision made in the mother’s abdomen and uterus, instead of delivering through the vagina. The decision to have a C-section is unique to each woman, said Dr. Mary Schaaf, chief of the Obstetrics-Gynecology Department at Kaiser Permanente Santa Teresa Medical Center.

“It’s a very individualized discussion,” Schaaf said. “There’s a lot of information a woman should discuss with her physician before deciding to do an elective cesarean.”

The surgery starts with epidural anesthesia, a shot given in the lower back near the spine, that numbs the mother from her chest to her legs. She is awake and alert but won’t feel any pain from the operation,though she may feel some pressure or movement during the surgery. General anesthesia is usually used only in special circumstances, such as an emergency C-section.

After the woman has the epidural, an incision is made in the skin on the lower abdomen, just above the pubic area.

Normally, the cut is about 6 to 8 inches and is typically a horizontal cut, though a vertical cut is used in rare cases. The position of the baby and any existing medical conditions – such as premature, abnormally positioned twins – dictate the direction of this cut, Schaaf said.

Once the skin is out of the way, a second incision is made in the uterus. When the uterus is open, the amniotic fluid – a clear liquid surrounding the fetus in the womb – is drained, and the baby is delivered.

The newborn’s nose and mouth are cleared and the umbilical cord is clamped and cut, as would happen in a vaginal birth. The mother’s uterus and abdomen are then closed and stitched up. A typical C-section delivery, from the first incision to the last stitch, takes about half an hour, Schaaf said.

Reasons for C-sections

At one time, doctors only performed cesareans for specific medical reasons, such as a breech birth – when the baby is positioned feet-first in the uterus – or a prolapsed umbilical cord, which is when the cord comes through the cervix before the baby.

Today, women choose to have C-sections for a myriad of reasons, such as to avoid the pain of labor or to know the exact date of birth.

Though a C-section avoids labor pains, Schaaf said some women forget to consider the pain of recovering from a surgical procedure.

“Post-operative healing can take four to eight weeks, and fully recovering – feeling like nothing ever happened – can take up to a year,” she said.

Other women think a cesarean will prevent long-term complications that are thought to happen after having a vaginal birth, such as incontinence later in life. However, there is no strong evidence that a C-section will prevent this condition, Schaaf said. Some doctors think just being pregnant puts enough excess pressure on the bladder to cause problems later.

Although some mothers would rather have C-sections, others opt for vaginal births for various reasons.

“Some women are so dedicated to having a vaginal birth that they feel they’re not fulfilling their obligation as a woman (if they have a cesarean),” Schaaf said. “That’s not the case. The most important thing to know is that this is a ‘normal’ way of having a baby. Having a cesarean does not mean you are a failure.”

After a Cesarean

Contrary to some schools of thought, most women are able to have a vaginal birth after a C-section.

“If she has a previous (horizontal) scar, about 75 percent of women who try to have a vaginal birth after a C-section will be successful,” Schaaf said.

A woman who has a vertical incision on her uterus, however, must always have cesareans, because the old scar may rupture during a vaginal birth.

Why ‘Cesarean’?

The term “Cesarean” is thought to come from the belief that Julius Caesar was born this way.

Though there are other theories as well, Schaaf said she believes the phrase comes from an old Roman law called “lex Cesare.” The law said that if a pregnant woman died, the baby must be removed from her abdomen and buried separately.

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