Caesarean: when, how is it practiced?

Why a C-section?
Today, one in five women giving birth by Caesarean section. This intervention, whether practiced in emergency or programmed (in 12% of cases), avoiding, at the time of birth, endanger the mother or her baby. Explanations.
with Dr. Guy Marie Cousin, obstetrician gynecologist, President of Syngof (National Union of Gynecologists and Obstetricians of France)
What is a cesarean section?
Under anesthesia, the phrase obstetrician, horizontally, between 9 and 10 centimeters, abdomen the pubis. He then removes the muscle layers to reach the uterus and extract the baby. After aspiration of the amniotic fluid, placenta is removed, then the physician sews tissues. Cesarean section allows her child to the world in just one hour.
In what cases can the be practiced emergency cesarean?
This is the case when:
• The cervix does not dilate enough.
• The baby's head goes down badly in the basin.
• Monitoring reveals fetal distress and that we must act quickly.
• Childbirth is premature. The medical team may decide not to tire the baby, especially if it needs a quick medical assistance. Depending on the situation, it may be asked Dad out of the delivery room.
In which cases can be programmed cesarean section?
This is the case when:
• You have ever had a cesarean (in 1% of cases, the scar is resistant hurt contractions)
• The baby is considered too large relative to the dimensions of the maternal pelvis.
• Your child does not look good: in place of the top of his head, he shows his head bent backwards or slightly raised, highlights his shoulder, buttocks or feet.
• You have placenta previa because better to avoid bleeding risk would imply a classic delivery.
• You have very high blood pressure or albumin in the urine and it is better you avoid the efforts of childbirth.
• You suffer from genital herpes crisis that could infect your child during its passage through the vaginal industry.
• Your baby has a significant growth retardation and seems overdue.
• You are expecting multiple babies. The triplets are often born by caesarean section. For twins, it all depends on the presentation of babies. Caesarean section can be practiced for all babies or only for one of them.
• This is your first pregnancy and you have more than 40 years: sometimes with age, the contractions are less effective.
• You ask for personal reasons a cesarean because you do not want to put your child into the world vaginally.
In all cases, the decision is made by mutual agreement between the physician and the mom.
What type of anesthesia for Caesarean section?
95% of planned cesareans are done under spinal anesthesia. This allows local anesthetic to stay fully conscious. The product is directly injected at once, in the spine. It works in minutes and eliminates any painful sensation. In case caesarean is decided during labor, an epidural is frequently used. Just because most of the time, women are already under epidural. Moreover, it is always preferable to general anesthesia carries more risk (choking, difficulty awakening) that the epidural. The operating suites are also simpler. The doctor first locally asleep part of your lumbar region prior to poking a thin plastic tube (a catheter) that broadcasts for four hours (renewable) the anesthetic between two vertebrae. The product then spreads around the envelopes of the spinal cord and is in fifteen to twenty minutes. Finally, general anesthesia is required in cases of extreme emergency, administered intravenously, it is in one or two minutes.

