Our Physicians and Certified Nurse Midwifes work very hard to ensure that every woman has the opportunity to attempt a vaginal delivery. However, during your pregnancy, it may become necessary for you to have a "non-traditional" mode of delivery by undergoing a cesarean section.
A cesarean delivery is performed by making an incision in the abdomen, going through the muscular uterine wall and removing the baby through this incision. After the baby is removed, the incision is repaired layer by layer and the skin is closed with suture or staples.
Indications for a Cesarean
Maternal indications can include:
- Women with prior vaginal tears with major anal involvement: or those with previous vaginal repair surgery for pelvic prolapse. These patients would be candidates for an outright cesarean delivery.
- Women with an abdominal cerclage: Those mothers with an incompetent cervix in whom vaginal cervical cerclages have failed should have a cesarean delivery.
- Obstructive lesions in the lower genital tract: such as large vulvar condyloma or lower genital tract cancers.
Fetal indications for cesarean delivery can include:
- Malpresentation: A fetus in a non-vertex presentation is at increased risk for trauma, cord prolapse, and head entrapment. Malpresentation includes term and preterm breech presentations as well as shoulder or even certain face presentations.
- Congenital anomalies: A cesarean delivery is recommended for several congenital anomalies; including fetal neural tube defects, some cases of hydrocephalus, and some skeletal dysplasias.
- Non-reassuring fetal heart rate: In the setting of a non-reassuring fetal heart rate pattern a cesarean delivery may be recommended to prevent hypoxia and fetal acidosis that could potentially cause significant morbidity and mortality.
- Genital herpes infections: Mothers with an active vaginal herpes infection (especially with primary outbreak) should undergo cesarean delivery. Neonatal infection with herpes can lead to significant complications, including encephalitis, meningitis and pneumonia, especially with a primary outbreak.
- Human immunodeficiency virus infections: Treatment of women with the human immunodeficiency virus has undergone tremendous change in the past few years. Women with a low CD4 count and high viral titers should be offered cesarean delivery at 38 weeks (or earlier if they go into labor). In women who are being treated with anti-retrovirals and have undetectable viral loads, a vaginal delivery may be offered.
Indications that may benefit both the mother and the fetus
- Abnormal placentation: In the presence of a placenta previa (ie, the placenta covering the internal cervical os), attempting vaginal delivery places both the mother and the fetus at risk for hemorrhagic complications.
- Abnormal labor due to cephalopelvic disproportion: Cephalopelvic disproportion can be suspected on the basis of possible macrosomia (excessively large fetus) or an arrest of labor despite augmentation with pitocin. Continuing to attempt a vaginal delivery in this setting increases the risk of hemorrhagic and metabolic consequences from a uterine rupture, increases the chance of infectious complications to both mother and fetus from prolonged rupture of membranes, and increases the risk of maternal trauma and fetal trauma from a shoulder dystocia.
- Contraindications to labor: In women who have a uterine scar from a prior myomectomy (removal of fibroid) in which the uterine cavity was entered, or those who have had a previous cesarean section, a cesarean section is usually recommended.
- Mothers who have had a previous shoulder dystocia: If a woman has had a previous pregnancy where the delivery was complicated by a shoulder dystocia (where the fetal shoulders become lodged in the pelvis), the risk of recurrence is so high and the risk of fetal injury so great that the recommendation has been to offer those women a primary elective cesarean section.
Most women who undergo a cesarean section stay in the hospital approximately 3 days, unless complications arise. We recommend that most women take it easy for the first 2 weeks after surgery to allow the inner layers to heal. We also recommend not lifting anything heavier than your baby during that time. After 2 weeks, patients may begin to increase their activity and start some light exercise such as walking. By 6 weeks, patients may return to full activity, and return to work if they desire.