cesarean section video
cesarean section video procedure slide
Watch: 720
Description: c-section
A cesarean birth happens through an incision in the abdominal wall and uterus rather than through the vagina. There has been a gradual increase in cesarean births over the past 30 years. In November of 2005, the Centers for Disease Control and Prevention (CDC) reported the national cesarean birth rate was the highest ever at 29.1%, which is over a quarter of all deliveries. This means that over 1 in 4 women will experience a cesarean birth.
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What can I expect in a Cesarean procedure?
The normal cesarean procedure will take an average of 45 minutes to an hour. The baby is usually delivered in the first 5-15 minutes and the remainder of time is used for closing the incision.
Pre surgery:
Before surgery, you will be given some type of anesthetic (general, spinal, or epidural) if you have not been given one earlier in your labor. General anesthetic is normally only used for emergency cesareans because it is effective immediately and the mother is sedated. The spinal and epidural anesthesia will numb the area from the abdomen to below the waist (sometimes the legs can be numb also), so that nothing can be felt during the procedure. You will probably receive a catheter to collect urine while your lower body is numb.
Surgery:
The health care provider will make an incision in the abdomen wall first. In an emergency cesarean this will most likely be a vertical incision (from the navel to the pubic area) which will allow the health care provider to deliver the baby faster. The most common incision is made horizontally (often called a bikini cut), just above the pubic bone. The muscles in your stomach will not be cut; they will be pulled apart so that the health care provider can get to the uterus.
An incision will then be made into the uterus, horizontally or vertically. The same type of incision does not have to be made in both the abdomen and uterus. The classical incision made vertically, is usually reserved for complicated situations such as placenta previa, emergencies, or babies with abnormalities. A vaginal birth after cesarean (VBAC) is not recommended for women with the classical incision. Another type of incision which is rarely used is the lower segment vertical incision. This would only be used if there were problems with the uterus that would not allow another type of incision to be made. The most common incision made is the low transverse incision. This incision has fewer risks and complications than the others and allows most women to attempt a VBAC in their next pregnancy with little risk of uterine rupture.
The health care provider will suction the amniotic fluid out and then will deliver the baby. Your babies head will be delivered first so that the mouth and nose can be cleaned out to allow for its first breath. Once the whole body is delivered, the baby will be lifted up so that you can meet your newborn. Most health care providers will then pass the baby on to the nurse for evaluation. The last thing to be delivered will be your placenta (you may feel some tugging) and then the surgical team will begin the close up process.
After the Surgery:
Once the surgery is over, you may begin to experience some nausea and trembling. This can be caused by the anesthesia, the effects of your uterus contracting, or from an adrenaline let down. This usually passes quickly and can be followed by some drowsiness. If your baby is healthy, this is usually the time when the baby can rest on your chest and you can begin breastfeeding and bonding. You and your baby will continually be monitored for any complications.
When you are discharged from the hospital you will be advised on the proper post-operative care for your incision and yourself.
Watch: 720
Description: c-section
A cesarean birth happens through an incision in the abdominal wall and uterus rather than through the vagina. There has been a gradual increase in cesarean births over the past 30 years. In November of 2005, the Centers for Disease Control and Prevention (CDC) reported the national cesarean birth rate was the highest ever at 29.1%, which is over a quarter of all deliveries. This means that over 1 in 4 women will experience a cesarean birth.
Your purchase supports the APA
What can I expect in a Cesarean procedure?
The normal cesarean procedure will take an average of 45 minutes to an hour. The baby is usually delivered in the first 5-15 minutes and the remainder of time is used for closing the incision.
Pre surgery:
Before surgery, you will be given some type of anesthetic (general, spinal, or epidural) if you have not been given one earlier in your labor. General anesthetic is normally only used for emergency cesareans because it is effective immediately and the mother is sedated. The spinal and epidural anesthesia will numb the area from the abdomen to below the waist (sometimes the legs can be numb also), so that nothing can be felt during the procedure. You will probably receive a catheter to collect urine while your lower body is numb.
Surgery:
The health care provider will make an incision in the abdomen wall first. In an emergency cesarean this will most likely be a vertical incision (from the navel to the pubic area) which will allow the health care provider to deliver the baby faster. The most common incision is made horizontally (often called a bikini cut), just above the pubic bone. The muscles in your stomach will not be cut; they will be pulled apart so that the health care provider can get to the uterus.
An incision will then be made into the uterus, horizontally or vertically. The same type of incision does not have to be made in both the abdomen and uterus. The classical incision made vertically, is usually reserved for complicated situations such as placenta previa, emergencies, or babies with abnormalities. A vaginal birth after cesarean (VBAC) is not recommended for women with the classical incision. Another type of incision which is rarely used is the lower segment vertical incision. This would only be used if there were problems with the uterus that would not allow another type of incision to be made. The most common incision made is the low transverse incision. This incision has fewer risks and complications than the others and allows most women to attempt a VBAC in their next pregnancy with little risk of uterine rupture.
The health care provider will suction the amniotic fluid out and then will deliver the baby. Your babies head will be delivered first so that the mouth and nose can be cleaned out to allow for its first breath. Once the whole body is delivered, the baby will be lifted up so that you can meet your newborn. Most health care providers will then pass the baby on to the nurse for evaluation. The last thing to be delivered will be your placenta (you may feel some tugging) and then the surgical team will begin the close up process.
After the Surgery:
Once the surgery is over, you may begin to experience some nausea and trembling. This can be caused by the anesthesia, the effects of your uterus contracting, or from an adrenaline let down. This usually passes quickly and can be followed by some drowsiness. If your baby is healthy, this is usually the time when the baby can rest on your chest and you can begin breastfeeding and bonding. You and your baby will continually be monitored for any complications.
When you are discharged from the hospital you will be advised on the proper post-operative care for your incision and yourself.
c-section cesarean section
Watch: 689
Description: Narrator: About 1 in 4 women delivers her baby via cesarean section, or C-section, as it's commonly known. Although vaginal delivery is the natural and preferred method for childbirth, a C-section may be performed for the safety of mother and baby.
Bruce Johnston, M.D.: Preoperatively, the process begins early during the prenatal care if the patient knows she's going to have an elective cesarean section. And then we talk about what she is to expect — the anesthetic or analgesia she's going to receive, the fact that she'll have a Foley catheter in her bladder (to drain urine), and that once she comes into the room, there will be many people in the room, including her scrub nurse, the anesthesiologist, the pediatrician and then the core of people that will actually perform her cesarean section. And we try to advise her what to expect, what times — how long potentially we think on an average time it will take actually to perform the actual cesarean section — and we like not to forget the father. The father is an important part of that and a good caregiver and a good handholder for people who are doing this under regional anesthesia.
Mother: That's kind of tart.
Gurinder Vasdev, M.D.: That was Bicitra, which neutralizes the acid in the stomach, because pregnant women tend to have a little bit more acid in their stomach than normal — and so that if she does feel nauseous or sick during surgery that she's not bringing up acid.
Narrator: Ninety-five percent of women having a planned C-section use regional analgesic for pain control — either an epidural or a spinal block. The other 5 percent use general anesthesia. You'll be made comfortable in a special surgical delivery room and administered pain medication. This video shows a spinal block. Placing a spinal begins with cleaning a small area in your lower back with antiseptic solution.
Dr. Vasdev: We're doing a spinal anesthetic, and we're going to draw up the medication for the spinal anesthetic. For that, we use a combination of a local anesthetic called bupivacaine, and we also add some opiate medication called fentanyl, and morphine — and that gives you analgesia for almost 24 to 48 hours after the C-section, so you don't require any form of IV pain relief.
Narrator: During placement of your spinal, you'll either lie on your side or sit up, and round your back. First an anesthetic is injected to numb the area. You may feel a pinprick when the anesthetic is injected, but the spinal block shouldn't cause any discomfort. Then the analgesic is injected into the sac of fluid surrounding the spinal nerves, below the level of the spinal cord. A spinal block takes effect almost immediately.
The blue shading in this illustration shows the area of your body numbed by the anesthetic.
Dr. Johnston: The total time for a cesarean section varies significantly for people who are having repeat cesarean sections. First, or primary, cesarean sections generally take approximately 30 minutes total.
Narrator: Once the anesthetic has taken effect, your abdomen will be prepped for delivery of your baby. Your doctor will make two incisions, one through your abdominal wall, and another into your uterus.
There are two types of abdominal incisions: vertical and horizontal. Vertical incisions are usually done only in an emergency, from just below your navel to just above the pubic bone.
Horizontal incisions are also called Pfannenstiel incisions, or more commonly, bikini incisions. The horizontal incision is made across the lower abdomen, near the pubic hairline. Bikini incisions are used in most C-sections because they typically heal well, the scar is not easily seen and they may cause less post-delivery discomfort. The initial incision is about 6 inches (15 centimeters) long and cuts through your skin, fat and muscle to get to the uterus, where your baby is. Your doctor uses a special knife that burns, or cauterizes, the tissues to help control bleeding.
Dr. Johnston: When we perform a cesarean section, it's the matter of several little steps. Basically most patients cosmetically are most interested in having an incision that goes across the lower part of their abdomen. It's called a Pfannenstiel incision. And once we make that incision, we go down through the skin and subcutaneous layers. Then we get to the layer of fascia, or connective tissue, that covers up the rectus abdominis muscles. That's incised and then gently separated so that we can actually enter the tummy cavity where the uterus is without cutting any muscles. And then once we do that, we make a little flap underneath the bladder and then make our incision below that — and make it at a location where then if later on if she would desire to have a vaginal birth after her cesarean section, that would be a possibility. Usually in approximately five to 10 minutes we've got the baby delivered, and the rest of the time is suturing and repairing the regional incision site.
