Caesarean Section in Iran: All you need to know
Caesarean delivery, also known as c-section, is a surgical procedure to deliver a baby. In this method, the baby is taken out through the mother’s abdomen. Most Caesarean deliveries are successful and both mother and baby will be healthy.
Since the caesarean section is a surgical procedure, like any other surgery, it has its complications and risks. Also, the recovery time after delivery is longer than in natural delivery. For this, although the tendency for Caesarean delivery has increased in recent decades, it is still recommended for healthy women who do not have any pregnancy complications and risk of childbirth to have a vaginal delivery. However, due to medical and pregnancy conditions or for personal reasons, some women are not able to have a vaginal delivery and a c-section is the best option for them.
Here are some facts you need to know about Caesarean delivery, including what it is, why and how it is done, and what are the pros and cons.
What is a C-section delivery?
Caesarean delivery is a surgical procedure in which the surgeon removes the baby from the body through incisions made in the woman’s abdomen and uterus. After removing the child, the incisions are closed with dissolvable stitches. According to the US Centers for Disease Control and Prevention, more than 30% of deliveries performed in 2015 were by c-section method.
When is a Caesarean delivery necessary?
Although the c-section is a surgical procedure and is not a priority, it is necessary to perform it in certain circumstances:
The progression of labor does not happen properly
For natural delivery to proceed properly, the uterine contractions must open the cervix wide enough so that the baby can pass through the birth canal well. If these contractions are not at the right time and in sufficient quantity, the doctor will usually recommend a Caesarean delivery to keep the baby healthy.
If your baby’s health is at risk
In some cases, prenatal tests and ultrasounds may indicate that your baby’s health is at risk. For example, when the fetus’ heartbeat is abnormal or the umbilical cord that connects the fetus to the uterus is wrapped around her neck or there is a loop of the umbilical cord ahead of your baby. In these cases, your doctor will usually schedule a preterm c-section to prevent your baby from having health problems.
If the position of the baby in the womb is inappropriate
Sometimes the baby’s head may not rotate properly inside the uterus, meaning that instead of the baby’s head, the baby’s legs are toward the cervix. This condition is called a breech. Sometimes the baby may be placed diagonally or transversely inside the uterus. In all of these cases, natural childbirth is either almost impossible or can endanger the health of both your baby and you.
If you are pregnant with twins or multiples
Although a c-section is not required for all twin or multiple births, it may be necessary if you need a preterm delivery or if the position of the fetus inside the uterus is not suitable for a natural delivery. Also, when you have any pregnancy problems that your doctor decides to plan a Caesarean section.
If your child is too big
Natural childbirth in babies who are larger than normal puts the mother and baby at risk. This usually happens in women with gestational diabetes who do not have good blood sugar control. One of the dangers that threaten these babies is dystocia, in which the baby’s head comes out of the vagina but the shoulders get stuck.
If the placenta has a problem
Sometimes it is placental problems that necessitate Caesarean delivery. For example, when the placenta is not properly formed or function or it is in the wrong place, implanted too deep or too tight in the uterine wall, etc. These conditions can lead to problems such as preventing sufficient oxygen and nutrients from reaching the fetus or may lead to vaginal bleeding, etc.
If the mother has a serious infection
Mothers with serious infections such as HIV or herpes may pass the infection to their baby during vaginal delivery. Caesarean delivery can prevent the virus from being transmitted to the baby.
Other conditions in the mother
The birth canal in some women is blocked for reasons such as large fibroids. Some women are also unable to give birth naturally due to severely displaced pelvic fractures.
Women who have severe heart or brain health problems or a genital herpes infection should also usually have a c-section. Also, women who have had a Caesarean section before, in some cases, have to repeat Caesarean delivery.
Is a Caesarean delivery painful?
One of the reasons that some women are more inclined to have a c-section than a natural delivery is that the delivery process is not painful and actually, they will not notice anything at all. Women who are about to have a Caesarean section will receive one of the following in addition to pain medications:
- They may receive an epidural block. The drug is injected into the spine and numbs the lower body. Although these medicines completely relieve the pain, you may be aware of some of the pulling or squeezing, which of course is not a concern.
- They may receive a spinal block. The spinal block is injected directly into the spinal fluid and numbs the lower body. These drugs have an immediate effect and cause the lower body to be numb immediately.
- They may receive general anesthesia and be unconscious during Caesarean delivery. Although general anesthesia is not common, it is used for emergency deliveries.
