Cesarean Section & Anesthesia 

When you think about having your baby, you're probably not thinking about surgery. But chances are, you may need a cesarean section. One in five women have cesarean birth.

Reasons for a cesarean section

There are many reasons for cesarean section, here a the most common that most women are faced with during labor. 

	Cephelopelvic disproportion (CPD)—the baby’s head is too large or the mother’s pelvis is too small. Unfortunately, the passenger does not fit through the passage way. Many times the baby is not too big and the mother’s pelvis is just right, but the baby’s head enters into the pelvis in an asymmetric angle (askew) and the baby can't get unstuck from the askew position they got themselves into. This is the case with babies that present face first, or remain in an occipital posterior position (sunny side up).
	Failure to progress—the opening to the cervix stops dilating. Usually because of the CPD.
	Abnormal presentation—the baby’s position in the uterus is other than head first. Possibly breech (feet or buttocks) or transverse lie (back or side presenting at the opening of the womb).
	Fetal distress—when the stress of the contractions is too strong for the baby to tolerate, this is indicated on the fetal monitor. Your doctor, midwife and nurses all have special training in interpreting the fetal monitor.
	Prolapsed cord—the umbilical cord is trapped between the mothers bony pelvis and the baby’s head, sometimes even coming out of the vagina. This causes the umbilical cord to be kinked, decreasing the oxygen supply to the baby.
	Maternal illness—genital herpes, severe pregnancy induced hypertension PIH (a.k.a.: toxemia/pre-eclampsia) multiple gestation (twins, triplets, and more), and many illnesses.

Avoiding a cesarean section

This might take a great effort on the mothers part. But changing positions frequently facilitates the baby to move in order to help the fetus obtain an optimal position in the pelvis. It is a known fact that when the mother moves the fetus will also adjust his position for comfort and circulation. The following tips may help avoid a cesarean section.

	Stay at home as long as possible (as long as the baby is moving normally, and your water has not broke).
	Change your position frequently during labor and keep your bladder empty.
	Try not to take pain mediation or the epidural in early labor.

VBAC—(Vaginal Birth After Cesarean) For the past decade vaginal births have been advocated following a cesarean section, but the  expert physicians in maternal/fetal medicine at the largest maternity school (University of Texas-Southwestern Medical School) in the U.S.A have encouraged obstetricians to carefully reconsider this decision. The risk to the mother occurs when the previous scar becomes very thin and opens during the labor process causing the uterus to rupture. A second more profound risk puts the unborn baby in jeopardy when oxygen and blood rapidly decrease.

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The operating room

You will leave the room where you had been laboring and be taken to an operating room. It is brightly lit with large light fixtures similar to the ones you would see in a TV or movie operating room scene. You will be moved from your bed onto a narrower bed in the operating room. The anesthetist will make sure you are free of any pain. If you have a labor epidural, it may be used as the anesthesia for the cesarean. If you do not have an epidural, one can be given, or a spinal or general anesthesia will be used. If you have an epidural or spinal, you will be awake for your birth. If you have a general, you will be asleep. Before the baby is born, several things have to be done: 

	You will be given an antacid to drink to neutralize  stomach secretion.
	The fine hair on your abdomen and part of your pubic hair will be shaved.
	A catheter will be placed in your bladder because the incision the doctor makes is close to the bladder.
	Your abdomen will be washed with a mild antiseptic solution
	A sterile drape will be placed over you, there's an opening in the drape where your tummy is showing.

Your doctor may have an assistant to help with the surgery and a scrub nurse will assist both doctors by giving the needed instruments and making sure all instruments and sponges are accounted for. There will be a nurse to receive your baby. Depending on the reason for your cesarean, a doctor for the baby may also be attending—there are a lot of professionals at this baby’s birthday!

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Coaching strategies

Some dads are uncomfortable with cesarean birth. When there is a need for an emergency cesarean section, it can be a frantic and fearful time. Dad and family may feel pushed aside during this time especially if it is an emergency and things are moving very fast. The nurses don’t mean for that to happen but the doctors first priority is to get babies safely born and protect the mother from harm.

If it is possible to go into the operating room dad will be given instructions to change into hospital clothing resembling that of the doctor. Mom will be taken to surgery for preparation and the coach will be given instructions on where to wait. The wait may seem long before you are shown to the operating room. If you leave the assigned area, the nurses may not be able to find you. Sometimes the coach may not be present for the surgery itself, but the nurse will take you to mom as soon as possible to hold the baby. It is never the hospital’s intention to make anyone upset or uncomfortable. Verbalize your needs.