Narrator: Because your anesthetic blocks pain but not motion, you'll likely feel some tugging when your baby is pulled out, but it shouldn't hurt. Once the baby is delivered, your doctor will remove the placenta and begin to close the incisions. Internal stitches dissolve and don't need to be removed.
Dr. Johnston: Of course, once we deliver the baby, then the steps are done in reverse, except it's like so many other things, it takes longer to repair than it originally did to make the incision. So we do the steps just backward and repair the incision in the uterus. Then we sequentially repair the body wall, which is done in two or three steps, and then either suture or staple the skin edges — which, if they're stapled, the staples are removed before the patient goes home approximately 72 to 96 hours later.
A cesarean birth happens through an incision in the abdominal wall and uterus rather than through the vagina. There has been a gradual increase in cesarean births over the past 30 years. In November of 2005, the Centers for Disease Control and Prevention (CDC) reported the national cesarean birth rate was the highest ever at 29.1%, which is over a quarter of all deliveries. This means that over 1 in 4 women will experience a cesarean birth.
Your purchase supports the APA
What can I expect in a Cesarean procedure?
The normal cesarean procedure will take an average of 45 minutes to an hour. The baby is usually delivered in the first 5-15 minutes and the remainder of time is used for closing the incision.
Pre surgery:
Before surgery, you will be given some type of anesthetic (general, spinal, or epidural) if you have not been given one earlier in your labor. General anesthetic is normally only used for emergency cesareans because it is effective immediately and the mother is sedated. The spinal and epidural anesthesia will numb the area from the abdomen to below the waist (sometimes the legs can be numb also), so that nothing can be felt during the procedure. You will probably receive a catheter to collect urine while your lower body is numb.
Surgery:
The health care provider will make an incision in the abdomen wall first. In an emergency cesarean this will most likely be a vertical incision (from the navel to the pubic area) which will allow the health care provider to deliver the baby faster. The most common incision is made horizontally (often called a bikini cut), just above the pubic bone. The muscles in your stomach will not be cut; they will be pulled apart so that the health care provider can get to the uterus.
An incision will then be made into the uterus, horizontally or vertically. The same type of incision does not have to be made in both the abdomen and uterus. The classical incision made vertically, is usually reserved for complicated situations such as placenta previa, emergencies, or babies with abnormalities. A vaginal birth after cesarean (VBAC) is not recommended for women with the classical incision. Another type of incision which is rarely used is the lower segment vertical incision. This would only be used if there were problems with the uterus that would not allow another type of incision to be made. The most common incision made is the low transverse incision. This incision has fewer risks and complications than the others and allows most women to attempt a VBAC in their next pregnancy with little risk of uterine rupture.
The health care provider will suction the amniotic fluid out and then will deliver the baby. Your babies head will be delivered first so that the mouth and nose can be cleaned out to allow for its first breath. Once the whole body is delivered, the baby will be lifted up so that you can meet your newborn. Most health care providers will then pass the baby on to the nurse for evaluation. The last thing to be delivered will be your placenta (you may feel some tugging) and then the surgical team will begin the close up process.
After the Surgery:
Once the surgery is over, you may begin to experience some nausea and trembling. This can be caused by the anesthesia, the effects of your uterus contracting, or from an adrenaline let down. This usually passes quickly and can be followed by some drowsiness. If your baby is healthy, this is usually the time when the baby can rest on your chest and you can begin breastfeeding and bonding. You and your baby will continually be monitored for any complications.
When you are discharged from the hospital you will be advised on the proper post-operative care for your incision and yourself.
Watch: 689
Description: Narrator: About 1 in 4 women delivers her baby via cesarean section, or C-section, as it's commonly known. Although vaginal delivery is the natural and preferred method for childbirth, a C-section may be performed for the safety of mother and baby.
Bruce Johnston, M.D.: Preoperatively, the process begins early during the prenatal care if the patient knows she's going to have an elective cesarean section. And then we talk about what she is to expect — the anesthetic or analgesia she's going to receive, the fact that she'll have a Foley catheter in her bladder (to drain urine), and that once she comes into the room, there will be many people in the room, including her scrub nurse, the anesthesiologist, the pediatrician and then the core of people that will actually perform her cesarean section. And we try to advise her what to expect, what times — how long potentially we think on an average time it will take actually to perform the actual cesarean section — and we like not to forget the father. The father is an important part of that and a good caregiver and a good handholder for people who are doing this under regional anesthesia.
Mother: That's kind of tart.
Gurinder Vasdev, M.D.: That was Bicitra, which neutralizes the acid in the stomach, because pregnant women tend to have a little bit more acid in their stomach than normal — and so that if she does feel nauseous or sick during surgery that she's not bringing up acid.
Narrator: Ninety-five percent of women having a planned C-section use regional analgesic for pain control — either an epidural or a spinal block. The other 5 percent use general anesthesia. You'll be made comfortable in a special surgical delivery room and administered pain medication. This video shows a spinal block. Placing a spinal begins with cleaning a small area in your lower back with antiseptic solution.
Dr. Vasdev: We're doing a spinal anesthetic, and we're going to draw up the medication for the spinal anesthetic. For that, we use a combination of a local anesthetic called bupivacaine, and we also add some opiate medication called fentanyl, and morphine — and that gives you analgesia for almost 24 to 48 hours after the C-section, so you don't require any form of IV pain relief.
Narrator: During placement of your spinal, you'll either lie on your side or sit up, and round your back. First an anesthetic is injected to numb the area. You may feel a pinprick when the anesthetic is injected, but the spinal block shouldn't cause any discomfort. Then the analgesic is injected into the sac of fluid surrounding the spinal nerves, below the level of the spinal cord. A spinal block takes effect almost immediately.
The blue shading in this illustration shows the area of your body numbed by the anesthetic.
Dr. Johnston: The total time for a cesarean section varies significantly for people who are having repeat cesarean sections. First, or primary, cesarean sections generally take approximately 30 minutes total.
Narrator: Once the anesthetic has taken effect, your abdomen will be prepped for delivery of your baby. Your doctor will make two incisions, one through your abdominal wall, and another into your uterus.
There are two types of abdominal incisions: vertical and horizontal. Vertical incisions are usually done only in an emergency, from just below your navel to just above the pubic bone.
Horizontal incisions are also called Pfannenstiel incisions, or more commonly, bikini incisions. The horizontal incision is made across the lower abdomen, near the pubic hairline. Bikini incisions are used in most C-sections because they typically heal well, the scar is not easily seen and they may cause less post-delivery discomfort. The initial incision is about 6 inches (15 centimeters) long and cuts through your skin, fat and muscle to get to the uterus, where your baby is. Your doctor uses a special knife that burns, or cauterizes, the tissues to help control bleeding.
Dr. Johnston: When we perform a cesarean section, it's the matter of several little steps. Basically most patients cosmetically are most interested in having an incision that goes across the lower part of their abdomen. It's called a Pfannenstiel incision. And once we make that incision, we go down through the skin and subcutaneous layers. Then we get to the layer of fascia, or connective tissue, that covers up the rectus abdominis muscles. That's incised and then gently separated so that we can actually enter the tummy cavity where the uterus is without cutting any muscles. And then once we do that, we make a little flap underneath the bladder and then make our incision below that — and make it at a location where then if later on if she would desire to have a vaginal birth after her cesarean section, that would be a possibility. Usually in approximately five to 10 minutes we've got the baby delivered, and the rest of the time is suturing and repairing the regional incision site.
Narrator: Because your anesthetic blocks pain but not motion, you'll likely feel some tugging when your baby is pulled out, but it shouldn't hurt. Once the baby is delivered, your doctor will remove the placenta and begin to close the incisions. Internal stitches dissolve and don't need to be removed.
Dr. Johnston: Of course, once we deliver the baby, then the steps are done in reverse, except it's like so many other things, it takes longer to repair than it originally did to make the incision. So we do the steps just backward and repair the incision in the uterus. Then we sequentially repair the body wall, which is done in two or three steps, and then either suture or staple the skin edges — which, if they're stapled, the staples are removed before the patient goes home approximately 72 to 96 hours later.
A cesarean birth happens through an incision in the abdominal wall and uterus rather than through the vagina. There has been a gradual increase in cesarean births over the past 30 years. In November of 2005, the Centers for Disease Control and Prevention (CDC) reported the national cesarean birth rate was the highest ever at 29.1%, which is over a quarter of all deliveries. This means that over 1 in 4 women will experience a cesarean birth.
Your purchase supports the APA
What can I expect in a Cesarean procedure?
The normal cesarean procedure will take an average of 45 minutes to an hour. The baby is usually delivered in the first 5-15 minutes and the remainder of time is used for closing the incision.
Pre surgery:
Before surgery, you will be given some type of anesthetic (general, spinal, or epidural) if you have not been given one earlier in your labor. General anesthetic is normally only used for emergency cesareans because it is effective immediately and the mother is sedated. The spinal and epidural anesthesia will numb the area from the abdomen to below the waist (sometimes the legs can be numb also), so that nothing can be felt during the procedure. You will probably receive a catheter to collect urine while your lower body is numb.
