Caesarean section - an overview

Sectio caesarea, that's what it's called in Latin. According to legend, Julius Caesar was cut out of his mother's womb. Today we know this procedure as a Caesarean section. Then as now, there are various reasons for a Caesarean section.

Planned or unplanned – why a Caesarean section?

In general, a distinction is made between a planned and an unplanned Caesarean section. These differ in the urgency of the procedure:

Unplanned or secondary caesarean sections are performed when labor has already started and complications arise. These include, for example,

• heavy vaginal bleeding or uterine rupture
• Mother's exhaustion
• Birth arrest
• Drop in heart rate or inadequate supply to the child, e.g. due to lack of oxygen or a prolapsed umbilical cord.

On the other hand, there may be factors in advance that speak in favour of a planned or primary Caesarean section, e.g.

• Previous illnesses of the mother
• Uterine malformations
• incorrect positioning or premature detachment of the placenta
• Transverse position or malformations of the child
• Multiple births
• Height and weight of the child
• the elective Caesarean section.

A cesarean section may seem frightening at first, but it is actually nothing to worry about. From a medical point of view, it is a fairly simple procedure.

From bikini lines to panhandles – how does a Caesarean section work?

A Caesarean section is one thing above all: a cut. But you won't notice much of it, because you will of course be anesthetized before your procedure. In the case of a planned Caesarean section, a local anesthetic is usually sufficient. This means you can hold your child in your arms shortly after the birth. Only in emergencies, when time is short, is the decision made to use a fast-acting general anesthetic. A bladder catheter is often also inserted to make the procedure easier for you and the doctors.

When everything is prepared, an incision is made: the so-called Pfannenstil incision is made at about the height of the bikini line, just above the pubic symphysis and is around ten centimeters long. Your doctor cuts through layers of skin, fat and muscle, can then carefully expose the uterus, open it and finally remove your child from it. While the placenta is then detached and removed, the midwife takes over the initial care of the child before you are given it in your arms for the first time.

Finally, the uterus and the individual layers are sewn back together, usually with threads that dissolve after a few weeks. All in all, the procedure often takes no longer than half an hour. With general anesthesia, there is of course also the time needed to wake up.

In addition to this classic procedure, there is a second approach, the so-called gentle Caesarean section, or Misgav Ladach method. This variant only differs in the opening of the uterus: the uterus is not cut open, but ripped open. This sounds brutal, but it has some advantages, such as less blood loss and better healing.

The trend is towards cutting – what are the risks?

Of course, a Caesarean section also carries certain risks: In addition to unwanted injuries to neighboring organs such as the ureter, intestines or bladder, it can lead to high blood loss or blood clots. After birth, infections can occur, as well as difficulties with wound healing. A Caesarean section can also have psychological consequences, for example if an emergency Caesarean section becomes a traumatic experience for the mother. Basically, however, every birth process is an individual masterpiece and more or less demanding depending on the situation - regardless of whether your child is born vaginally or by Caesarean section. It is important that you talk to the medical staff beforehand. In most hospitals, Caesarean sections are now a routine procedure - in 2019, one in three children was born this way*.

Time to heal – what comes after a cesarean section?

Whether you have a vaginal birth or a Caesarean section, a physical and psychological healing process follows. After a Caesarean section, you will usually spend the first 4-7 days of your postpartum period in the hospital so that the surgical wound can be cared for. It is possible that it will still be painful or numb for days and weeks after the birth. How long the healing process lasts depends on your personal wound healing, the course of the Caesarean section and your behavior after the birth. As with a vaginal birth, the following applies: rest and settle in.

A cesarean section may seem rather unromantic at first. In fact, in certain situations it offers clear advantages over a vaginal birth. And ultimately, every birth is so unique, every newborn so special, that there can be no universally correct method. The important thing is that you familiarize yourself with your options, talk to doctors about all the possibilities and ultimately find your own way to welcome the new family member into the world.

Author: Constanze Dochantschi

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* https://www.aerzteblatt.de/nachrichten/sw/Kaiserschnitt