Cesarean section: History, indications, and risks of the operation
Caesarean section - or C-section, is a surgical method increasingly employed in modern obstetric practice.
Many women opt for a C-section, considering it an "easy way" to give birth, regardless of medical indications.
In this article, we will discuss how a cesarean section is performed, when it is necessary, and whether it can be performed for every pregnant woman regardless of indications. We will also find out the cost of the operation and where it can be done.
History of Cesarean Section:
The term "Cesarean section" is associated with the legend of the birth of Caesar. It is said that he was taken out of the womb of his mother, already after her death. In fact, historical sources say that Caesar's mother died 10 years before the death of the emperor himself. However, the term has stuck and the operation is still called "cesarean section" today.
the Italian obstetrician Eduardo Porro at the end of the 19th century. Progress in obstetrics was facilitated by the achievements of modern medicine: asepsis, anesthesiology and bacteriostatic drugs. All this allowed doctors to begin using cesarean section in cases that often ended in the death of the fetus and mother, and to save lives.
The method developed by Porro consisted in the simultaneous removal of the uterus with the suturing of the stump of the cervix into the membrane of the abdominal cavity. This limited the possibility of developing various infections during surgery. Cesarean sectionThe author of the first technique similar to the modern technique of performing a cesarean section was before the Porro method almost in 100% of cases ended in the death of the mother. Mortality with the Porro method was about 60%.
In those days, this was a turning point in obstetrics. Side effects in the form of infertility and early menopause of the woman in labor then seemed a small price to pay for the saved life.
The first step towards cesarean section in the form in which it is performed today was taken by the German obstetrician Max Zenger. He proposed a much less radical procedure aimed at preserving the mother's fertility. His operation did not include hysterectomy and salpingo-oophorectomy, that is, it did not involve the removal of the uterus. Instead, the method consisted of removing the peritoneum from part of the anterior wall of the uterus and performing a wedge resection of the anterior wall of the uterus 2 cm wide.
The wedge was cut so that the thick edge of the myometrium adjoined the peritoneum, and the thin edge adjoined the cavity of the endometrium. These modifications allowed the serous edges to be joined to close with silk stitches.
Thus, the Zenger method helped to preserve the uterus during cesarean section and prevent the spread of infection.
Modern Cesarean Section:
Caesarean section - is a complex surgical manipulation that is used as an alternative to natural childbirth.
Cesarean section is used only if there are direct indications for the operation. The main indication is to minimize the possible risks during natural childbirth and preserve the health and life of the fetus and mother.
Cesarean section is most often a planned operation. This means that it is fully controlled and safe for the mother and child. There are cases of urgent cesarean section, when the obstetrician-gynecologist decides on the operation during natural childbirth or complications that have arisen in the last stages of pregnancy, in order to save the life of the mother and child.
The progress of surgical and anesthetic technologies has made childbirth through cesarean section a routine practice in obstetrics. Complications associated with the operation are very rare, and the mother and child go through the rehabilitation process quite quickly, and return home within 5 to 10 days.
Indications for cesarean section
Sometimes cesarean section is safer for the mother and child than natural childbirth.
The attending physician may recommend a cesarean section if:
- The woman cannot "give birth." The effect in which labor does not develop can occur if the cervix does not open sufficiently, despite strong contractions for several hours.
- There is a threat to the health and life of the child. If the attending physician is concerned about changes in the heartbeat of the child, cesarean section may be the best option.
- The fetus is in a position different from the norm. Cesarean section can be the safest way to give birth if the feet or buttocks of the child enter the birth canal first (breech presentation) or the child is located sideways and the shoulder forward (transverse position).
- Multiple pregnancy. Cesarean section may be required if the patient is carrying twins, and the leading child is in a position different from the norm, if there are three or more fetuses.
- A problem with the placenta. I If the placenta covers the opening of the cervix (placenta previa), cesarean section is recommended for childbirth.
- Umbilical cord prolapse. . Cesarean section may be recommended if a loop of the umbilical cord passes through the cervix in front of the child.
- The woman has health problems. Cesarean section may be recommended if the mother has serious health problems. For example, cardiovascular diseases. Cesarean section is also recommended if the patient has an active genital herpes infection during childbirth.
- Mechanical Obstacle. Cesarean section may be required if a pregnant woman has a large fibroid obstructing the birth canal, a serious pelvic fracture with displacement, or a condition in the baby where the head may become unusually large (severe hydrocephalus).
- When the patient has had a previous cesarean section. If a woman has had one or more cesarean sections before the current pregnancy, a cesarean section is scheduled to avoid the risk of tearing previous stitches.
Some women request a cesarean section themselves when giving birth for the first time to avoid contractions or potential complications from vaginal delivery. However, doctors do not recommend cesarean section without direct indications.