Surgery:
The health care provider will make an incision in the abdomen wall first. In an emergency cesarean this will most likely be a vertical incision (from the navel to the pubic area) which will allow the health care provider to deliver the baby faster. The most common incision is made horizontally (often called a bikini cut), just above the pubic bone. The muscles in your stomach will not be cut; they will be pulled apart so that the health care provider can get to the uterus.
An incision will then be made into the uterus, horizontally or vertically. The same type of incision does not have to be made in both the abdomen and uterus. The classical incision made vertically, is usually reserved for complicated situations such as placenta previa, emergencies, or babies with abnormalities. A vaginal birth after cesarean (VBAC) is not recommended for women with the classical incision. Another type of incision which is rarely used is the lower segment vertical incision. This would only be used if there were problems with the uterus that would not allow another type of incision to be made. The most common incision made is the low transverse incision. This incision has fewer risks and complications than the others and allows most women to attempt a VBAC in their next pregnancy with little risk of uterine rupture.
The health care provider will suction the amniotic fluid out and then will deliver the baby. Your babies head will be delivered first so that the mouth and nose can be cleaned out to allow for its first breath. Once the whole body is delivered, the baby will be lifted up so that you can meet your newborn. Most health care providers will then pass the baby on to the nurse for evaluation. The last thing to be delivered will be your placenta (you may feel some tugging) and then the surgical team will begin the close up process.
After the Surgery:
Once the surgery is over, you may begin to experience some nausea and trembling. This can be caused by the anesthesia, the effects of your uterus contracting, or from an adrenaline let down. This usually passes quickly and can be followed by some drowsiness. If your baby is healthy, this is usually the time when the baby can rest on your chest and you can begin breastfeeding and bonding. You and your baby will continually be monitored for any complications.
When you are discharged from the hospital you will be advised on the proper post-operative care for your incision and yourself.
CESAREAN SECTiON
Watch: 956
Description: Types
Pulling out the baby.
A Caesarean section in progress.
Suturing of the uterus after extraction.
Closed Incision for low transverse abdominal incision after stapling has been completed.There are several types of Caesarean section (CS). An important distinction lies in the type of incision (longitudinal or latitudinal) made on the uterus, apart from the incision on the skin.
The classical Caesarean section involves a midline longitudinal incision which allows a larger space to deliver the baby. However, it is rarely performed today as it is more prone to complications.
The lower uterine segment section is the procedure most commonly used today; it involves a transverse cut just above the edge of the bladder and results in less blood loss and is easier to repair.
An emergency Caesarean section is a Caesarean performed once labour has commenced.
A crash Caesarean section is a Caesarean performed in an obstetric emergency, where complications of pregnancy onset suddenly during the process of labour, and swift action is required to prevent the deaths of mother, child(ren) or both.
A Caesarean hysterectomy consists of a Caesarean section followed by the removal of the uterus. This may be done in cases of intractable bleeding or when the placenta cannot be separated from the uterus.
Traditionally other forms of Caesarean section have been used, such as extraperitoneal Caesarean section or Porro Caesarean section.
a repeat Caesarean section is done when a patient had a previous Caesarean section. Typically it is performed through the old scar.
In many hospitals, especially in Argentina, the United States, United Kingdom, Canada, Norway, Sweden, Finland, Australia, and New Zealand the mother's birth partner is encouraged to attend the surgery to support the mother and share the experience. The anaesthetist will usually lower the drape temporarily as the child is delivered so the parents can see their newborn.
RisksRisks for the motherThe mortality rate for both Caesarian sections and vaginal birth, in the Western world, continues to drop steadily. In 2000, the mortality rate for Caesareans in the United States were 20 per 1,000,000.[23] The UK National Health Service gives the risk of death for the mother as three times that of a vaginal birth.[24] However, it is misleading to directly compare the mortality rates of vaginal and Caesarean deliveries. Women with severe medical conditions, or higher-risk pregnancies, often require a Caesarean section which can distort the mortality figures.
A study published in the 13 February 2007 issue of the Canadian Medical Association Journal found that the absolute differences in severe maternal morbidity and mortality was small, but that the additional risk over vaginal delivery should be considered by women contemplating an elective Caesarean delivery and by their physicians.[25]
As with all types of abdominal surgery, a Caesarean section is associated with risks of post-operative adhesions, incisional hernias (which may require surgical correction) and wound infections.[23] If a Caesarean is performed under emergency situations, the risk of the surgery may be increased due to a number of factors. The patient's stomach may not be empty, increasing the anaesthesia risk.[26] Other risks include severe blood loss (which may require a blood transfusion) and post spinal headaches.[23]
A study published in the June 2006 issue of the journal Obstetrics and Gynecology found that women who had multiple Caesarean sections were more likely to have problems with later pregnancies, and recommended that women who want larger families should not seek Caesarean section as an elective. The risk of placenta accreta, a potentially life-threatening condition, is only 0.13% after two Caesarean sections but increases to 2.13% after four and then to 6.74% after six or more surgeries. Along with this is a similar rise in the risk of emergency hysterectomies at delivery. The findings were based on outcomes from 30,132 Caesarean deliveries.[27]
It is difficult to study the effects of Caesarean sections because it can be difficult to separate out issues caused by the procedure itself versus issues caused by the conditions that require it. For example, a study published in the February 2007 issue of the journal Obstetrics and Gynecology found that women who had just one previous Caesarean section were more likely to have problems with their second birth. Women who delivered their first child by Caesarean delivery had increased risks for malpresentation, placenta previa, antepartum hemorrhage, placenta accreta, prolonged labor, uterine rupture, preterm birth, low birth weight, and stillbirth in their second delivery. However, the authors conclude that some risks may be due to confounding factors related to the indication for the first Caesarean, rather than due to the procedure itself
A Caesarean section, (also C-section, Caesarian section, Cesarean section, Caesar, etc.) is a surgical procedure in which one or more incisions are made through a mother's abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies, or, rarely, to remove a dead fetus. A late-term abortion using Caesarean section procedures is termed a hysterotomy abortion and is very rarely performed. The first modern Caesarean section was performed by German gynecologist Ferdinand Adolf Kehrer in 1881.
A Caesarean section is usually performed when a vaginal delivery would put the baby's or mother's life or health at risk, although in recent times it has been also performed upon request for childbirths that could otherwise have been natural.[1][2][3] In recent years the rate has risen to a record level of 46% in China and to levels of 25% and above in many Asian and European countries, Latin America, and the USA.[4]
Cesarean Section - Topic Overview
Is this topic for you?
If you have had a C-section and would like information about how a cesarean affects future deliveries, see the topic Vaginal Birth After Cesarean (VBAC).
What is a cesarean section?
A cesarean section is the delivery of a baby through a cut (incision) in the mother’s belly and uterus. It is often called a C-section. In most cases, a woman can be awake during the birth and be with her newborn soon afterward. See a picture of a delivery by C-section .
If you are pregnant, chances are good that you will be able to deliver your baby through the birth canal (vaginal birth). But there are cases when a C-section is needed for the safety of the mother or baby. So even if you plan on a vaginal birth, it’s a good idea to learn about C-section, in case the unexpected happens.
When is a C-section needed?
A C-section may be planned or unplanned. In most cases, doctors do cesarean sections because of problems that arise during labor. Reasons you might need an unplanned C-section include:
Labor is slow and hard or stops completely.
The baby shows signs of distress, such as a very fast or slow heart rate.
A problem with the placenta or umbilical cord puts the baby at risk.
The baby is too big to be delivered vaginally.
When doctors know about a problem ahead of time, they may schedule a C-section. Reasons you might have a planned C-section include:
The baby is not in a head-down position close to your due date.
You have a problem such as heart disease that could be made worse by the stress of labor.
You have an infection that you could pass to the baby during a vaginal birth.
You are carrying more than one baby (multiple pregnancy).
You had a C-section before, and you have the same problems this time or your doctor thinks labor might cause your scar to tear (uterine rupture).
In some cases, a woman who had a C-section in the past may be able to deliver her next baby through the birth canal. This is called vaginal birth after cesarean (VBAC). If you have had a previous C-section, ask your doctor if VBAC might be an option this time.
In the past 40 years, the rate of cesarean deliveries has jumped from about 1 out of 20 births to about 1 out of 4 births.1 This trend has caused experts to worry that C-section is being done more often than it is needed. Because of the risks, experts feel that C-section should only be done for medical reasons.
What are the risks of C-section?
Most mothers and babies do well after C-section. But it is major surgery, so it carries more risk than a normal vaginal delivery. Some possible risks of C-section include:
Infection of the incision or the uterus.
Heavy blood loss.
Blood clots in the mother’s legs or lungs.
Injury to the mother or baby.
Problems from the anesthesia, such as nausea, vomiting, and severe headache.
Breathing problems in the baby if it was delivered before its due date.
Further Reading:Once a C, Always a C? Aiming to Avoid the Scalpel Elective Cesarean: Babies On Demand What to Expect if You Have a Cesarean Delivery C-Section May Affect Future Fertility C-Section No Cure-All for Problem Births Preterm Birth and C-Section Rates Up See All C-Section Topics
Watch: 956
Description: Types
Pulling out the baby.
A Caesarean section in progress.
Suturing of the uterus after extraction.
Closed Incision for low transverse abdominal incision after stapling has been completed.There are several types of Caesarean section (CS). An important distinction lies in the type of incision (longitudinal or latitudinal) made on the uterus, apart from the incision on the skin.
The classical Caesarean section involves a midline longitudinal incision which allows a larger space to deliver the baby. However, it is rarely performed today as it is more prone to complications.