Caesarean step by step
Cesarean section is a common surgical procedure since it concerns about 21% of births (data from the French Perinatal Survey 2010) but moms do not always familiar with its development. Focus on this, step by step ...
With Professor Gilles Kayem, obstetrician-gynecologist at the Louis-Mourier Hospital (92)Direction block
That is scheduled cesarean or emergency, the pregnant woman is installed in an operating room. Some maternity accept, when conditions allow, the father is present at his side. First, it cleans the skin of the abdomen with antiseptic product from the bottom of the thighs to the chest, emphasizing the navel. A urinary catheter is then asked to empty the bladder continuously. If the mother is already under epidural, the anesthetist adds an extra dose of anesthetics to complete analgesia.The skin incision
The obstetrician can now proceed with cesarean section. It used to be realized a vertical midline incision under umbilical on the skin and on the uterus. It caused a lot of bleeding and uterine scar during subsequent pregnancy was more fragile. Today, skin and uterus are usually incised transversely. This is the so-called Pfannenstiel incision. This technique provides added strength. Many mothers are afraid of having too much scar. This is understandable. But if the incision is too narrow, the child's removal may be more difficult. What matters is to cut the skin in the right place. The suggested conventional width is 12 to 14 cm. The incision is carried out at 2-3 cm above the pubis. The advantage? There, the scar is almost invisible because it is in a skin fold.The opening of the abdominal wall
After the skin incision, the obstetrician cutting fat then the fascia (tissue that surrounds the muscles). The technique of caesarean section has evolved in recent years under the influence of Joel Cohen and Michael Stark teachers. Fat and muscle are spread fingers. The peritoneum is opened in the same manner permitting access to the abdominal cavity and the uterus. The abdominal cavity contains different organs such as the stomach, colon or bladder. This method is faster. It takes between 1 and 3 minutes to reach the peritoneal cavity during a first caesarean. Shortening the duration of surgery reduces bleeding and possibly reduce the risk of infection, which could thus allow the mother to recover faster after surgery.The opening of the uterus: hysterotomy
The physician then accesses the uterus. Hysterotomy is formed at the lower segment where tissues are most purposes. It is an area that bleeds little without superimposed pathology. More uterine scar is stronger than a suture body of the uterus during the next pregnancy. An upcoming birth by natural means is possible. Once the uterus is incised, the gynecologist expanding the incision to fingers and breaks the amniotic sac. Finally extract the child by the head first or feet depending on the presentation. The baby is placed skin to skin with the mother for a few minutes. Note: if the mother has had a caesarean, the procedure may take a little longer because there may have accolements, especially between uterus and bladder.Delivery
After birth, the obstetrician removes the placenta. That is the issue. Then, it checks that the uterus is empty. The uterus is then closed. The surgeon may decide to externalize the suturing easier or leave it in the abdominal cavity. Generally, the visceral peritoneum covering the uterus and the bladder is not closed. The fascia is closed. The skin of your belly is, meanwhile, sutured according to practitioners, the absorbable suture or not, or with staples. No skin closure technique has shown better cosmetic result six months after surgery
The technique of extraperitoneal cesarean
In the case of an extraperitoneal cesarean section, is not incise the peritoneum. To access the uterus, the surgeon takes off the peritoneum and pushes the bladder. Avoiding the passage through the peritoneal cavity, so one less irritate the digestive system. The main advantage of this method of cesarean section for those who propose it, is that the mother would have a quicker resumption of intestinal transit. However, this technique has been validated by comparative studies with the conventional technique. His practice is therefore very uncommon. Similarly, as it is more complex and time to achieve, it can not in any case be performed urgently.
The post-caesarean
Pain, scarring, Fitness ... You are told everything about the post-cesarean.
with Dr. Guy Marie Cousin, obstetrician gynecologist, President of Syngof (National Union of Gynecologists and Obstetricians of France)Does it hurt after a caesarean?
Your maternal residence time (5-8 days instead of 3 to 6), pain or scarring, everything is a little different compared to a conventional birth. Your scar will make you suffer a few days. The sitting position is often painful, and the first steps, the day after surgery. It is recommended to get up quickly (from the 12th hour after delivery), to walk with the help of a nurse or at least to move the legs in bed, to stimulate blood circulation and reduce the risk of phlebitis and thrombosis. Same thing when your bowel movements will return up (about 48 hours after birth) or when to return to its original size, your uterus will cause last few contractions. But anyway, you can from the second or third day you move and take care of your baby. Know that it now has effective analgesics. They are injected through transfusion immediately after the procedure and usually for 24 hours. Then you are given the tablets. A high-fiber diet with plenty of fruits and vegetables, may also be advised against pain associated with the resumption of transit.Healing after a caesarean
The son or staples used by your surgeon must remain in place between five and eight days. If they are not absorbable, or when the time comes you're still in the hospital, a nurse and that's the service that removes. Either you're already gone and it is unnecessary in this case, to return there. Speak to your GP instead. Side dressing, two solutions can be used: classical compress change daily during the week following the birth, or if you propose, the film spray at once, which forms an antiseptic barrier and breaks down after a few days. In general, you should avoid taking baths for a few weeks (moisture slowing healing) and UV, which in the absence of sun protection can permanently pigmented scar tissue (especially if for reasons of extreme urgency was incised to the vertical). Also avoid lifting heavy objects for a month. You can as early as you will want to resume smoothly sexual activity with your partner. As for sport, depending on your fitness. It is advisable to wait at least six to eight weeks. Do not hesitate to ask in the postnatal consultation (at the end of the second month).

Test yourself: Misconceptions about cesarean
You have a caesarean or worried that things do not go as planned and having to go to the block. Is that conventional wisdom - often catastrophic - on the cesarean die hard. Retail magazine story dramatize things.