Cesarean Operation

The cesarean operation is a surgical intervention recommended in cases where natural birth is not possible or when it poses a risk to the health/life of the mother and/or fetus.

During this operation, through a 10 cm horizontal incision (the so-called Pfannestiel laparotomy) at the bottom of the abdomen, the uterus is opened in order to extract the baby.

The perception about giving birth through cesarean operation has changed significantly over the years. It used to be considered as the last alternative to conclude childbirth. However, nowadays, many women choose to give birth through cesarean operation, even when it is not necessary. This is simply because they do not want to experience a prolonged birth (a fear which in most cases is exaggerated and unjustified). Nevertheless, the majority of obstetricians respect the patient's decision.

When is birth by cesarean operation indicated?

Usually, a birth is recommended to be performed by cesarean operation in the following cases:

1. When the baby's head is too large to pass safely and without complications through the birth canal, or when the maternal pelvis (the mother's basin) is too narrow to allow the safe and uncomplicated passage of the baby's head. Both situations are known by the common name cephalopelvic disproportion.
2. When the baby has not taken the correct position in the womb for a natural birth.
3. When the previous birth was also done by cesarean operation.
4. When the patient has had past operations on the uterus (removal of fibroids, septa, etc.).
5. In case of multiple pregnancies (twins/triplets), it is safer for the babies to be born by cesarean operation.
6. When the baby is smaller than expected for the gestational week (IUGR - intrauterine growth restriction)

There are also cases when the cesarean operation is not chosen from the beginning, but becomes necessary during the onset of labor:

1. When the umbilical cord is around the baby's neck, thus presenting an increased risk during labor.
2. When the dilation (opening) of the cervix does not complete.
3. When the umbilical cord protrudes in front of the baby outside the cervix (cord prolapse).
4. When there is a sudden and immediate detachment of the placenta from the uterine wall (placental abruption)

Type of anesthesia

The most used anesthesia is epidural or spinal. Epidural is preferred more because it can be used up to even 48 hours after the operation while spinal anesthesia has an effect of 4-6 hours, and for this reason, there is a need for other analgesics to fight post-operative pain of the first 2 days. Epidural anesthesia is preferred not only by gynecologists but also by pediatricians. In very rare cases (emergencies or when epidural or spinal anesthesia is not indicated) general anesthesia is used.

Type of sutures

The sutures are resorbable and leave no consequences. In very rare cases, there may be undesirable reactions from the used sutures (granulation). On the skin, an intradermal suture (hidden) is usually used, which has a superior aesthetic effect.

Duration of the operation

The duration is 30-45 minutes.

Recovery time

The patient usually gets up on her feet within the first 24-48 hours after the operation.

Breastfeeding

There is no negative effect of cesarean birth on breastfeeding the newborn.

Possible complications:

Like any surgical intervention, the cesarean operation can also be accompanied by undesirable complications for the patient and the operating team. Fortunately, these complications are very rare. Some of the complications include:

• Infections
• Hemorrhage
• Deep vein thrombosis or pulmonary embolism