The lower uterine segment section is the procedure most commonly used today; it involves a transverse cut just above the edge of the bladder and results in less blood loss and is easier to repair.
An emergency Caesarean section is a Caesarean performed once labour has commenced.
A crash Caesarean section is a Caesarean performed in an obstetric emergency, where complications of pregnancy onset suddenly during the process of labour, and swift action is required to prevent the deaths of mother, child(ren) or both.
A Caesarean hysterectomy consists of a Caesarean section followed by the removal of the uterus. This may be done in cases of intractable bleeding or when the placenta cannot be separated from the uterus.
Traditionally other forms of Caesarean section have been used, such as extraperitoneal Caesarean section or Porro Caesarean section.
a repeat Caesarean section is done when a patient had a previous Caesarean section. Typically it is performed through the old scar.
In many hospitals, especially in Argentina, the United States, United Kingdom, Canada, Norway, Sweden, Finland, Australia, and New Zealand the mother's birth partner is encouraged to attend the surgery to support the mother and share the experience. The anaesthetist will usually lower the drape temporarily as the child is delivered so the parents can see their newborn.
RisksRisks for the motherThe mortality rate for both Caesarian sections and vaginal birth, in the Western world, continues to drop steadily. In 2000, the mortality rate for Caesareans in the United States were 20 per 1,000,000.[23] The UK National Health Service gives the risk of death for the mother as three times that of a vaginal birth.[24] However, it is misleading to directly compare the mortality rates of vaginal and Caesarean deliveries. Women with severe medical conditions, or higher-risk pregnancies, often require a Caesarean section which can distort the mortality figures.
A study published in the 13 February 2007 issue of the Canadian Medical Association Journal found that the absolute differences in severe maternal morbidity and mortality was small, but that the additional risk over vaginal delivery should be considered by women contemplating an elective Caesarean delivery and by their physicians.[25]
As with all types of abdominal surgery, a Caesarean section is associated with risks of post-operative adhesions, incisional hernias (which may require surgical correction) and wound infections.[23] If a Caesarean is performed under emergency situations, the risk of the surgery may be increased due to a number of factors. The patient's stomach may not be empty, increasing the anaesthesia risk.[26] Other risks include severe blood loss (which may require a blood transfusion) and post spinal headaches.[23]
A study published in the June 2006 issue of the journal Obstetrics and Gynecology found that women who had multiple Caesarean sections were more likely to have problems with later pregnancies, and recommended that women who want larger families should not seek Caesarean section as an elective. The risk of placenta accreta, a potentially life-threatening condition, is only 0.13% after two Caesarean sections but increases to 2.13% after four and then to 6.74% after six or more surgeries. Along with this is a similar rise in the risk of emergency hysterectomies at delivery. The findings were based on outcomes from 30,132 Caesarean deliveries.[27]
It is difficult to study the effects of Caesarean sections because it can be difficult to separate out issues caused by the procedure itself versus issues caused by the conditions that require it. For example, a study published in the February 2007 issue of the journal Obstetrics and Gynecology found that women who had just one previous Caesarean section were more likely to have problems with their second birth. Women who delivered their first child by Caesarean delivery had increased risks for malpresentation, placenta previa, antepartum hemorrhage, placenta accreta, prolonged labor, uterine rupture, preterm birth, low birth weight, and stillbirth in their second delivery. However, the authors conclude that some risks may be due to confounding factors related to the indication for the first Caesarean, rather than due to the procedure itself
A Caesarean section, (also C-section, Caesarian section, Cesarean section, Caesar, etc.) is a surgical procedure in which one or more incisions are made through a mother's abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies, or, rarely, to remove a dead fetus. A late-term abortion using Caesarean section procedures is termed a hysterotomy abortion and is very rarely performed. The first modern Caesarean section was performed by German gynecologist Ferdinand Adolf Kehrer in 1881.
A Caesarean section is usually performed when a vaginal delivery would put the baby's or mother's life or health at risk, although in recent times it has been also performed upon request for childbirths that could otherwise have been natural.[1][2][3] In recent years the rate has risen to a record level of 46% in China and to levels of 25% and above in many Asian and European countries, Latin America, and the USA.[4]
Cesarean Section - Topic Overview
Is this topic for you?
If you have had a C-section and would like information about how a cesarean affects future deliveries, see the topic Vaginal Birth After Cesarean (VBAC).
What is a cesarean section?
A cesarean section is the delivery of a baby through a cut (incision) in the mother’s belly and uterus. It is often called a C-section. In most cases, a woman can be awake during the birth and be with her newborn soon afterward. See a picture of a delivery by C-section .
If you are pregnant, chances are good that you will be able to deliver your baby through the birth canal (vaginal birth). But there are cases when a C-section is needed for the safety of the mother or baby. So even if you plan on a vaginal birth, it’s a good idea to learn about C-section, in case the unexpected happens.
When is a C-section needed?
A C-section may be planned or unplanned. In most cases, doctors do cesarean sections because of problems that arise during labor. Reasons you might need an unplanned C-section include:
Labor is slow and hard or stops completely.
The baby shows signs of distress, such as a very fast or slow heart rate.
A problem with the placenta or umbilical cord puts the baby at risk.
The baby is too big to be delivered vaginally.
When doctors know about a problem ahead of time, they may schedule a C-section. Reasons you might have a planned C-section include:
The baby is not in a head-down position close to your due date.
You have a problem such as heart disease that could be made worse by the stress of labor.
You have an infection that you could pass to the baby during a vaginal birth.
You are carrying more than one baby (multiple pregnancy).
You had a C-section before, and you have the same problems this time or your doctor thinks labor might cause your scar to tear (uterine rupture).
In some cases, a woman who had a C-section in the past may be able to deliver her next baby through the birth canal. This is called vaginal birth after cesarean (VBAC). If you have had a previous C-section, ask your doctor if VBAC might be an option this time.
In the past 40 years, the rate of cesarean deliveries has jumped from about 1 out of 20 births to about 1 out of 4 births.1 This trend has caused experts to worry that C-section is being done more often than it is needed. Because of the risks, experts feel that C-section should only be done for medical reasons.
What are the risks of C-section?
Most mothers and babies do well after C-section. But it is major surgery, so it carries more risk than a normal vaginal delivery. Some possible risks of C-section include:
Infection of the incision or the uterus.
Heavy blood loss.
Blood clots in the mother’s legs or lungs.
Injury to the mother or baby.
Problems from the anesthesia, such as nausea, vomiting, and severe headache.
Breathing problems in the baby if it was delivered before its due date.
Further Reading:Once a C, Always a C? Aiming to Avoid the Scalpel Elective Cesarean: Babies On Demand What to Expect if You Have a Cesarean Delivery C-Section May Affect Future Fertility C-Section No Cure-All for Problem Births Preterm Birth and C-Section Rates Up See All C-Section Topics
CESAREAN SECTiON ViDEO
Watch: 1044
Description: Cesarean Section - Topic Overview
Is this topic for you?
If you have had a C-section and would like information about how a cesarean affects future deliveries, see the topic Vaginal Birth After Cesarean (VBAC).
What is a cesarean section?
A cesarean section is the delivery of a baby through a cut (incision) in the mother’s belly and uterus. It is often called a C-section. In most cases, a woman can be awake during the birth and be with her newborn soon afterward. See a picture of a delivery by C-section .
If you are pregnant, chances are good that you will be able to deliver your baby through the birth canal (vaginal birth). But there are cases when a C-section is needed for the safety of the mother or baby. So even if you plan on a vaginal birth, it’s a good idea to learn about C-section, in case the unexpected happens.
When is a C-section needed?
A C-section may be planned or unplanned. In most cases, doctors do cesarean sections because of problems that arise during labor. Reasons you might need an unplanned C-section include:
Labor is slow and hard or stops completely.
The baby shows signs of distress, such as a very fast or slow heart rate.
A problem with the placenta or umbilical cord puts the baby at risk.
The baby is too big to be delivered vaginally.
When doctors know about a problem ahead of time, they may schedule a C-section. Reasons you might have a planned C-section include:
The baby is not in a head-down position close to your due date.
You have a problem such as heart disease that could be made worse by the stress of labor.
You have an infection that you could pass to the baby during a vaginal birth.
You are carrying more than one baby (multiple pregnancy).
You had a C-section before, and you have the same problems this time or your doctor thinks labor might cause your scar to tear (uterine rupture).
In some cases, a woman who had a C-section in the past may be able to deliver her next baby through the birth canal. This is called vaginal birth after cesarean (VBAC). If you have had a previous C-section, ask your doctor if VBAC might be an option this time.
In the past 40 years, the rate of cesarean deliveries has jumped from about 1 out of 20 births to about 1 out of 4 births.1 This trend has caused experts to worry that C-section is being done more often than it is needed. Because of the risks, experts feel that C-section should only be done for medical reasons.
What are the risks of C-section?
Most mothers and babies do well after C-section. But it is major surgery, so it carries more risk than a normal vaginal delivery. Some possible risks of C-section include:
Infection of the incision or the uterus.
Heavy blood loss.
Blood clots in the mother’s legs or lungs.
Injury to the mother or baby.
Problems from the anesthesia, such as nausea, vomiting, and severe headache.
Breathing problems in the baby if it was delivered before its due date.
Further Reading:Once a C, Always a C? Aiming to Avoid the Scalpel Elective Cesarean: Babies On Demand What to Expect if You Have a Cesarean Delivery C-Section May Affect Future Fertility C-Section No Cure-All for Problem Births Preterm Birth and C-Section Rates Up See All C-Section Topics
Watch: 1044
Description: Cesarean Section - Topic Overview
Is this topic for you?