How is a Caesarean delivery performed?
Caesarean section usually takes about 45 to 60 minutes. Due to the fact that it is a surgery, it will be performed in an equipped operating room with a calm atmosphere. Depending on your choice and your circumstances, your doctor may use an epidural block, spinal block or general anesthesia for you. Your abdomen is thoroughly cleansed and disinfected before surgery. You will have an IV to receive fluids and medications during surgery. You will also have a catheter to drain urine from your bladder so that your bladder is not damaged during surgery. Your heart rate, blood pressure, and breathing are also monitored throughout the surgery.
At the beginning of the surgery, the doctor makes an incision that is about 6 inches in the lower abdomen, from side to side. The doctor passes the skin, fat, and muscle through these incisions and accesses the cavity inside your abdomen. The next incision is made in the uterus and is large enough for the baby to pass through. To better get the baby out, the doctor uses his or her hand to support the baby, and another doctor pushes the baby out by squeezing the uterus.
Fluid in the baby’s mouth and nose is removed through suction. If you are alert, your doctor will show you the baby at this stage. The baby’s umbilical cord should then be cut and the placenta removed. After cleansing and disinfecting your uterus and abdomen, your doctor will close the incisions with dissolvable stitches. This stage will take longer than the delivery itself.
How long does c-section recovery take?
After completing the surgical procedure, you will be transferred to the recovery room to be monitored for a few hours. In the first few hours, you may experience tremors, nausea, and drowsiness, which are usually normal and not a cause for concern. Once you are stabilized, you will be transferred to the ward. When you and your baby are ready, the doctor will ask the nurse to bring your baby so you can hug and nurse your baby.
You usually have to stay in the hospital for 2 to 4 days. Try not to accept too many visitors so that you can relax more. Recovery from a Caesarean section takes at least six weeks. Try not to push yourself and rest more. Get help if needed. Discomfort and fatigue are common during c-section recovery process. Here are some tips to speed up the recovery process:
- Get more rest. Before giving birth, try to provide everything you need for the comfort of yourself and your baby. Heavy lifting is prohibited in the first few weeks. You are also not allowed to lifting from a squatting position.
- To relieve the pain of a surgical incision, in addition to taking over-the-counter pain relievers such as ibuprofen, acetaminophen, or other medications you can also use a heating pad.
- Sex is not recommended in the first six weeks after Caesarean section because it increases the risk of infection and suture opening.
- It is also not possible to drive for 1 to 2 weeks because during this time you can not easily control the car or turn your body to check for blind spots, etc.
During the recovery process, you should constantly check your incision for signs of infection. Contact your doctor immediately if you notice any of the following symptoms:
- If your incision is red, swollen or has discharge.
- If you have a fever.
- If you have heavy bleeding.
- If your pain gets worse over time.
Another issue after childbirth, whether Caesarean or vaginal, is postpartum depression. Severe mood swings, loss of appetite, fatigue, and lack of vitality and energy can be signs of postpartum depression. These symptoms usually go away on their own, but if they persist, you should talk to a counselor.
What are the complications and risks of Caesarean delivery?
Because Caesarean delivery is a type of surgery, there are some risks and complications for both mother and baby, although they are rare. Some of the possible risks of c-section are:
- Blood clots in the legs, pelvis, or lungs
- Damage to organs around the uterus such as the intestines or bladder
- Reaction to anesthetics and other drugs
You have to keep in mind that there is a risk of many of these complications in natural childbirth as well. Also, the recovery period after Caesarean delivery is longer than vaginal delivery. The higher the number of Caesarean deliveries, the greater the likelihood of the problems mentioned above and problems such as uterine rupture and placental problems in subsequent pregnancies. If you perform a Caesarean delivery with an experienced specialist, the risk of many of these complications is greatly reduced.
Is it possible to have a vaginal birth after a Caesarean delivery?
One of the FAQ women who are planning to have a Caesarean delivery or have experienced it before ask is: “can they have a vaginal birth after a c-section?”
One of the dangers that threaten these women is that the c-section scar on the uterus will open up during a natural delivery. Although it occurs in less than 1% of women, it can lead to uterine rupture.
However, most women can have a vaginal birth after a C-section (VBAC), especially if they have only given birth once before. In fact, according to the emerging evidence, having several Caesarean deliveries in a row can also cause you serious harm. The decision as to whether or not you can have a VBAC is made by a specialist and depends on several factors, including the type of incision made in your uterus in your previous c-section delivery.