C-section

What is a cesarean section?

A cesarean section, or c-section, is the delivery of a baby through a surgical incision in the mother's abdomen and uterus. In certain circumstances, a c-section is scheduled in advance. In others, it's done in response to an unforeseen complication.

According to the Centers for Disease Control and Prevention, about 30 percent of American women who gave birth in 2005 had a cesarean delivery, up from 6 percent in 1970, 17 percent in 1980, and 23 percent in 1990.

 C-section is major abdominal surgery, so it is riskier than a vaginal delivery. Moms who have c-sections are more likely to have an infection, excessive bleeding, blood clots, more postpartum pain, a longer hospital stay, and a significantly longer recovery. Injuries to the bladder or bowel, although very rare, are also more common.

C-section

In addition, if you plan to have more children, each c-section you have increases your future risk of these complications as well as placenta previa and placenta accreta. That said, not all c-sections can, or should be prevented. In some situations, a c-section is necessary for the well-being of the mother, the baby, or both.

Why would I have a planned c-section?

Sometimes it's clear that a woman will need a cesarean even before she goes into labor. Conditions that may require a planned c-section include:

You've had a previous cesarean with a "classical" vertical uterine incision or more than one previous c-section. (If you've had only one previous c-section with a horizontal incision, you may be a good candidate for a vaginal birth after cesarean, or VBAC.If you're not trying for a VBAC, your practitioner will schedule your c-section for no earlier than 39 weeks to minimize the risk that the baby's lungs are still immature.)

You've had some other kind of invasive uterine surgery, such as a myomectomy (the surgical removal of fibroids).

You're carrying more than one baby. (Some twins can be delivered vaginally, but all higher-order multiples require a c-section.)

Your baby is expected to be very large (a condition known as macrosomia). This is particularly true if you're diabetic or you had a previous baby of the same size or smaller who suffered serious trauma during a vaginal birth.

Your baby is in a breech (bottom first) or transverse (sideways) position. (In some cases, such as a twin pregnancy in which the first baby is head down but the second baby is breech, the breech baby may be delivered vaginally.)

You have placenta previa (when the placenta is so low in the uterus that it covers the cervix).

The baby has a known illness or abnormality that would make a vaginal birth risky.

You're HIV-positive, and blood tests done near the end of pregnancy show that you have a high viral load.

Why would I have an unplanned cesarean delivery?

You may need to have a c-section if problems arise that make continuing or inducing labor risky. These include the following:
Your cervix stops dilating or your baby stops moving down the birth canal, and attempts to stimulate contractions to get things moving again haven't worked.


Your baby's heart rate gives your practitioner cause for concern, and she decides that your baby can't withstand continued labor or induction.

The umbilical cord slips through your cervix (a prolapsed cord). If that happens, your baby needs to be delivered immediately because a prolapsed cord can cut off his oxygen supply.

Your placenta starts to separate from your uterine wall (placental abruption), which means your baby won't get enough oxygen unless he's delivered right away.

You have a genital herpes outbreak when you go into labor or when your water breaks (whichever happens first). Delivering your baby by c-section will help him avoid infection.

What happens right before a c-section?

First, your practitioner will explain why she believes a c-section is necessary, and you'll be asked to sign a consent form. If your prenatal practitioner is a midwife, you'll be assigned an obstetrician for the surgery who will make the final decision and get your consent.

Typically, your husband or partner can be with you during most of the preparation and for the birth. In the rare instance that a c-section is such an emergency that there's no time for your partner to change clothes — or you need general anesthesia, which would knock you out completely — your partner might not be allowed to stay in the operating room with you.

An anesthesiologist will then come by to review various pain-management options. It's rare these days to be given general anesthesia, except in the most extreme emergency situations or if you can't have regional pain relief for some reason.


More likely, you'll be given an epidural or spinal block, which will numb the lower half of your body but leave you awake and alert for the birth of your baby.

If you've already had an epidural for pain relief during labor, it'll be used for your c-section as well. Before the surgery, you'll get extra medication to ensure that you're completely numb. (You may still feel some pressure or a tugging sensation at some point during the surgery.)