If you have had a C-section and would like information about how a cesarean affects future deliveries, see the topic Vaginal Birth After Cesarean (VBAC).
What is a cesarean section?
A cesarean section is the delivery of a baby through a cut (incision) in the mother’s belly and uterus. It is often called a C-section. In most cases, a woman can be awake during the birth and be with her newborn soon afterward. See a picture of a delivery by C-section .
If you are pregnant, chances are good that you will be able to deliver your baby through the birth canal (vaginal birth). But there are cases when a C-section is needed for the safety of the mother or baby. So even if you plan on a vaginal birth, it’s a good idea to learn about C-section, in case the unexpected happens.
When is a C-section needed?
A C-section may be planned or unplanned. In most cases, doctors do cesarean sections because of problems that arise during labor. Reasons you might need an unplanned C-section include:
Labor is slow and hard or stops completely.
The baby shows signs of distress, such as a very fast or slow heart rate.
A problem with the placenta or umbilical cord puts the baby at risk.
The baby is too big to be delivered vaginally.
When doctors know about a problem ahead of time, they may schedule a C-section. Reasons you might have a planned C-section include:
The baby is not in a head-down position close to your due date.
You have a problem such as heart disease that could be made worse by the stress of labor.
You have an infection that you could pass to the baby during a vaginal birth.
You are carrying more than one baby (multiple pregnancy).
You had a C-section before, and you have the same problems this time or your doctor thinks labor might cause your scar to tear (uterine rupture).
In some cases, a woman who had a C-section in the past may be able to deliver her next baby through the birth canal. This is called vaginal birth after cesarean (VBAC). If you have had a previous C-section, ask your doctor if VBAC might be an option this time.
In the past 40 years, the rate of cesarean deliveries has jumped from about 1 out of 20 births to about 1 out of 4 births.1 This trend has caused experts to worry that C-section is being done more often than it is needed. Because of the risks, experts feel that C-section should only be done for medical reasons.
What are the risks of C-section?
Most mothers and babies do well after C-section. But it is major surgery, so it carries more risk than a normal vaginal delivery. Some possible risks of C-section include:
Infection of the incision or the uterus.
Heavy blood loss.
Blood clots in the mother’s legs or lungs.
Injury to the mother or baby.
Problems from the anesthesia, such as nausea, vomiting, and severe headache.
Breathing problems in the baby if it was delivered before its due date.
Further Reading:Once a C, Always a C? Aiming to Avoid the Scalpel Elective Cesarean: Babies On Demand What to Expect if You Have a Cesarean Delivery C-Section May Affect Future Fertility C-Section No Cure-All for Problem Births Preterm Birth and C-Section Rates Up See All C-Section Topics
cesarean section video procedure slide
Watch: 720
Description: c-section
A cesarean birth happens through an incision in the abdominal wall and uterus rather than through the vagina. There has been a gradual increase in cesarean births over the past 30 years. In November of 2005, the Centers for Disease Control and Prevention (CDC) reported the national cesarean birth rate was the highest ever at 29.1%, which is over a quarter of all deliveries. This means that over 1 in 4 women will experience a cesarean birth.
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What can I expect in a Cesarean procedure?
The normal cesarean procedure will take an average of 45 minutes to an hour. The baby is usually delivered in the first 5-15 minutes and the remainder of time is used for closing the incision.
Pre surgery:
Before surgery, you will be given some type of anesthetic (general, spinal, or epidural) if you have not been given one earlier in your labor. General anesthetic is normally only used for emergency cesareans because it is effective immediately and the mother is sedated. The spinal and epidural anesthesia will numb the area from the abdomen to below the waist (sometimes the legs can be numb also), so that nothing can be felt during the procedure. You will probably receive a catheter to collect urine while your lower body is numb.
Surgery:
The health care provider will make an incision in the abdomen wall first. In an emergency cesarean this will most likely be a vertical incision (from the navel to the pubic area) which will allow the health care provider to deliver the baby faster. The most common incision is made horizontally (often called a bikini cut), just above the pubic bone. The muscles in your stomach will not be cut; they will be pulled apart so that the health care provider can get to the uterus.
An incision will then be made into the uterus, horizontally or vertically. The same type of incision does not have to be made in both the abdomen and uterus. The classical incision made vertically, is usually reserved for complicated situations such as placenta previa, emergencies, or babies with abnormalities. A vaginal birth after cesarean (VBAC) is not recommended for women with the classical incision. Another type of incision which is rarely used is the lower segment vertical incision. This would only be used if there were problems with the uterus that would not allow another type of incision to be made. The most common incision made is the low transverse incision. This incision has fewer risks and complications than the others and allows most women to attempt a VBAC in their next pregnancy with little risk of uterine rupture.
The health care provider will suction the amniotic fluid out and then will deliver the baby. Your babies head will be delivered first so that the mouth and nose can be cleaned out to allow for its first breath. Once the whole body is delivered, the baby will be lifted up so that you can meet your newborn. Most health care providers will then pass the baby on to the nurse for evaluation. The last thing to be delivered will be your placenta (you may feel some tugging) and then the surgical team will begin the close up process.
After the Surgery:
Once the surgery is over, you may begin to experience some nausea and trembling. This can be caused by the anesthesia, the effects of your uterus contracting, or from an adrenaline let down. This usually passes quickly and can be followed by some drowsiness. If your baby is healthy, this is usually the time when the baby can rest on your chest and you can begin breastfeeding and bonding. You and your baby will continually be monitored for any complications.
When you are discharged from the hospital you will be advised on the proper post-operative care for your incision and yourself.
Watch: 720
Description: c-section
A cesarean birth happens through an incision in the abdominal wall and uterus rather than through the vagina. There has been a gradual increase in cesarean births over the past 30 years. In November of 2005, the Centers for Disease Control and Prevention (CDC) reported the national cesarean birth rate was the highest ever at 29.1%, which is over a quarter of all deliveries. This means that over 1 in 4 women will experience a cesarean birth.
Your purchase supports the APA
What can I expect in a Cesarean procedure?
The normal cesarean procedure will take an average of 45 minutes to an hour. The baby is usually delivered in the first 5-15 minutes and the remainder of time is used for closing the incision.
Pre surgery:
Before surgery, you will be given some type of anesthetic (general, spinal, or epidural) if you have not been given one earlier in your labor. General anesthetic is normally only used for emergency cesareans because it is effective immediately and the mother is sedated. The spinal and epidural anesthesia will numb the area from the abdomen to below the waist (sometimes the legs can be numb also), so that nothing can be felt during the procedure. You will probably receive a catheter to collect urine while your lower body is numb.
Surgery:
The health care provider will make an incision in the abdomen wall first. In an emergency cesarean this will most likely be a vertical incision (from the navel to the pubic area) which will allow the health care provider to deliver the baby faster. The most common incision is made horizontally (often called a bikini cut), just above the pubic bone. The muscles in your stomach will not be cut; they will be pulled apart so that the health care provider can get to the uterus.
An incision will then be made into the uterus, horizontally or vertically. The same type of incision does not have to be made in both the abdomen and uterus. The classical incision made vertically, is usually reserved for complicated situations such as placenta previa, emergencies, or babies with abnormalities. A vaginal birth after cesarean (VBAC) is not recommended for women with the classical incision. Another type of incision which is rarely used is the lower segment vertical incision. This would only be used if there were problems with the uterus that would not allow another type of incision to be made. The most common incision made is the low transverse incision. This incision has fewer risks and complications than the others and allows most women to attempt a VBAC in their next pregnancy with little risk of uterine rupture.
The health care provider will suction the amniotic fluid out and then will deliver the baby. Your babies head will be delivered first so that the mouth and nose can be cleaned out to allow for its first breath. Once the whole body is delivered, the baby will be lifted up so that you can meet your newborn. Most health care providers will then pass the baby on to the nurse for evaluation. The last thing to be delivered will be your placenta (you may feel some tugging) and then the surgical team will begin the close up process.
After the Surgery:
Once the surgery is over, you may begin to experience some nausea and trembling. This can be caused by the anesthesia, the effects of your uterus contracting, or from an adrenaline let down. This usually passes quickly and can be followed by some drowsiness. If your baby is healthy, this is usually the time when the baby can rest on your chest and you can begin breastfeeding and bonding. You and your baby will continually be monitored for any complications.
When you are discharged from the hospital you will be advised on the proper post-operative care for your incision and yourself.
c-section cesarean section
Watch: 689
Description: Narrator: About 1 in 4 women delivers her baby via cesarean section, or C-section, as it's commonly known. Although vaginal delivery is the natural and preferred method for childbirth, a C-section may be performed for the safety of mother and baby.
Bruce Johnston, M.D.: Preoperatively, the process begins early during the prenatal care if the patient knows she's going to have an elective cesarean section. And then we talk about what she is to expect — the anesthetic or analgesia she's going to receive, the fact that she'll have a Foley catheter in her bladder (to drain urine), and that once she comes into the room, there will be many people in the room, including her scrub nurse, the anesthesiologist, the pediatrician and then the core of people that will actually perform her cesarean section. And we try to advise her what to expect, what times — how long potentially we think on an average time it will take actually to perform the actual cesarean section — and we like not to forget the father. The father is an important part of that and a good caregiver and a good handholder for people who are doing this under regional anesthesia.
Mother: That's kind of tart.
