In the operating room Getting ready

Most Caesarean births are performed in operating rooms specially set aside for that purpose. The atmosphere in the operating room may be a lot different from what you've experienced in the birthing room. Because surgery is a team effort, many more people will be there. In fact, if you or your baby have a complex medical problem, as many as 12 people may be in the room.

If you don't already have an IV, you'll get one now. You might receive extra oxygen through a face mask.

If you're going to have an epidural or spinal block and your anesthesiologist hasn't administered it yet, you'll sit up with your back rounded or lie curled up on your side. The anesthesiologist can scrub your back with antiseptic solution and inject a medication to numb the site. Then he or she can administer the blocking medication by inserting a needle between two vertebrae and through the tough tissue next to your spinal column.

You may receive just one dose of medication through the needle, which will then be removed. Or your anesthesiologist may thread a narrow catheter through the needle, slide the needle out and tape the catheter to your back to keep it in place. This will allow you to receive repeat doses of anesthetic as needed.

If you need to have general anesthesia, all preparations for surgery, including washing your entire abdomen with antiseptic solution, will be done before you receive an anesthetic agent. Your anesthesiologist can administer the general anesthetic drugs by injecting the drugs into your IV. These drugs will circulate in your bloodstream to all areas of your body, including your brain, causing you to lose consciousness.

Once you're anesthetized, awake or not, you'll be placed lying on your back with your legs positioned securely in place. A wedge may be placed under the right side of your back so that you're turned to the left. This shifts the uterine weight left, which can help ensure good uterine blood flow.

Your arms likely will be outstretched and secured on padded platforms. A nurse may shave the hair on your abdomen and the upper portion of your pubic hair, if it will interfere with surgery or removing bandages after surgery. Alternatively, a portion of your pubic hair may be clipped.

A nurse will likely scrub your abdomen with an antiseptic solution and drape it with sterile cloths. A drape (anesthesia screen) can be placed below your chin to help keep the surgical field clean.

Abdominal incision

Once you're in position, your abdomen is clean and you're numb or asleep, your surgeon will make the first incision. This will be the abdominal incision, made in your abdominal wall. The incision on your abdomen will probably be about 6 inches long, going through your skin, fat and muscle to reach the lining of your abdominal cavity, called the peritoneum. Bleeding blood vessels can be sealed with heat (cauterized) or tied off.

The location of your abdominal incision will depend on several factors, such as whether your Caesarean birth is an emergency and whether you have any previous abdominal scars. Your baby's size or the position of placenta also will be considered.

A bikini incision, curved across your lower abdomen along the line of an imaginary bikini bottom, is the generally preferred abdominal incision. It heals well and causes the least pain after surgery. It's also preferred for cosmetic reasons and gives your surgeon a good view of the lower pregnant uterus.

However, sometimes a low vertical incision, made from just below your navel to just above your pubic bone, is the best option. This incision allows faster access to the lower portion of your uterus, allowing your surgeon to remove your baby more quickly. Occasionally, time is of the essence. Seconds matter. Low vertical incisions also have less blood loss and allow for the incision to be extended around the belly button, should that be necessary.

Uterine incision

Once your abdominal incision is complete, your surgeon can safely move the bladder off of the lower part of the uterus and make a second incision in the wall of your uterus. Your uterine incision may or may not be the same type as you have on your abdomen. The uterine incision is usually smaller than the abdominal incision.

As with the abdominal incision, the location of the uterine incision will depend on several factors, such as whether your Caesarean is an emergency, how big your baby is and how your baby or placenta is positioned inside the uterus.

The low transverse incision, made sideways across the lower portion of the uterus, is the most common, used in more than 90 percent of all Caesarean births. It provides greater ease of entry, bleeds less than incisions higher on the uterus and poses less risk of bladder injury. It also forms a strong scar, presenting little danger of rupture during future labors. This makes vaginal birth after Caesarean (VBAC) a real option for future pregnancies.

Low transverseincision

Class icalincision

Low vertical incision

Low transverseincision

Class icalincision

Low vertical incision

In some cases, a vertical uterine incision is more appropriate. A low vertical incision, made vertically in your lower uterus where the tissue is thinner, may be used if your baby is positioned feet-first, rump-first or sideways in your uterus (breech or transverse lie). It may also be used if your surgeon thinks your incision may need to be extended to a high vertical incision — what doctors sometimes call a classical incision.

In the past, Caesarean births were almost always done with a classical incision, made in the upper portion of the uterus. Today, classical incisions are used in less than 10 percent of all Caesarean births, mainly because of the increased risk of bleeding and rupture of the uterus in later pregnancies. In fact, women with classical Caesarean incisions who become pregnant again are at increased risk of uterine rupture even before labor starts. The main advantage of the classical incision is the speed by which your surgeon can enter your uterus and remove your baby. This can be vitally important if your baby is acutely ill. A classical incision may occasionally be done to avoid bladder injury if a woman has decided this is her last pregnancy.


With your uterus exposed, your surgeon can open your amniotic sac so that your baby can make his or her grand appearance. If you're awake, you will probably feel some tugging, pulling or pressure as your baby is pulled out. This is because your surgeon is trying to keep the incision in your uterus as small as possible. You should not feel any pain.

After your baby is born, your surgeon can clamp the umbilical cord and hand your baby to another member of your health care team. This person can make sure your baby's nose and mouth are free of fluids and that your baby is breathing well. In just a matter of minutes, you'll have your first look at your baby. If your partner is in the room, he may have the option of cutting the umbilical cord. At this point, you may also receive a dose of antibiotics through your IV to help prevent uterine infection.

Removal of the placenta and closing of the incision

After your baby is delivered, your surgeon can detach and remove your placenta from your uterus. He or she can then begin to close your incisions, layer by layer. Because you may feel drowsy, the time will probably pass quickly.

The stitches on your internal organs and tissues can dissolve on their own and won't need to be removed. With the incision on your skin, your surgeon may use stitches to close it or may use a type of staples — small metal clips that bend in the middle to pull the edges of the incision together. Throughout this repair, you may feel some movement but no pain. If your incision is closed with staples, your doctor or nurse can remove them with a tiny pair of pliers before you go home.

Seeing your baby

Although a Caesarean typically takes 45 minutes to an hour, your baby will likely be born in the first five to 10 minutes of the procedure. If you're feeling up to it and are awake, you may be able to hold your baby as your surgeon closes the incisions in your uterus and abdomen. At the very least, you'll probably be able to see your baby snuggled into your partner's arms. Before giving your baby to you or your partner, your health care team can suction your baby's nose and mouth and do the first Apgar check, which is a quick assessment of a baby's appearance, pulse, reflexes, activity and respiration taken at one minute after birth.

The Complete Compendium Of Everything Related To Health And Wellness

The Complete Compendium Of Everything Related To Health And Wellness

A lot of us run through the day with so many responsibilities that we don't have even an instant to treat ourselves. Coping with deadlines at work, attending to the kids, replying to that demanding client we respond and react to the needs of other people. It's time to do a few merciful things to reward yourself and get your health in order.

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