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16 Aug, Tuesday
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Montreal Families

C-Sections Explained

When a pregnant woman discusses her choices about where and how to give birth, an operating room is rarely the top choice. But when problems crop up during labour, a cesarean section (c-section) may be necessary.

Approximately 24 per cent of women in Canada deliver their baby by c-section, according to the Canadian Institute for Health Information. While this figure is lower than the rates in the United States (30 per cent), it is still higher than the 15 per cent rate the World Health Organization (WHO) recommends countries try to attain. 

Newborn BabyWhile health care professionals debate the reasons behind these numbers, women need to keep in mind that their labour and delivery may not go as planned. Dr. Marc-Yvon Arsenault, an obstetrician-gynecologist (ob-gyn) at the Centre hospitalier Lasalle, says every birth involves a number of factors that can conspire to make a c-section necessary.

A woman’s labour may not progress, the baby may be in a breech position, and the mom’s pelvis may be small and the baby very large. “It’s not always possible to say with certainty why a woman needed a cesarean,” he says. There are also conditions such as placenta previa (placenta is on or near the cervix) for which a c-section will be scheduled ahead of time to prevent serious harm to mother and baby.

Here is basic information about this procedure:

What are common reasons for a c-section?
Your doctor may schedule you for the surgery if you’re carrying two or more babies, your baby is breech, very large, or has been diagnosed in utero with a birth defect or a placental abnormality. You might need to undergo an emergency c-section if, during labour, your baby shows signs of distress (such as elevated heart rate); your labour fails to progress; or if you are running a fever.

What are the risk associated with a C-section?
“This is major abdominal surgery,” notes Dr. Arsenault and while most women do not have major complications, there are still certain risks such as internal bleeding that may require a blood transfusion; surgical injuries to the bowel, bladder, and other internal organs; blood clots; uterine damage or infection.

Is a c-section safer for my baby than a vaginal birth?
Babies born via a c-section have an increased incidence of respiratory problems, says Dr. Arsenault, meaning that they may need to spend more time in the hospital’s nursery rather than in the mother’s room. However, if labour is not progressing or the baby is showing signs of distress, a c-section is a safer alternative.

Does the surgery hurt?
Although you’re usually awake during a c-section, spinal anesthesia will ensure you are completely numb and pain-free from the chest down. Expect to be sore after surgery; you may be given an IV narcotic pain reliever for 24 hours. You’ll likely spend about four days in the hospital, and you’ll have to take it easy for at least six weeks while your incision heals.

Can I choose a c-section if I’m scared of labour?
Dr. Arsenault says he and his colleagues receive very few demands for c-section and generally won’t perform them. Given the risks to mother and baby, the costs and the recovery time of a c-section, doctors are not inclined to perform them except when medically necessary.

Must I have a c-section if I’m having multiples?
It depends on how the babies are positioned in your uterus, says Dr. Arsenault. If the first baby’s head is positioned downward, a doctor might agree to try a vaginal delivery. It’s important to discuss these issues with your doctor before the birth.

Is vaginal birth after c-section (VBAC) safe?
Doctors used to worry about uterine rupture — a potentially life-threatening tear in the uterus — during a VBAC. Dr. Arsenault notes that recent research has helped doctors better pinpoint the risks associated with uterine rupture, so it’s easier to decide if a woman is a good candidate for a VBAC or not. Dr. Arsenault says it’s important for women and their doctors to discuss why a c-section was done in the first place. For example, was it because the baby was breech? Or did labour go on for hours without any progress? Understanding what happened in the past can help a woman and her doctor realistically evaluate her chances of a successful VBAC.

What kind of recovery can I expect after a c-section?
A c-section requires a longer recovery time than a vaginal birth does. Typically, you’re in the hospital for four days instead of two. You’ll also need to avoid over-exerting yourself for several weeks, while the incision (in both your uterus and abdomen) heals. Women should avoid lifting and straining but are free to walk (even up and down stairs) and carry their baby. The first few weeks after a c-section are a great time to call in favours from friends and family — get help with the housework, meals and childcare. You’ve had major surgery and you’ll need extra rest (with a newborn to care for, of course!).

Labour, like life, doesn’t always go as planned. When discussing your birthing options, make sure you ask questions about c-sections. It’s not a surgery most women would choose to have, but it does bring with it a reward unlike any other adventure: a new baby.

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