Gurinder Vasdev, M.D.: That was Bicitra, which neutralizes the acid in the stomach, because pregnant women tend to have a little bit more acid in their stomach than normal — and so that if she does feel nauseous or sick during surgery that she's not bringing up acid.
Narrator: Ninety-five percent of women having a planned C-section use regional analgesic for pain control — either an epidural or a spinal block. The other 5 percent use general anesthesia. You'll be made comfortable in a special surgical delivery room and administered pain medication. This video shows a spinal block. Placing a spinal begins with cleaning a small area in your lower back with antiseptic solution.
Dr. Vasdev: We're doing a spinal anesthetic, and we're going to draw up the medication for the spinal anesthetic. For that, we use a combination of a local anesthetic called bupivacaine, and we also add some opiate medication called fentanyl, and morphine — and that gives you analgesia for almost 24 to 48 hours after the C-section, so you don't require any form of IV pain relief.
Narrator: During placement of your spinal, you'll either lie on your side or sit up, and round your back. First an anesthetic is injected to numb the area. You may feel a pinprick when the anesthetic is injected, but the spinal block shouldn't cause any discomfort. Then the analgesic is injected into the sac of fluid surrounding the spinal nerves, below the level of the spinal cord. A spinal block takes effect almost immediately.
The blue shading in this illustration shows the area of your body numbed by the anesthetic.
Dr. Johnston: The total time for a cesarean section varies significantly for people who are having repeat cesarean sections. First, or primary, cesarean sections generally take approximately 30 minutes total.
Narrator: Once the anesthetic has taken effect, your abdomen will be prepped for delivery of your baby. Your doctor will make two incisions, one through your abdominal wall, and another into your uterus.
There are two types of abdominal incisions: vertical and horizontal. Vertical incisions are usually done only in an emergency, from just below your navel to just above the pubic bone.
Horizontal incisions are also called Pfannenstiel incisions, or more commonly, bikini incisions. The horizontal incision is made across the lower abdomen, near the pubic hairline. Bikini incisions are used in most C-sections because they typically heal well, the scar is not easily seen and they may cause less post-delivery discomfort. The initial incision is about 6 inches (15 centimeters) long and cuts through your skin, fat and muscle to get to the uterus, where your baby is. Your doctor uses a special knife that burns, or cauterizes, the tissues to help control bleeding.
Dr. Johnston: When we perform a cesarean section, it's the matter of several little steps. Basically most patients cosmetically are most interested in having an incision that goes across the lower part of their abdomen. It's called a Pfannenstiel incision. And once we make that incision, we go down through the skin and subcutaneous layers. Then we get to the layer of fascia, or connective tissue, that covers up the rectus abdominis muscles. That's incised and then gently separated so that we can actually enter the tummy cavity where the uterus is without cutting any muscles. And then once we do that, we make a little flap underneath the bladder and then make our incision below that — and make it at a location where then if later on if she would desire to have a vaginal birth after her cesarean section, that would be a possibility. Usually in approximately five to 10 minutes we've got the baby delivered, and the rest of the time is suturing and repairing the regional incision site.
Narrator: Because your anesthetic blocks pain but not motion, you'll likely feel some tugging when your baby is pulled out, but it shouldn't hurt. Once the baby is delivered, your doctor will remove the placenta and begin to close the incisions. Internal stitches dissolve and don't need to be removed.
Dr. Johnston: Of course, once we deliver the baby, then the steps are done in reverse, except it's like so many other things, it takes longer to repair than it originally did to make the incision. So we do the steps just backward and repair the incision in the uterus. Then we sequentially repair the body wall, which is done in two or three steps, and then either suture or staple the skin edges — which, if they're stapled, the staples are removed before the patient goes home approximately 72 to 96 hours later.
A cesarean birth happens through an incision in the abdominal wall and uterus rather than through the vagina. There has been a gradual increase in cesarean births over the past 30 years. In November of 2005, the Centers for Disease Control and Prevention (CDC) reported the national cesarean birth rate was the highest ever at 29.1%, which is over a quarter of all deliveries. This means that over 1 in 4 women will experience a cesarean birth.
Your purchase supports the APA
What can I expect in a Cesarean procedure?
The normal cesarean procedure will take an average of 45 minutes to an hour. The baby is usually delivered in the first 5-15 minutes and the remainder of time is used for closing the incision.
Pre surgery:
Before surgery, you will be given some type of anesthetic (general, spinal, or epidural) if you have not been given one earlier in your labor. General anesthetic is normally only used for emergency cesareans because it is effective immediately and the mother is sedated. The spinal and epidural anesthesia will numb the area from the abdomen to below the waist (sometimes the legs can be numb also), so that nothing can be felt during the procedure. You will probably receive a catheter to collect urine while your lower body is numb.
Surgery:
The health care provider will make an incision in the abdomen wall first. In an emergency cesarean this will most likely be a vertical incision (from the navel to the pubic area) which will allow the health care provider to deliver the baby faster. The most common incision is made horizontally (often called a bikini cut), just above the pubic bone. The muscles in your stomach will not be cut; they will be pulled apart so that the health care provider can get to the uterus.
An incision will then be made into the uterus, horizontally or vertically. The same type of incision does not have to be made in both the abdomen and uterus. The classical incision made vertically, is usually reserved for complicated situations such as placenta previa, emergencies, or babies with abnormalities. A vaginal birth after cesarean (VBAC) is not recommended for women with the classical incision. Another type of incision which is rarely used is the lower segment vertical incision. This would only be used if there were problems with the uterus that would not allow another type of incision to be made. The most common incision made is the low transverse incision. This incision has fewer risks and complications than the others and allows most women to attempt a VBAC in their next pregnancy with little risk of uterine rupture.
The health care provider will suction the amniotic fluid out and then will deliver the baby. Your babies head will be delivered first so that the mouth and nose can be cleaned out to allow for its first breath. Once the whole body is delivered, the baby will be lifted up so that you can meet your newborn. Most health care providers will then pass the baby on to the nurse for evaluation. The last thing to be delivered will be your placenta (you may feel some tugging) and then the surgical team will begin the close up process.
After the Surgery:
Once the surgery is over, you may begin to experience some nausea and trembling. This can be caused by the anesthesia, the effects of your uterus contracting, or from an adrenaline let down. This usually passes quickly and can be followed by some drowsiness. If your baby is healthy, this is usually the time when the baby can rest on your chest and you can begin breastfeeding and bonding. You and your baby will continually be monitored for any complications.
When you are discharged from the hospital you will be advised on the proper post-operative care for your incision and yourself.
Watch: 689
Description: Narrator: About 1 in 4 women delivers her baby via cesarean section, or C-section, as it's commonly known. Although vaginal delivery is the natural and preferred method for childbirth, a C-section may be performed for the safety of mother and baby.
Bruce Johnston, M.D.: Preoperatively, the process begins early during the prenatal care if the patient knows she's going to have an elective cesarean section. And then we talk about what she is to expect — the anesthetic or analgesia she's going to receive, the fact that she'll have a Foley catheter in her bladder (to drain urine), and that once she comes into the room, there will be many people in the room, including her scrub nurse, the anesthesiologist, the pediatrician and then the core of people that will actually perform her cesarean section. And we try to advise her what to expect, what times — how long potentially we think on an average time it will take actually to perform the actual cesarean section — and we like not to forget the father. The father is an important part of that and a good caregiver and a good handholder for people who are doing this under regional anesthesia.
Mother: That's kind of tart.
Gurinder Vasdev, M.D.: That was Bicitra, which neutralizes the acid in the stomach, because pregnant women tend to have a little bit more acid in their stomach than normal — and so that if she does feel nauseous or sick during surgery that she's not bringing up acid.
Narrator: Ninety-five percent of women having a planned C-section use regional analgesic for pain control — either an epidural or a spinal block. The other 5 percent use general anesthesia. You'll be made comfortable in a special surgical delivery room and administered pain medication. This video shows a spinal block. Placing a spinal begins with cleaning a small area in your lower back with antiseptic solution.
Dr. Vasdev: We're doing a spinal anesthetic, and we're going to draw up the medication for the spinal anesthetic. For that, we use a combination of a local anesthetic called bupivacaine, and we also add some opiate medication called fentanyl, and morphine — and that gives you analgesia for almost 24 to 48 hours after the C-section, so you don't require any form of IV pain relief.
Narrator: During placement of your spinal, you'll either lie on your side or sit up, and round your back. First an anesthetic is injected to numb the area. You may feel a pinprick when the anesthetic is injected, but the spinal block shouldn't cause any discomfort. Then the analgesic is injected into the sac of fluid surrounding the spinal nerves, below the level of the spinal cord. A spinal block takes effect almost immediately.
The blue shading in this illustration shows the area of your body numbed by the anesthetic.
Dr. Johnston: The total time for a cesarean section varies significantly for people who are having repeat cesarean sections. First, or primary, cesarean sections generally take approximately 30 minutes total.
Narrator: Once the anesthetic has taken effect, your abdomen will be prepped for delivery of your baby. Your doctor will make two incisions, one through your abdominal wall, and another into your uterus.
There are two types of abdominal incisions: vertical and horizontal. Vertical incisions are usually done only in an emergency, from just below your navel to just above the pubic bone.
Horizontal incisions are also called Pfannenstiel incisions, or more commonly, bikini incisions. The horizontal incision is made across the lower abdomen, near the pubic hairline. Bikini incisions are used in most C-sections because they typically heal well, the scar is not easily seen and they may cause less post-delivery discomfort. The initial incision is about 6 inches (15 centimeters) long and cuts through your skin, fat and muscle to get to the uterus, where your baby is. Your doctor uses a special knife that burns, or cauterizes, the tissues to help control bleeding.