A catheter is then inserted into your urethra to drain urine during the procedure, and an IV is started if you don't have one already. The top section of your pubic hair is shaved, and you're moved into an operating room.

Anesthesia will be administered, and a screen will be raised above your waist so you won't have to see the incision being made. (If you'd like to witness the moment of birth, ask a nurse to lower the screen slightly so you can see the baby but not much else.) Your partner or husband, freshly attired in operating room garb, may take a seat by your head.

How is a c-section done?

Once the anesthesia has taken effect, your belly will be swabbed with an antiseptic, and the doctor will most likely make a small, horizontal incision in the skin above your pubic bone (sometimes called a "bikini cut").

The doctor will cut through the underlying tissue, slowly working her way down to your uterus. When she reaches your abdominal muscles, she'll separate them (usually manually rather than cutting through them) and spread them to expose what's underneath.

When the doctor reaches your uterus, she'll probably make a horizontal cut in the lower section of it. This is called a low transverse incision.

In rare circumstances, the doctor will opt for a vertical or "classical" uterine incision. This might be the case if your baby is very premature and the lower part of your uterus is not yet thinned out enough to cut. (If you have a classical incision, it's much less likely that you'll be allowed to attempt a vaginal delivery with your next pregnancy.)

Then the doctor will reach in and pull out your baby. You'll have a chance to see the baby briefly before he's handed off to a pediatrician or nurse. While the staff is examining your newborn, the doctor will deliver your placenta and then begin the process of closing you up.

After your baby has been examined, the pediatrician or nurse may hand him to your partner, who can hold him right next to you so you can admire, nuzzle, and kiss him while you're being stitched up, layer by layer. The final layer — the skin — may be closed with stitches or staples, which are usually removed three days to a week later. Closing your uterus and belly will take a lot longer than opening you up, usually about 30 minutes.

After the surgery is complete, you'll be wheeled into a recovery room, where you'll be closely monitored for a few hours. If your baby is fine, he'll be with you in the recovery room and you can finally hold him.

If you plan to breastfeed, give it a try now. You may find nursing more comfortable if you and your newborn lie on your sides facing each other.

You can expect to stay in the hospital for three or four days before going home.

How To Cope With Back Pain During Pregnancy

Tips On How To Cope With Back Pain While In Pregnancy

If you are pregnant and experiencing back pain in the course of pregnancy, you might desire to know tips on how to take care of that. Have to you have agony relief pills or just let it go like that? Can you do anything at all to alleviate the discomfort? This article is going to discuss tips on how to deal with such discomfort.

Acquiring back pain throughout pregnancy is usually very typical. It can be estimated that eighty per cent of women who are pregnant suffer back pain. Fortunately, the discomfort is commonly short term. We hardly discover lengthy term back pain from being pregnant. The causes with the anguish are not truly laid out. 1 achievable cause may be the improve of mother's and child's pounds. This can be specifically true inside last trimester of the patient's pregnancy.

When we look into the age aspect, we discovered that younger mothers tend to suffer more discomfort that the older ones. Usually, the mother can continue everyday activities as usual. Only ten per cent in the patients describe the pain as very disabling. In that case, the mother has to have a excellent rest until the anguish goes away.



Pregnancy



In pregnant women, using medication must be carried out under close supervision of the doctor. If possible, the physician tends to ask the patient not to utilize any medication. Consequently, using pain killer could not be as suitable. The most recommended methods to take care of the anguish include avoiding excessive weight gain, exercising to strengthen your back muscles, maintain correct postures throughout the day and wearing sensible shoes with no high heels. These typical measurements have helped a lot of individuals lower the possibility of obtaining back pain. You can also use them to decrease the chance of getting one.

Taking care of back pain through being pregnant might be completed without having much trouble if you know what it is possible to do. You don't want any medication and you will be happier expecting your baby to come out.

32 Weeks Pregnant: Pain Management During Labor

32 Weeks Pregnant

In this article:

• Pregnancy Week 32: All About You
• Pregnancy Week 32: All About Baby
• How Big Is Baby?
• Most Common Pregnancy Questions
• Multiple Madness
• For Your Partner
• Fun Fact

Are you planning for a natural birth?