How to prepare for a cesarean section surgery.
Since in most cases, cesarean section is a planned operation, expectant mothers have time to thoroughly prepare for it.
- The obstetrician-gynecologist sets the date for the operation. Unlike natural childbirth, where the delivery dates are approximate and vary, in the case of a cesarean section, parents know the exact date of their child's arrival. Often, the date of the cesarean section is slightly earlier than the natural term of delivery.
- On the day of the operation, the expectant mother arrives at the clinic in advance. It is necessary to have a referral, passport, current insurance certificate, pregnancy card, and the results of all necessary tests with you.
- Often, a day before the operation, the doctor prescribes blood and urine tests for the pregnant woman.
- It is necessary to arrive at the clinic with a pre-prepared set of necessary things for the first time after childbirth. Recommendations for such a list can be provided by the clinic, and they can also be easily found online.
- The list of necessary items often includes: a baby blanket, a shirt for the mother, absorbent night pads, and several sets of changeable underwear.
- Cesarean section, like any surgery, is performed on an empty stomach. The clinic's nurse usually informs patients when they can eat or drink water.
How the Cesarean Section Procedure Takes Place
The operation typically lasts about 30 minutes on average. However, preparation for a cesarean section takes a bit longer.
At the beginning, a midwife or nurse connects the pregnant woman to a fetal cardiotocography device to ensure the baby's well-being. Then, temperature and blood pressure are measured, and a nurse sets up an intravenous drip.
During the cesarean section, the mother remains conscious, and spinal anesthesia is administered to minimize pain.
The procedure involves making an incision in the abdominal membranes about 15 cm long in the lower part of the abdomen above the pubic area. The doctor cuts through the skin, muscles, and uterus sequentially to safely extract the fetus.
The patient cannot see the entire operation as a special screen is placed between her and the surgical field. However, when the baby is delivered, the new mother can catch a glimpse of her newborn. The umbilical cord is then cut, and the baby is handed over to a neonatologist for examination. The doctor and midwife conclude the operation by removing the placenta and stitching the uterus and abdominal membranes.
Rehabilitation Process
The cesarean section itself is considerably shorter than natural childbirth. However, the recovery time after a cesarean section is longer than after vaginal delivery.
After the cesarean section, the woman stays in the hospital for 5 to 10 days. The first day is spent in the postoperative room under close supervision of doctors and nurses. In the initial days after the operation, the patient experiences pain and functional limitations.
After discharge, the woman should refrain from any physical activity for 1.5 to 2 months to avoid damaging the stitches. It is advisable for the new mother to receive physical assistance from relatives in the first 3-4 weeks after the cesarean section.
Over time, gradual introduction of light physical activities is recommended to return to normal life. Full rehabilitation usually takes about 6 months.
It is important to note that after a cesarean section, women are not advised to conceive again for at least 2 years to allow the body to fully recover.
Contraindications for Cesarean Section
Any surgical intervention has its contraindications.
The main contraindication for a cesarean section is a patient's tendency to thrombosis or a history of thrombophilia. Cesarean section poses a risk of significant blood loss, which can be fatal for patients with thrombophilia.
Natural childbirth is a better option for patients with thrombophilia.
Cost of Cesarean Section in CIS Countries
In state institutions in Ukraine, cesarean sections are performed for free. The government compensates clinics a fixed amount of 41,000 hryvnias per operation, as of 2020. Additional analyses are considered paid services, and the same applies to medications prescribed after the operation.
In private clinics, the cost of cesarean section is openly priced. For example, in a popular clinic in Kiev, a patient pays from 1000 euros for the operation alone. This amount does not include clinic stay, analyses, or additional consultations with the doctor.
In Russia, cesarean sections in state clinics are also presented as free procedures covered by the compulsory medical insurance policy.
Alternatively, women can opt for paid contracts with costs ranging from 28,000 rubles in a state clinic to 300,000 rubles or around 3500 euros.
Childbirth in Switzerland: Cost of Cesarean Section in Switzerland
For those seeking the best conditions for childbirth, including operative delivery, with a desire for top-notch service and safety, giving birth in Switzerland is an option.
Affluent medical tourists have chosen Switzerland for giving birth for many years.
Deliveries in the best Swiss clinics Sant'Anna, Betanien and Lindberg cost an average of 36,000 francs. Cesarean section deliveries cost 47,000 francs on average.
This sum covers all expenses from anesthesia to the stay in the clinic and round-the-clock monitoring of the mother and child's condition.
Clinics in Switzerland not only allow childbirth but also help prepare for the arrival of the baby and the new parental status.
Learn more about childbirth and cesarean section in Switzerland on our website.
In conclusion, a cesarean section is a result of medical progress that has saved many lives of mothers and their children.
Find a doctor, you can trust and follow all their recommendations.