Dr. Johnston: When we perform a cesarean section, it's the matter of several little steps. Basically most patients cosmetically are most interested in having an incision that goes across the lower part of their abdomen. It's called a Pfannenstiel incision. And once we make that incision, we go down through the skin and subcutaneous layers. Then we get to the layer of fascia, or connective tissue, that covers up the rectus abdominis muscles. That's incised and then gently separated so that we can actually enter the tummy cavity where the uterus is without cutting any muscles. And then once we do that, we make a little flap underneath the bladder and then make our incision below that — and make it at a location where then if later on if she would desire to have a vaginal birth after her cesarean section, that would be a possibility. Usually in approximately five to 10 minutes we've got the baby delivered, and the rest of the time is suturing and repairing the regional incision site.
Narrator: Because your anesthetic blocks pain but not motion, you'll likely feel some tugging when your baby is pulled out, but it shouldn't hurt. Once the baby is delivered, your doctor will remove the placenta and begin to close the incisions. Internal stitches dissolve and don't need to be removed.
Dr. Johnston: Of course, once we deliver the baby, then the steps are done in reverse, except it's like so many other things, it takes longer to repair than it originally did to make the incision. So we do the steps just backward and repair the incision in the uterus. Then we sequentially repair the body wall, which is done in two or three steps, and then either suture or staple the skin edges — which, if they're stapled, the staples are removed before the patient goes home approximately 72 to 96 hours later.
A cesarean birth happens through an incision in the abdominal wall and uterus rather than through the vagina. There has been a gradual increase in cesarean births over the past 30 years. In November of 2005, the Centers for Disease Control and Prevention (CDC) reported the national cesarean birth rate was the highest ever at 29.1%, which is over a quarter of all deliveries. This means that over 1 in 4 women will experience a cesarean birth.
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What can I expect in a Cesarean procedure?
The normal cesarean procedure will take an average of 45 minutes to an hour. The baby is usually delivered in the first 5-15 minutes and the remainder of time is used for closing the incision.
Pre surgery:
Before surgery, you will be given some type of anesthetic (general, spinal, or epidural) if you have not been given one earlier in your labor. General anesthetic is normally only used for emergency cesareans because it is effective immediately and the mother is sedated. The spinal and epidural anesthesia will numb the area from the abdomen to below the waist (sometimes the legs can be numb also), so that nothing can be felt during the procedure. You will probably receive a catheter to collect urine while your lower body is numb.
Surgery:
The health care provider will make an incision in the abdomen wall first. In an emergency cesarean this will most likely be a vertical incision (from the navel to the pubic area) which will allow the health care provider to deliver the baby faster. The most common incision is made horizontally (often called a bikini cut), just above the pubic bone. The muscles in your stomach will not be cut; they will be pulled apart so that the health care provider can get to the uterus.
An incision will then be made into the uterus, horizontally or vertically. The same type of incision does not have to be made in both the abdomen and uterus. The classical incision made vertically, is usually reserved for complicated situations such as placenta previa, emergencies, or babies with abnormalities. A vaginal birth after cesarean (VBAC) is not recommended for women with the classical incision. Another type of incision which is rarely used is the lower segment vertical incision. This would only be used if there were problems with the uterus that would not allow another type of incision to be made. The most common incision made is the low transverse incision. This incision has fewer risks and complications than the others and allows most women to attempt a VBAC in their next pregnancy with little risk of uterine rupture.
The health care provider will suction the amniotic fluid out and then will deliver the baby. Your babies head will be delivered first so that the mouth and nose can be cleaned out to allow for its first breath. Once the whole body is delivered, the baby will be lifted up so that you can meet your newborn. Most health care providers will then pass the baby on to the nurse for evaluation. The last thing to be delivered will be your placenta (you may feel some tugging) and then the surgical team will begin the close up process.
After the Surgery:
Once the surgery is over, you may begin to experience some nausea and trembling. This can be caused by the anesthesia, the effects of your uterus contracting, or from an adrenaline let down. This usually passes quickly and can be followed by some drowsiness. If your baby is healthy, this is usually the time when the baby can rest on your chest and you can begin breastfeeding and bonding. You and your baby will continually be monitored for any complications.
When you are discharged from the hospital you will be advised on the proper post-operative care for your incision and yourself.
CESAREAN SECTiON
Watch: 956
Description: Types
Pulling out the baby.
A Caesarean section in progress.
Suturing of the uterus after extraction.
Closed Incision for low transverse abdominal incision after stapling has been completed.There are several types of Caesarean section (CS). An important distinction lies in the type of incision (longitudinal or latitudinal) made on the uterus, apart from the incision on the skin.
The classical Caesarean section involves a midline longitudinal incision which allows a larger space to deliver the baby. However, it is rarely performed today as it is more prone to complications.
The lower uterine segment section is the procedure most commonly used today; it involves a transverse cut just above the edge of the bladder and results in less blood loss and is easier to repair.
An emergency Caesarean section is a Caesarean performed once labour has commenced.
A crash Caesarean section is a Caesarean performed in an obstetric emergency, where complications of pregnancy onset suddenly during the process of labour, and swift action is required to prevent the deaths of mother, child(ren) or both.
A Caesarean hysterectomy consists of a Caesarean section followed by the removal of the uterus. This may be done in cases of intractable bleeding or when the placenta cannot be separated from the uterus.
Traditionally other forms of Caesarean section have been used, such as extraperitoneal Caesarean section or Porro Caesarean section.
a repeat Caesarean section is done when a patient had a previous Caesarean section. Typically it is performed through the old scar.
In many hospitals, especially in Argentina, the United States, United Kingdom, Canada, Norway, Sweden, Finland, Australia, and New Zealand the mother's birth partner is encouraged to attend the surgery to support the mother and share the experience. The anaesthetist will usually lower the drape temporarily as the child is delivered so the parents can see their newborn.
RisksRisks for the motherThe mortality rate for both Caesarian sections and vaginal birth, in the Western world, continues to drop steadily. In 2000, the mortality rate for Caesareans in the United States were 20 per 1,000,000.[23] The UK National Health Service gives the risk of death for the mother as three times that of a vaginal birth.[24] However, it is misleading to directly compare the mortality rates of vaginal and Caesarean deliveries. Women with severe medical conditions, or higher-risk pregnancies, often require a Caesarean section which can distort the mortality figures.
A study published in the 13 February 2007 issue of the Canadian Medical Association Journal found that the absolute differences in severe maternal morbidity and mortality was small, but that the additional risk over vaginal delivery should be considered by women contemplating an elective Caesarean delivery and by their physicians.[25]
As with all types of abdominal surgery, a Caesarean section is associated with risks of post-operative adhesions, incisional hernias (which may require surgical correction) and wound infections.[23] If a Caesarean is performed under emergency situations, the risk of the surgery may be increased due to a number of factors. The patient's stomach may not be empty, increasing the anaesthesia risk.[26] Other risks include severe blood loss (which may require a blood transfusion) and post spinal headaches.[23]
A study published in the June 2006 issue of the journal Obstetrics and Gynecology found that women who had multiple Caesarean sections were more likely to have problems with later pregnancies, and recommended that women who want larger families should not seek Caesarean section as an elective. The risk of placenta accreta, a potentially life-threatening condition, is only 0.13% after two Caesarean sections but increases to 2.13% after four and then to 6.74% after six or more surgeries. Along with this is a similar rise in the risk of emergency hysterectomies at delivery. The findings were based on outcomes from 30,132 Caesarean deliveries.[27]
It is difficult to study the effects of Caesarean sections because it can be difficult to separate out issues caused by the procedure itself versus issues caused by the conditions that require it. For example, a study published in the February 2007 issue of the journal Obstetrics and Gynecology found that women who had just one previous Caesarean section were more likely to have problems with their second birth. Women who delivered their first child by Caesarean delivery had increased risks for malpresentation, placenta previa, antepartum hemorrhage, placenta accreta, prolonged labor, uterine rupture, preterm birth, low birth weight, and stillbirth in their second delivery. However, the authors conclude that some risks may be due to confounding factors related to the indication for the first Caesarean, rather than due to the procedure itself
A Caesarean section, (also C-section, Caesarian section, Cesarean section, Caesar, etc.) is a surgical procedure in which one or more incisions are made through a mother's abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies, or, rarely, to remove a dead fetus. A late-term abortion using Caesarean section procedures is termed a hysterotomy abortion and is very rarely performed. The first modern Caesarean section was performed by German gynecologist Ferdinand Adolf Kehrer in 1881.
A Caesarean section is usually performed when a vaginal delivery would put the baby's or mother's life or health at risk, although in recent times it has been also performed upon request for childbirths that could otherwise have been natural.[1][2][3] In recent years the rate has risen to a record level of 46% in China and to levels of 25% and above in many Asian and European countries, Latin America, and the USA.[4]
Cesarean Section - Topic Overview
Is this topic for you?
If you have had a C-section and would like information about how a cesarean affects future deliveries, see the topic Vaginal Birth After Cesarean (VBAC).
What is a cesarean section?
A cesarean section is the delivery of a baby through a cut (incision) in the mother’s belly and uterus. It is often called a C-section. In most cases, a woman can be awake during the birth and be with her newborn soon afterward. See a picture of a delivery by C-section .