Considering an epidural? Use pregnancy week 32 to find out what your options are and how your decision can impact both you and Baby.This week your baby should be in a head-down position. Ninety-six percent of all babies present head first by the time labor begins. If your fetus is breech, your provider might consider turning it manually. Read more information on fetal presentation.

Are your friends throwing you a baby shower?

Start planning your layette list—here's what you need to begin!

Pregnancy Week 32: All About You

Only a few weeks to go and you're probably counting down the days! No wonder, with all the aches and pains throughout your body. But along with a sore back and swollen ankles, you may notice less painful signs that delivery day is around the corner. A whitish to clear fluid may leak out of your breasts. This foremilk, called colostrum, will sustain your baby for the first few days of his life if you choose to breastfeed. You may also have a whitish, vaginal discharge called leukorrhea. This is normal throughout pregnancy and will increase as you approach delivery.

Alternatives to Medication
You have a lot of choices when it comes to pain management during childbirth. What kind of strategy you go with is an extremely personal decision. You should consider several methods and even combinations and backup plans as you think about delivery day.

Here are a few popular methods pregnant women use to go through labor medication-free.

Lamaze: You've probably heard of Lamaze, an approach to childbirth that encourages women to be active during labor by moving around and using breathing strategies versus medication to cope with pain. Your partner is a key part of making this method a success. This practice has been around since the 1960s and remains popular today. To fully understand Lamaze, locate an instructor in your area by going to Lamaze.org.

The Bradley Method: A cousin to Lamaze, the Bradley Method also relies on women being active participants in labor. In Bradley Method classes, couples learn deep-breathing strategies to cope with labor pain. It's expected that your partner will help you focus on these breathing exercises as well as other strategies during labor. (Contact Bradleybirth.com for more information.)

Even if you haven't attended classes in Lamaze or the Bradley Method, you may still try an alternative route to deal with pain. A certified nurse midwife or doula may guide you through labor with a variety of coping strategies.

Water therapy: Warm temperatures and soothing water can help your body relax, potentially making labor and delivery easier. If you're not ready to give birth in the tub, you can still experience the benefits of water therapy in the shower. "Women don't realize how soothing water can be until they're in the water," says Dr. Joanne Motino Bailey PhD, and a certified nurse midwife. Dr. Bailey says water therapy is "underutilized" as a method of pain relief in labor.

Movement and body positions: During childbirth class or even at the instruction of your certified nurse midwife during labor, you can try several body stances to ease your pain. For example, you may find the rhythmic motion of rocking back and forth helpful. To help you focus and move labor along, "Try to stay upright and go walking," suggests Dr. Bailey.

This is certainly not a comprehensive list of what's available when it comes to managing childbirth pain without medication. Along with these methods, there are plenty of others such as acupuncture, hypnosis, and more. 

Research any coping strategy you intend to try before delivery day and discuss your desires with your healthcare provider. Some hospitals are more accepting of certain options than others; for example, some hospitals don't have watertubs for childbirth, and some physicians may not be prepared to deliver your baby in the shower or with you under hypnosis.

Around this week you may experience an increased discharge called leukorrhea. Your expanding uterus is pressing against your diaphragm, and you may find it more difficult to catch your breath. This will get better once the baby "drops" (usually about two to three weeks before delivery). Try sitting up straight and sleeping in a propped up position to alleviate any discomfort you might be feeling.

Another point to be aware of this week is to watch for any increase in swelling. Swelling of the feet is normal in advanced pregnancy, but if you experience facial swelling, severe headaches, abdominal pain or nausea, contact your doctor immediately. You may be suffering from preeclampsia.

Pregnancy Week 32: All About Baby

Just like you, your unborn baby will establish a daily routine. You'll notice at times your baby is active and wiggly, while at other times you can't feel her movements. Once your baby's born, she'll most likely continue with her in-utero pattern. Along with a routine, your baby has favorite positions too. A favorite of many unborn babies is to have their heads down, rumps up towards the ribs (conveniently, the perfect position for labor).

How Big Is Baby?

Your unborn baby weighs around 4 pounds and stretches to over 16 inches in length (crown to heel). Baby is about the size of a zucchini.

