Caesarean section

Synonyms

Caesarean section, Caesarean section

English: abdominal delivery

introduction

With a caesarean section (caesarean section, Sectio caesaera, sectio = Cut, caesaera = imperial) the fetus is surgically removed from the mother's uterus. In the past, this variant was only possible for medical reasons. Nowadays, however, the mother's wish is often addressed, who wants to avoid the pain of childbirth in this way.

Epidemiology / frequency

The frequency of the Caesarean section development has increased significantly in recent years. While around 18% of children in Germany were born by caesarean section in 1995, it was already 28% in 2005 and around 30% of all births in 2009. It is believed that not the Complications During Pregnancy The reason for this increase are, rather, the desired caesarean sections. The significantly improved diagnostics will probably increasingly lead to the "safe" variant of caesarean delivery. So doctors can avoid possible complications during the birth get out of the way if there are signs of diagnostic problems beforehand.

Indications

There are various indications for a caesarean section.

1. Mechanical birth indications: These are usually positions that are impossible to give birth, such as transverse position, disproportion between head and pelvis, a child that is significantly too large (macrosomia,> 4500g) or a head that is too large. Breeching of the child can also be an indication for a caesarean section.
2. Pediatric indication: pathological CTG findings (pathological labor recorder findings), umbilical cord prolapse (pinching of the umbilical cord by sliding forward into the vagina, which leads to an under-supply of the child with oxygen), premature placental detachment, rhesus incompatibility, diabetes mellitus, child malformations or Infections are reasons to choose a caesarean section over natural birth. Infections that can be transmitted during childbirth include HIV infection, rubella infection and genital herpes.
3. Maternal indication: These are usually severe exhaustion or general illnesses.
4. mixed indication: threatened eclampsia, one Placenta previa (Placenta is in front of the cervix) or an impending uterine rupture are further reasons for a caesarean section.

Ultimately, a distinction can also be made between an absolute indication and a relative indication. About 10% of all caesarean sections are performed based on an absolute indication. These include early placental detachment, lateral position of the child, eclampsia, uterine rupture or placenta previa.

In 90% of the cases it is a relative indication for a caesarean section. Relative indications are too big a child (> 4500g), a breech position, multiple pregnancy, birth arrest, pathological CTG or severe exhaustion of the mother.

Read more about this under: Birth from breech position or placental insufficiency

Primary and secondary caesarean section

In principle, a distinction is made between a primary and a secondary caesarean section. The main difference is the progress of labor at the time of the caesarean section.

1. primary caesarean section:

A primary caesarean section takes place planned and before the start of the birth instead of. That means that the Amniotic sac Has not yet burst at the time of the operation and has not yet started to give birth effectively. The reason for a primary caesarean section is not just the patient's wish. Also positions that are impossible to deliver, complications during the pregnancy or a risk to mother and child during natural birth can be indications for a primary caesarean section. Also read our topic Caesarean section on request

2. secondary caesarean section:

The secondary caesarean section takes place after the birth has started. That is, the Amniotic sac has burst or cervical contractions have started. A secondary caesarean is therefore often associated with complications during childbirth. Such complications can change the child's Heart sounds, birth arrest or insufficient rotation of the child during the birth process.

The third distinction is that Emergency caesarean section. This can be primary or secondary. It is only a description of the urgency of a caesarean section. Indications for such an emergency intervention are steadily falling child's heartbeat, eclampsia, HELLP syndrome, early placenta detachment, or a ruptured uterus. An emergency caesarean section should usually lead to the birth of the child within 10 minutes.

Anesthetic procedure

Of the Caesarean section can under Regional anesthesia or under general anesthesia. Regional anesthesia is close to the spinal cord Epidural anesthesia or Spinal anesthesia. The choice of anesthetic method depends on the ability to plan the procedure and the mother's resilience. Since regional anesthesia takes a few minutes to be effective and requires a certain amount of cooperation on the part of the patient, emergency caesarean sections are usually performed in general anesthetic carried out. As a result, the operation can be carried out much faster and thus lowers the risk for mother and child. The mortality rate due to a caesarean section is 1: 25,000. So it's very rare.The current data indicate that general anesthesia means a greater risk than regional anesthesia. However, the benefits for mother and child clearly outweigh the benefits of an emergency caesarean section.

Regional anesthesia has the advantage that the father is usually allowed to go to the operating room and the mother can see her child immediately after the birth.
more on the subject anesthesia

surgery

Thanks to the latest techniques and surgical procedures, it is now possible to perform a caesarean section very gently and with the least possible complications. In most cases, the abdominal wall is opened by a deep incision in the lower abdomen (so-called panhandle incision). After pushing off the bladder, the uterus is opened in the lower uterine segment. There is enough connective tissue at this point so that good healing is possible. Then the uterus is bluntly widened without another incision and the child is developed with the hand or the suction cup. This approach enables the best possible and rapid wound healing, which hardly results in wound healing disorders or other complications. It usually only takes a few minutes from the start of the operation to the birth of the child. The subsequent closing of the wound often takes up most of the time.

After the child has developed, the placenta is manually loosened and completely removed before the uterus and abdominal wall are closed with a suture.

Find out more now: Scar care

Complications and risks

The risks and complications of caesarean section are very low these days. It is mainly about wound infections, wound healing disorders and scar adhesions. It can also damage neighboring organs. The urinary bladder, but also the ureter and the intestine, are particularly affected. In addition, patients can lose a lot of blood if complications arise.

There are hardly any risks for the child. It is possible that the children suffer minor abrasions, cuts or fractures as a result of the caesarean section. But this is very rare. The children can also have an incompletely functioning intestinal flora at the beginning. The reason for this is that the children swallow the mother's vaginal secretions during a natural birth, and thus their intestinal flora mature better. A slightly more common problem is the adjustment of mother and child. Caesarean section children often have breastfeeding problems at the beginning, as the bonding phase after a caesarean section can be insufficient.

Long-term consequences can be uterine ruptures in another pregnancy, as the scar tissue is more fragile.

You might also be interested in this topic: Air embolism

More births after a caesarean section

In the past, the rule was that after a caesarean section, all subsequent children also had to be born by caesarean section. The reason for this was the fear of a uterine rupture on the scar. The fabric is no longer so resilient at this point and can tear more easily. In the meantime, however, it has been shown that a previous caesarean section is not a compelling indication for a further surgical procedure for childbirth. However, only if there are no further indications or complications. However, the frequency of uterine ruptures does not increase after a previous caesarean section.

Summary

Of the Caesarean section nowadays represents a safe way of birth if there is a corresponding indication. With a caesarean section, dangers for both the mother and the child can be avoided or kept low. However, the caesarean section should not become the norm as it is not a natural birth. After a caesarean section, bonding problems between mother and child can arise. That too Breastfeeding is often more problematic after a caesarean birth than after a natural birth. For these reasons will Desired caesarean sections not done in some hospitals. When deciding whether or not to have a caesarean section, it should not be forgotten that it is an operation that can involve risks. Nevertheless, there are indications that make natural childbirth impossible. In such cases, the caesarean section is a very good and largely risk-free way to spare or even save mother and child.