Surgical Procedure for Cesarean Section

Depending on the hospital, your delivery will take place either in the labor and delivery area or in a surgical operating room. The location might be a factor in your partner’s participation. Some hospitals have a policy of not allowing any relatives in the operating room.

Whether your cesarean is planned or unplanned, you may feel apprehensive as you are being wheeled in for surgery. You can minimize this with advance preparation and the use of relaxation techniques. If your partner plans to be present for the birth, he will change into scrub clothes (a mask, scrub suit, cap, and shoe covers) while you are being taken to the delivery room. Unless you have made prior arrangements with your doctor, your partner will not rejoin you until the surgical team is ready to begin the operation.

Once you have been placed on the table, an IV will be started in one of your arms, if you do not already have one. That arm will then be strapped to a board. A blood pressure cuff will be put on your other arm, and electrocardiogram leads will be attached to your chest. If you would like to hold your partner’s hand during surgery and touch your baby once he is born, you will need to request that one arm be left free.

Next, the anesthesiologist will administer the chosen regional anesthesia. He may also offer you oxygen, which you can breathe through a mask until the baby is born. A nurse will insert a urinary catheter to drain your bladder. She will probably do this after the regional anesthetic has taken effect to minimize the discomfort. Because of its location, the bladder must be kept flat and out of the way to avoid being damaged during the surgery. Your abdomen and thighs will be scrubbed with a reddish orange antiseptic solution, a screen will be placed across your shoulders, and sterile drapes will be adjusted to cover everything. Because of the screen, you and your partner will not see anything you do not wish to see. If you would like to see the baby emerge, talk to your doctor about having a mirror in the room or the screen lowered at the moment of birth. When everything is set up and the doctor is ready to begin the surgery, your partner will be brought into the room and seated next to your head. If general anesthesia is used, it will not be administered until this time to decrease the amount of anesthesia that gets to the baby.

The type of skin and uterine incisions that your doctor will use will be influenced by his preferences, the baby’s position, your desires, and the speed with which the baby must be delivered. (For a discussion of the incisions used for cesareans, see “Skin and Uterine Incisions.”) If your physician uses a cautery to stop the bleeding from small blood vessels during the surgery, a burnt odor may be noticed. After he makes the incisions, the doctor will suction the amniotic fluid, which you may hear. Within a few minutes, you may feel a tugging or pulling sensation as your baby is born. If your doctor uses fundal pressure (downward pressure on the top of your abdomen) to assist the delivery, you may feel a great deal of pressure. The doctor will then lift the baby out, using either his hands, forceps, or a vacuum extractor. If you feel discomfort from this, try slow paced breathing. Within moments, you will hear your baby’s first cry. The cord will be clamped and cut, and the baby will be handed to the pediatrician or nursery nurse. You will be shown your new son or daughter, and then the baby will be examined. A nurse will perform routine identification procedures. (For a discussion of the routine followed at most hospitals and birth centers, see “Care Given to the Baby at Birth”) These exams can usually be done within your view to help relieve any anxiety that you may have about your baby’s condition.

Your doctor will also deliver your placenta through the incision and will give you Pitocin through the IV to help your uterus contract. He will examine your uterus, ovaries, and tubes, then repair the uterus, abdominal muscles, sub-cutaneous tissues, and skin. Some doctors use clamps or staples to close the skin incision. The repair work normally takes about 45 minutes. If you feel nauseated or experience any other sensations, tell the anesthesiologist.

While the repair work is being completed, you can ask to touch and hold your baby. If your arms are strapped, your partner may be allowed to hold the baby next to your cheek. Since the operating room will be cold, your baby and partner will leave during the repair, and your partner can stay with the new¬born in the nursery. When you are moved to the recovery room, your partner and newborn can be reunited with you. If your partner was not present for the delivery, the baby can be brought out to him immediately after the birth. Seeing the baby will help to relieve your partner’s anxiety about your condition and that of the baby.

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