Most Common Pregnancy Questions

Who can be with me during my labor and delivery? And what's a doula?
Most hospitals allow one other person in the room in addition to your partner. If you decide to have another person present for your delivery, choose carefully. Make sure that this person will be there to support you and your partner.

A doula can be a great asset to you during labor and delivery. She is trained to help a woman and her partner in different aspects of the birth experience. Many women connect with a doula during pregnancy and begin to form a relationship that helps establish trust and connection for labor. Doula, translated from Greek, means "woman's servant". A doula can provide emotional, educational, and logistical support to you and your partner during the delivery process.

Some doulas will provide support during labor, while other may also offer postpartum support to aid your recovery at home. A postpartum doula can assist with newborn baby care and breastfeeding while you are settling in to your new life with our baby.

It is important to ask for references when selecting a doula. You will want to make sure you spend a fair amount of time with her before birth if she is to act as your labor support person. (you want to feel comfortable with her and trust her).

DONA (Doulas of North America) offers certifications and enhances the level of professionalism and knowledge so that she can be an asset to your experience.

A doula is not a nurse and cannot and should not diagnose, treat, or medicate. However, in a hospital setting, a doula can be an asset to your nurse by offering continued support and physical assistance to you.

Some of the things a doula may do during pregnancy, labor, and postpartum include:

• Offer advice and planning tools during pregnancy
• Help you putting a birth plan together
• Offer massage during labor
• Coach you with breathing during pushing or laboring
• Offer assistance while you're in the bathroom, taking shower, or with walking
• Offer Position suggestions for pushing or laboring
• Collaborate with your labor nurse
• Offer you support (and help your partner help you!)
• Assist you with breastfeeding and baby care postpartum
• Offer emotional support
• Help take photos during delivery
• Some doulas may offer meal preparation postpartum

Multiple Madness

Last-Minute Preparations
By this point your nursery is probably starting to take shape. There are a few last-minute (and often not thought about) items you should put on your to-purchase or to-create list.

• A feeding/diaper changing log. For some, it's easiest to have a separate log for each baby (different color paper helps differentiate). Keep each on its own clipboard or have one clipboard with the logs one after the other. Find a convenient place in the nursery to store it. Hanging it on the wall near the feeding/changing area is a great idea.
• A nightlight or lamp on a dimmer switch. You'll need to see in the middle of the night, but that sudden burst of bright light won't be good for you or the babies (no reason to go blind!).
• Maxi pads (for you, not the babies). The hospital will likely send you home with some, but you'll need them for many weeks to come. Purchase a variety that comes with multiple absorbency-level pads in one box.
• We've mentioned this before, but be sure to make and post a "Please Knock" sign over your doorbell. There's little more frustrating than dozing off or finally getting your babies to sleep only to have a delivery man or well-meaning friend ring the bell.

Remember, you don't have to have it all at-the-ready from Day One. You'll slowly acquire (or invent) additional sanity-savers required to make it all work—one day at a time.

For Your Partner

Preparing the Nursery
Planning the nursery can be a fun and creative experience for parents-to-be. You and your partner may already have ideas for what you'd like to do with your new baby's environs. Imagine what it will be like to bring your baby home, put her to sleep in her own room, and cuddle together as a family! Don't be afraid to let yourself get caught up in the excitement of it all.

The 32nd week of pregnancy is a big milestone. From this point on, your baby can be born and be perfectly healthy, and if she's at a good weight, she may not even need to spend much time in the hospital. Once your wife's pregnancy reaches this point, it is a good idea to start getting everything ready. (If you wait until the last weeks of pregnancy, you may find you waited too long!)

This is also a good time to ask friends and family which gadgets and baby supplies made parenting easier (and which were deemed unnecessary or unhelpful). These may be things people don't register for, but parents don't want to live without. Seemingly small conveniences, such as stroller straps, night lights, and car window shades, are all great assets that can ease your role of raising Baby.

Fun Fact

Although researchers are still debating the effectiveness and safety risks of water births, according to the National Library of Medicine (NLM), preliminary studies point to the positive effects of a tub delivery. In one study, conducted over nine years in a Swiss hospital, women who delivered in water had fewer episiotomies, perineal tearing, and less blood loss than women who birthed in beds.