Cesarean delivery: step by step, when it is indicated and possible complications


Cesarean delivery, or cesarean section, is a type of delivery in which the obstetrician makes a cut in the abdominal region, under anesthesia applied to the woman’s spine by the anesthesiologist, to allow the birth of the baby.

This type of delivery can be scheduled by the obstetrician in advance if the woman wishes or if there is a risk of complications for the woman or the baby, such as in cases of gestational diabetes or prolonged labor without complete dilation, but it can also be done in emergency situations such as uterine rupture or placental infection, for example.

It is important to have prenatal care during pregnancy, so that the obstetrician can assess the health status of the woman and baby, and, if necessary, indicate a cesarean section.

Cesarean step by step

The first step of a cesarean section is the anesthesia that is given to the pregnant woman’s spine, and the woman must be seated for the administration of anesthesia. Next, a catheter is placed in the epidural space to facilitate drug administration, and a catheter is placed to contain the urine.

After the anesthesia begins to take effect, the doctor will make a cut approximately 10 to 12 cm wide in the abdominal region, close to the “bikini line”, and will cut 6 more layers of tissue until reaching the baby. Then the baby is taken out.

When the baby is removed from the belly, the pediatric neonatologist must assess whether the baby is breathing properly and then the nurse can show the baby to the mother, while the doctor also removes the placenta. The baby will be properly cleaned, weighed and measured and only then can it be given to the mother for breastfeeding.

The final part of the surgery is closing the cut. At this point the doctor will sew up all the layers of fabric cut for delivery, which can take an average of 30 minutes.

It is normal for a scar to form after the cesarean section, however, after removing the stitches and reducing the swelling in the region, the woman can resort to massages and creams that must be applied on the spot, as it is possible to make the scar more uniform. Here’s how to take care of a cesarean scar.

When cesarean section is indicated

The cesarean section should be discussed together with the doctor, so that it is possible to make a general assessment of the general health status of the woman and the baby. In addition, performing routine exams with the doctor are important to check health throughout pregnancy and the development of complications, such as eclampsia, gestational diabetes and changes in the placenta, for example.

Although it is often indicated when there are risks to the mother or baby associated with the normal delivery, cesarean section can be performed regardless of the presence of complications, as long as the woman wishes. See more about cesarean section indications.

1. Absolute indication

Absolute indications for cesarean section refer to situations in which cesarean section is fully recommended, and include:

  • Eclampsia or preeclampsia;
  • HELLP Syndrome;
  • Uterine rupture, as it can endanger the life of the woman and the fetus, requiring immediate delivery;
  • Infection of the placenta and possibly the fetus, requiring immediate delivery;
  • Fetal asphyxia or fetal acidosis, which are situations that can lead to fetal hypoxia, which is the decrease or absence of oxygen, and endanger the life of the fetus;
  • Umbilical cord prolapse, which is the exit of the umbilical cord through the vaginal opening, before the fetus, which can lead to fetal asphyxia;
  • Placenta previa, which occurs when the placenta is positioned on or near the internal opening of the cervix, preventing vaginal delivery;
  • Abnormalities in the position of the fetus, which make vaginal delivery impossible;
  • Small maternal pelvis, making vaginal delivery impossible;
  • Deformity of the maternal pelvis, due to congenital malformations, which make normal delivery impossible;
  • Pregnancy with twins, if one of the babies is not in the birth position, turned upside down;
  • Active herpes simplex virus infection;
  • Maternal HIV infection, no antiretroviral treatment and/or unknown viral load or greater than 1000.
  • Fetal distress, in the presence of signs and symptoms such as decreased or altered fetal heartbeat, decreased fetal movements and decreased volume of amniotic fluid.

In addition, other situations that have absolute indications for cesarean delivery are diabetes mellitus, chronic kidney disease, or lung disease.

In these cases, even if the parents want a normal delivery, cesarean section is the safest option, being recommended by doctors.

2. Relative indication

Relative indications for cesarean section refer to situations in which the doctor may or may not indicate cesarean section, and include:

  • Have had two or more cesarean sections previously;
  • Gestational diabetes, in cases where the estimated weight of the fetus on ultrasound is greater than 4.5 kg;
  • Fetus with estimated weight, by ultrasound, greater than 5 kg;
  • Failure of normal labor to progress, being stationary, being prolonged and not fully dilated.

In these cases, the obstetrician must evaluate the pregnancy and the health conditions of the mother and baby and, if necessary, indicate a cesarean section.

possible risks

Cesarean section is considered a safe procedure, however due to the use of anesthesia and the fact that it is an invasive procedure, there is a higher risk of complications, especially when compared to normal delivery, the main ones being:

  • Development of infection;
  • hemorrhages;
  • Thrombosis;
  • Baby injury during surgery;
  • Poor healing or difficulty healing, especially in overweight women;
  • Keloid formation;
  • Difficulty in breastfeeding;
  • Placenta accreta, which is when the placenta is attached to the uterus after delivery
  • placenta previa;
  • endometriosis.

These complications are more frequent in women who have had 2 or more cesarean sections, as the repetition of the procedure increases the chances of complications in childbirth and fertility problems.

In addition, it is important to keep in mind that the cesarean section only increases the risk, which does not mean that these problems happen, as cesarean deliveries are usually without complications.

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