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Post cesarean care

Pain—your doctor will have medication ordered for you at your request. For the first few days ask for medication on regular intervals. You will need to ask the nurse for medication because this is the way the doctor has it ordered to protect you from being over medicated. Some women do not like the way pain medication makes them feel, because it causes drowsiness. But being asleep and free of pain is better than being awake and in pain. Nausea and vomiting are common side effects of pain medication. If this occurs, take half the mediation. This may provide relief without the nausea or drowsiness. Also, use your conscience relaxation and breathing technique. Gas is also common after a cesarean section. To reduce digestive pain move around (walking, turning in bed), avoid drinking though a straw, and avoid carbonated beverages (stir the bubbles out).

	Food—slowly resume regular food intake. Your doctor is the one who knows the best time to begin solid food. Take the doctors advice. Start with clear liquids first (water, lemon/lime drinks—stir the bubbles out—, Popsicles, etc.). as you tolerate these, then advance your diet.
	Breastfeeding—this should not affect your decision to breastfeed your baby. Lying on your side or placing baby at your side (football hold) will be the best positions for you. Your nurse or lactation consultant will show you different positions to guard your comfort.
	Catheter—this is used to drain your bladder during surgery and for a brief time afterward. It will be removed once your doctor feels it is safe for you to get out of bed.
	IV—the IV may remain infusing fluids until you are able to tolerate liquids by mouth or to empty your bladder after your catheter is out. If you have a fever, it may remain longer.
	Incision care—sutures, staples, and metal clips are all commonly used on the skin after surgery. Your doctor has chosen the best for you from his/her experience. They are usually removed after the fourth day. You may shower, but you might not want the water beating down on your tummy—ouch!
	Walking—once your doctor feels it is safe for you to get out of bed you should walk frequently. If you tire, you should rest; you are the best judge—some women need a little more encouragement than others. Moving reduces muscle soreness, pain, and other complications that can develop after surgery if you remain in bed. You will resume bowel function faster, reduce the risk of blood clots in the legs (phlebitis), and return to normal and feel better more quickly.

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Epidural and other pain management

Epidural—given during labor or before your cesarean section. It diminishes pain sensory nerves from the waist down the your toes. It takes away pain, but you will still feel the sensation of touch and pressure. It is important that you stay in the position that your anesthetist or nurse places you, or the epidural may not work properly. Do not raise or lower the head of the bed because this may alter the level of the medication. Ask your nurse before changing positions. It may take 10–20 minutes for the epidural to take effect, but gradually the ability to move your lower body diminishes—similar to a dimmer switch. Do not get out of bed after the epidural is placed.

Spinal—in resent years this has been reserved and used for cesarean section because of its dense pain blocking agent and short acting effect; about 1½ hours. In the past it was also called a saddle block and was given at the time of a vaginal birth in the second stage of labor. An injection is given similar to the epidural but the medication is given directly into the spinal canal.

Local—an injection is given into the perineum as the baby’s head is crowning. The nerve fibers in the perineum are distended when the baby’s head is crowning, which causes the feeling of the injection to be diminished. This is used to numb the perineum for an episiotomy.

Pudendal block—is given just prior to birth and numbs the vagina and perineum. It may also cause some numbness down the legs. A small slender guide is inserted into the vagina, and a needle is slid though the guide. Medication is injected through the needle guide and then into the pudendal nerve at the base of the pelvis.

General anesthesia—used for cesarean sections when an epidural or spinal is not used. But in some instances may also be used for vaginal births. Medication is given through your IV and a tube that is placed in your windpipe to help you breathe easily during the operation. During the recovery period you may be drowsy but can respond to voices. Your throat may be scratchy or sore from the breathing tube.

Analgesics (pain medication)—can be used for labor or after the birth for the discomfort of afterbirth or episiotomy pain. For labor, they decrease anxiety and help maintain control. It will not take the pain away completely, but just takes the edge off the pain. It can be given IM (a shot) or through the IV. It mainly helps with relaxation. Your doctor has ordered medication that suits you best. The medication will make you drowsy and relieve the sharp pain of labor while providing rest between contractions. With some medication nausea is a common side effect; you should not be concerned about this being an allergy. Sometimes taking half the dosage will provide relief without the nausea.

Antiemetic—most pain medications cause nausea and may even cause vomiting, this is a common side effect—not an allergic reaction. Some women are more sensitive than others, so another mediation is used in combination with the pain medicine to decrease the nausea.

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Celebrity Cesarean

People Magazine reported that Madonna's birth plan "had been to have natural childbirth with the soundtrack of a romantic 1988 Alan Rudolph film called 'The Moderns' playing." As she was later taken to the operating room for a Cesarean section (due to 'failure to progress'), she reportedly called out, "Goodbye, everyone. I'm going to get my nose job now!"

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