Preoperative Procedures for Cesarean

If you are having a planned cesarean, you have the choice of entering the hospital the day before the surgery or on the morning of the baby’s birth. Some women choose the second option because it gives them one more night at home with family members. This can be important, especially if small children are involved. It also allows the woman to get a more restful night’s sleep in a familiar environment.

Though every doctor and every hospital follow a different set of procedures, certain procedures are standard almost everywhere. You will be instructed to take in nothing by mouth (NPO) for 8 to 12 hours before surgery to prevent aspiration of stomach contents if general anesthesia is needed. If you elect to spend those hours at home, it is your responsibility to refrain from eating. Most doctors also recommend a light, bland dinner the night before surgery.

You will need to have blood drawn for several tests and for typing and cross matching. Most doctors also require a urinalysis. Some may request a chest X-ray and respiratory function tests if you are a smoker or are congest¬ed. You can have all of these tests done on an outpatient basis.

In the hospital, a nurse will shave your abdomen in preparation for the surgery, but the area she shaves may vary. If you are given a partial prep, your hair will be removed from your abdomen down to your pubic area. A small amount of hair may remain visible when you hold your legs together. If you are given a complete prep, you will be shaved from beneath your breasts down to and between your legs and up to your tailbone. Many doctors today feel that the extensive shaving of a complete prep is unnecessary and adds to postpartum discomfort.

Your doctor may also order an enema before surgery. Discuss this with him beforehand. He may allow you to give yourself the enema at home.

A hospital representative will ask you to sign a consent form for the surgery and the anesthesia, and will ask if you have a living will. Read all documents carefully before signing them.

The anesthesiologist will visit you prior to surgery to discuss preoperative medication and surgical anesthesia. Tell him about any allergies or sensitivities that you have to medications, and discuss with him your preferences.

If you enter the hospital the night before surgery, you may be offered a sedative or sleeping pill. The decision whether to take it is yours. If you have difficulty sleeping, you may need it. On the other hand, it may make you feel groggy, rather than rested, in the morning.

Whether your cesarean is planned or unplanned, you may be offered a sedative or tranquilizer prior to surgery. Prepared women often feel that they do not need anything, choosing instead to rely on relaxation techniques. A sedative or tranquilizer can make both the woman and baby sleepy at the time of birth. Many physicians also routinely order a shot of atropine before surgery to dry up secretions. Unless you choose general anesthesia, you may not need this medication.

The two types of anesthesia that are used for a cesarean birth are regional and general anesthesia. Most women and doctors prefer regional anesthesia because it allows the mother and father to actively participate in the birth and does not depress the baby. Unless an extreme emergency exists, adequate time is available for regional anesthesia to be administered.

Regional anesthesia includes spinals and epidurals, with epidurals being more common. They produce similar effects, although spinals provide deeper anesthesia. When the anesthesia is administered, you will feel warm, then tingly, and finally numb. With an epidural, you may still experience some physical sensations such as tugging and pulling as the baby is born. Some women feel that this allows them to experience the baby’s birth more completely. Because an epidural is usually administered through a catheter, it can be continuously dosed to give you comfort during the bonding period, and it can continue to provide pain relief for the first 24 hours after surgery. A spinal is administered in one injection. Because of this, a general anesthetic is sometimes required for the repair work if the surgery took longer than expected and the effects of the spinal have begun to wear off.

When the health of the woman or baby demands immediate delivery, general anesthesia is used. Because the woman is unconscious, the labor partner usually is not permitted to participate in the birth. However, some doctors allow the husband to be present to permit him to bond with the baby and to later tell his wife the story of the birth.

If you need general anesthesia, you will first be put to sleep with an injection of medication into your IV. Next, a medication will be given to relax your muscles, and a tube will be inserted into your trachea (windpipe). A mixture of oxygen and a gas will be administered via the endotracheal tube to maintain breathing and keep you unconscious throughout the surgery.

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