Cesarean Section Video Transcript

I’m William Andrew. I’m an obstetrician/gynecologist. I work with Hilltop Obstetrics and Gynecology and I’m section chief for obstetrics/gynecology at Atrium Medical Center.

Reasons for a Cesarean

For most people the reason they are going to have a Cesarean section is because they’ve been in labor and for whatever reason . . the baby is too big or the mom’s pelvis is too small . . . and the baby won’t come out. That’s not generally an emergent process. It’s generally something that evolves over time. You watch the woman labor and the baby’s head is not descending, the baby is not delivering and you make a decision that it is better that the baby be delivered by Cesarean section. There’s not a lot of rushing around and while it’s not a scheduled Cesarean section, it’s not unplanned. It’s something we’re well prepared for.

Scheduled Cesarean Section

In certain cases we know before the woman goes into labor that we don’t want her to labor. There are a variety of reasons; one common reason is that the baby is in a position that doesn’t deliver easily. For example, a baby in the breech position (presenting butt first instead of head first), in that case the majority of people are going to have a Cesarean section. That might be scheduled so you’re would know going into the hospital that you’re going to have a Cesarean section that morning.

Anesthesia for a Cesarean Section

The anesthetic actually diffuses from the epidural space into the area around the spinal cord and it really doesn’t circulate in any significant levels in the mom’s blood and if it doesn’t circulate into the mom’s blood it doesn’t transfer across the placenta and get onboard the baby. If there is not an epidural on board when mom needs to undergo a Cesarean section, usually a spinal anesthetic is needed. A spinal anesthetic is even easier for the anesthetist to place than an epidural. It’s perfectly safe and it’s quick. It does involve mom sitting up, usually at this point she’s been transferred to the operating room, so she sits up on the operating table and a little medication is injected into the back and she’s lain down and the spinal anesthetic takes effect and renders the area that is going to be operated numb.

Risks to Baby

Anytime we perform a Cesarean section, we’re performing it because we think it’s for the benefit of the baby, the mother or both. We’re not looking to do any more invasive therapy for anyone than is absolutely necessary. The fact of the matter is a Cesarean section is a very safe procedure. Lots of Cesarean sections are done and the complication rate is fairly low. Sometimes babies that are born by Cesarean section are at some increased risk of developing tachypnea of the newborn, which is some difficulty breathing. It’s felt that if a baby has been in labor with mom beforehand, the baby gets all the advantages of having been in labor. Sometimes that means the lungs have had an opportunity to change in a certain way, it reduces the chances of baby having a problem breathing afterward. If someone undergoes an elective Cesarean section, that is that they just opt to have a C-section or maybe a scheduled Cesarean section, there might be a small increased risk of the baby having some difficulty breathing after delivery. Usually that resolves within 24 hours.

Emergency Cesarean Section

In a true emergency Cesarean section it has to be performed very quickly. From the time at which it’s decided to perform the C-section to the time that we actually make an incision should be less than 15 or 20 minutes. In that situation we’re going to be hurrying back to the operating room and we may not have time to dose an epidural or even give a spinal anesthetic. In that situation the mother may need to go to sleep and have general anesthesia.

Recovery

Recovery from a Cesarean section is usually a couple of days in the hospital and it takes a little bit longer to recover outside the hospital just because the incision can be sore. But most moms are up and about taking care of their baby and tending to the rest of their family within a week or so.

Vaginal Birth After a Cesarean Section

So the pendulum has swung back on forth on whether or not someone can deliver vaginally after having a Cesarean section. Right now the pendulum is in the camp that most people end up having another Cesarean section and have C-sections for all their children. Though a motivated patient could have a vaginal delivery after a Cesarean section depending on what the indications for the first Cesarean section were. Best case scenario is for a woman who had a Cesarean section the first time because maybe the baby was breech but if the second time the baby is not breech, she might be a good candidate to deliver to deliver vaginally.