If you are pregnant, chances are good that you will be able to deliver your baby through the birth canal (vaginal birth). But there are cases when a C-section is needed for the safety of the mother or baby. So even if you plan on a vaginal birth, it’s a good idea to learn about C-section, in case the unexpected happens.
When is a C-section needed?
A C-section may be planned or unplanned. In most cases, doctors do cesarean sections because of problems that arise during labor. Reasons you might need an unplanned C-section include:
Labor is slow and hard or stops completely.
The baby shows signs of distress, such as a very fast or slow heart rate.
A problem with the placenta or umbilical cord puts the baby at risk.
The baby is too big to be delivered vaginally.
When doctors know about a problem ahead of time, they may schedule a C-section. Reasons you might have a planned C-section include:
The baby is not in a head-down position close to your due date.
You have a problem such as heart disease that could be made worse by the stress of labor.
You have an infection that you could pass to the baby during a vaginal birth.
You are carrying more than one baby (multiple pregnancy).
You had a C-section before, and you have the same problems this time or your doctor thinks labor might cause your scar to tear (uterine rupture).
In some cases, a woman who had a C-section in the past may be able to deliver her next baby through the birth canal. This is called vaginal birth after cesarean (VBAC). If you have had a previous C-section, ask your doctor if VBAC might be an option this time.
In the past 40 years, the rate of cesarean deliveries has jumped from about 1 out of 20 births to about 1 out of 4 births.1 This trend has caused experts to worry that C-section is being done more often than it is needed. Because of the risks, experts feel that C-section should only be done for medical reasons.
What are the risks of C-section?
Most mothers and babies do well after C-section. But it is major surgery, so it carries more risk than a normal vaginal delivery. Some possible risks of C-section include:
Infection of the incision or the uterus.
Heavy blood loss.
Blood clots in the mother’s legs or lungs.
Injury to the mother or baby.
Problems from the anesthesia, such as nausea, vomiting, and severe headache.
Breathing problems in the baby if it was delivered before its due date.
Further Reading:Once a C, Always a C? Aiming to Avoid the Scalpel Elective Cesarean: Babies On Demand What to Expect if You Have a Cesarean Delivery C-Section May Affect Future Fertility C-Section No Cure-All for Problem Births Preterm Birth and C-Section Rates Up See All C-Section Topics
Watch: 956
Description: Types
Pulling out the baby.
A Caesarean section in progress.
Suturing of the uterus after extraction.
Closed Incision for low transverse abdominal incision after stapling has been completed.There are several types of Caesarean section (CS). An important distinction lies in the type of incision (longitudinal or latitudinal) made on the uterus, apart from the incision on the skin.
The classical Caesarean section involves a midline longitudinal incision which allows a larger space to deliver the baby. However, it is rarely performed today as it is more prone to complications.
The lower uterine segment section is the procedure most commonly used today; it involves a transverse cut just above the edge of the bladder and results in less blood loss and is easier to repair.
An emergency Caesarean section is a Caesarean performed once labour has commenced.
A crash Caesarean section is a Caesarean performed in an obstetric emergency, where complications of pregnancy onset suddenly during the process of labour, and swift action is required to prevent the deaths of mother, child(ren) or both.
A Caesarean hysterectomy consists of a Caesarean section followed by the removal of the uterus. This may be done in cases of intractable bleeding or when the placenta cannot be separated from the uterus.
Traditionally other forms of Caesarean section have been used, such as extraperitoneal Caesarean section or Porro Caesarean section.
a repeat Caesarean section is done when a patient had a previous Caesarean section. Typically it is performed through the old scar.
In many hospitals, especially in Argentina, the United States, United Kingdom, Canada, Norway, Sweden, Finland, Australia, and New Zealand the mother's birth partner is encouraged to attend the surgery to support the mother and share the experience. The anaesthetist will usually lower the drape temporarily as the child is delivered so the parents can see their newborn.
RisksRisks for the motherThe mortality rate for both Caesarian sections and vaginal birth, in the Western world, continues to drop steadily. In 2000, the mortality rate for Caesareans in the United States were 20 per 1,000,000.[23] The UK National Health Service gives the risk of death for the mother as three times that of a vaginal birth.[24] However, it is misleading to directly compare the mortality rates of vaginal and Caesarean deliveries. Women with severe medical conditions, or higher-risk pregnancies, often require a Caesarean section which can distort the mortality figures.
A study published in the 13 February 2007 issue of the Canadian Medical Association Journal found that the absolute differences in severe maternal morbidity and mortality was small, but that the additional risk over vaginal delivery should be considered by women contemplating an elective Caesarean delivery and by their physicians.[25]
As with all types of abdominal surgery, a Caesarean section is associated with risks of post-operative adhesions, incisional hernias (which may require surgical correction) and wound infections.[23] If a Caesarean is performed under emergency situations, the risk of the surgery may be increased due to a number of factors. The patient's stomach may not be empty, increasing the anaesthesia risk.[26] Other risks include severe blood loss (which may require a blood transfusion) and post spinal headaches.[23]
A study published in the June 2006 issue of the journal Obstetrics and Gynecology found that women who had multiple Caesarean sections were more likely to have problems with later pregnancies, and recommended that women who want larger families should not seek Caesarean section as an elective. The risk of placenta accreta, a potentially life-threatening condition, is only 0.13% after two Caesarean sections but increases to 2.13% after four and then to 6.74% after six or more surgeries. Along with this is a similar rise in the risk of emergency hysterectomies at delivery. The findings were based on outcomes from 30,132 Caesarean deliveries.[27]
It is difficult to study the effects of Caesarean sections because it can be difficult to separate out issues caused by the procedure itself versus issues caused by the conditions that require it. For example, a study published in the February 2007 issue of the journal Obstetrics and Gynecology found that women who had just one previous Caesarean section were more likely to have problems with their second birth. Women who delivered their first child by Caesarean delivery had increased risks for malpresentation, placenta previa, antepartum hemorrhage, placenta accreta, prolonged labor, uterine rupture, preterm birth, low birth weight, and stillbirth in their second delivery. However, the authors conclude that some risks may be due to confounding factors related to the indication for the first Caesarean, rather than due to the procedure itself
A Caesarean section, (also C-section, Caesarian section, Cesarean section, Caesar, etc.) is a surgical procedure in which one or more incisions are made through a mother's abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies, or, rarely, to remove a dead fetus. A late-term abortion using Caesarean section procedures is termed a hysterotomy abortion and is very rarely performed. The first modern Caesarean section was performed by German gynecologist Ferdinand Adolf Kehrer in 1881.
A Caesarean section is usually performed when a vaginal delivery would put the baby's or mother's life or health at risk, although in recent times it has been also performed upon request for childbirths that could otherwise have been natural.[1][2][3] In recent years the rate has risen to a record level of 46% in China and to levels of 25% and above in many Asian and European countries, Latin America, and the USA.[4]
Cesarean Section - Topic Overview
Is this topic for you?
If you have had a C-section and would like information about how a cesarean affects future deliveries, see the topic Vaginal Birth After Cesarean (VBAC).
What is a cesarean section?
A cesarean section is the delivery of a baby through a cut (incision) in the mother’s belly and uterus. It is often called a C-section. In most cases, a woman can be awake during the birth and be with her newborn soon afterward. See a picture of a delivery by C-section .
If you are pregnant, chances are good that you will be able to deliver your baby through the birth canal (vaginal birth). But there are cases when a C-section is needed for the safety of the mother or baby. So even if you plan on a vaginal birth, it’s a good idea to learn about C-section, in case the unexpected happens.
When is a C-section needed?
A C-section may be planned or unplanned. In most cases, doctors do cesarean sections because of problems that arise during labor. Reasons you might need an unplanned C-section include:
Labor is slow and hard or stops completely.
The baby shows signs of distress, such as a very fast or slow heart rate.
A problem with the placenta or umbilical cord puts the baby at risk.
The baby is too big to be delivered vaginally.
When doctors know about a problem ahead of time, they may schedule a C-section. Reasons you might have a planned C-section include:
The baby is not in a head-down position close to your due date.
You have a problem such as heart disease that could be made worse by the stress of labor.
You have an infection that you could pass to the baby during a vaginal birth.
You are carrying more than one baby (multiple pregnancy).
You had a C-section before, and you have the same problems this time or your doctor thinks labor might cause your scar to tear (uterine rupture).
In some cases, a woman who had a C-section in the past may be able to deliver her next baby through the birth canal. This is called vaginal birth after cesarean (VBAC). If you have had a previous C-section, ask your doctor if VBAC might be an option this time.
In the past 40 years, the rate of cesarean deliveries has jumped from about 1 out of 20 births to about 1 out of 4 births.1 This trend has caused experts to worry that C-section is being done more often than it is needed. Because of the risks, experts feel that C-section should only be done for medical reasons.
What are the risks of C-section?
Most mothers and babies do well after C-section. But it is major surgery, so it carries more risk than a normal vaginal delivery. Some possible risks of C-section include:
Infection of the incision or the uterus.
Heavy blood loss.
Blood clots in the mother’s legs or lungs.
Injury to the mother or baby.
Problems from the anesthesia, such as nausea, vomiting, and severe headache.
Breathing problems in the baby if it was delivered before its due date.
Further Reading:Once a C, Always a C? Aiming to Avoid the Scalpel Elective Cesarean: Babies On Demand What to Expect if You Have a Cesarean Delivery C-Section May Affect Future Fertility C-Section No Cure-All for Problem Births Preterm Birth and C-Section Rates Up See All C-Section Topics
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