Dr. Jennifer’s Cesarean Delivery
Her OB/GYN describes the procedure
by Lisa M. Masterson, MD: From the beginning of her pregnancy, my patient, Dr. Jennifer, knew that she would have a cesarean delivery. Her first vaginal delivery involved complications. There were enough reasons to warrant and medically indicate a cesarean.
As a surgical procedure, a cesarean delivery carries the risk of bleeding, infection, injury to neighboring organs (i.e. bowel, bladder) as well as the risks of anesthesia and transfusion. Worst-case scenario is death to the mother. It holds much less risk to the infant, although more reports of complications due to fluid trapped in the lungs have been noted.
Surgery was scheduled for 7:30 am. Jennifer arrived along with her husband, Greg, calm but eager and ready to meet her baby. Every cesarean begins with the patient getting an epidural. This is a local anesthetic delivered through a tiny tube called a catheter placed in the small of the back, just outside the spinal canal.
An advantage of the epidural is that it allows most women to fully participate in the birth experience (continue to feel touch and pressure) while relieving most, if not all, of the pains of labor. So, Jennifer was alert and her husband, Greg, was able to stay with her throughout.
We then test the patient to make sure she is well anesthetized. Jennifer confirmed that she was feeling an appropriate amount of numbness and was comfortable. Then, I proceeded to make a small incision along her “bikini line” and successively entered the other tissue layers of the abdomen using heat. The muscles were gently separated and I entered the abdominal cavity.
At this point, the surgeon is able to see and feel the pregnant uterus. The bladder is then moved out of the way, and a transverse incision is made on the lower segment of the uterus, and extended upward on both sides.
I reached in and cupped the baby’s head with my hands, while an assistant put pressure on Jennifer’s abdomen so that I could gently glide the infant through the incision. A beautiful baby girl was handed off to the awaiting pediatrician after the umbilical cord had been clamped and cut. The pediatrician immediately brought the new baby to Jennifer and husband so they have a first look at their baby. Because the anesthetized woman is not in a secure position to hold the infant, we wait until she has completely recovered to put the baby in her arms.
Still, Jennifer was able to kiss and welcome her daughter into the world. My attention was then focused on the removal of the placenta and sewing the uterus closed. All the layers of the abdomen that were cut were repaired and the skin was closed with sutures. The whole procedure only took about 20 minutes. The incision appeared as thin as a small cut.
Recovering is more difficult than recuperating from a vaginal delivery. It is, after all, major surgery. In addition to bleeding and discharge, constipation, fatigue and hormonal shifts, patients can expect incision pain, severe gas pain, and possible anemia.
Today, I am happy to report, Jennifer and baby are both doing beautifully!