Cesarean birth

In short: Caesarean birth accounts for 25–30% of deliveries. Reasons include breech position, a previous caesarean, pre-eclampsia, twins, placenta praevia, distress of the baby and obstructed labour. Spinal anaesthesia is usually preferred. The mother stays in hospital 24–48 hours, and the catheter is removed after 6–8 hours so she can move early. Risks include bleeding, infection, clots and adhesions.

Cesarean section is needed for delivery in 25-30% of ladies.

There are many indications for cesarean birth.

Cesarean birth has many benefits, yet it also has many disadvantages.

Indications for cesarean birth:

• breech presentation

• previous cesarean birth when vaginal birth after cesarean (VBAC) is not suitable or not chosen (e.g. two or more previous cesareans, previous classical incision or uterine rupture)

• severe pre-eclampsia when urgent delivery is needed and induction of labour is not suitable

• chorioamnionitis when vaginal delivery cannot be achieved promptly or there are other obstetric reasons (infection itself is treated with antibiotics and delivery, often vaginally)

• genital herpes: a first episode in the last 6 weeks of pregnancy, or active lesions at the start of labour (genital warts are not usually a reason for cesarean unless they block the birth canal)

• multiple pregnancy when the first twin is not head-down, in monoamniotic twins, or in triplets and higher-order pregnancies (many uncomplicated twins can be delivered vaginally)

• placenta previa

• placenta accreta

• fetal distress

• cephalopelvic disproportion

• slow progression of labor

• maternal choice after full counselling

Complications of cesarean birth:

• bleeding
• the need for blood transfusion
• ICU admission
• neonatal ICU admission
• placenta previa and accreta in future pregnancies
• more postpartum pain
• infection
• formation of adhesions, and in future pregnancies a small increased risk of uterine rupture and stillbirth

This symptom and its types are described in our article on urinary incontinence in women.

How scar tissue relates to conception is explained in our article on pelvic adhesions and infertility.

What to do to reduce the rate of infection?

Give intravenous antibiotic prophylaxis 30 minutes before skin incision

How do we reduce the risk of thrombosis after cesarean section?

• early ambulation
• encourage hydration
• anticoagulation

Which mode of anesthesia is better for cesarean section?

The mode of anesthesia is determined according to many factors, but generally spinal anesthesia is preferred.

how is pain managed after cesarean section?

• intramuscular analgesia or intravenous analgesia:
• Narcotics
• NSAIDS
• Paracetamol
• patient-controlled analgesia through special devices

For how long do we keep the urinary catheter after cesarean section?

Depending on the case, it is usually removed once you are able to walk, typically 6–12 hours after surgery (and no sooner than 12 hours after the last epidural top-up), to allow early ambulation

What is the length of hospital stay after cesarean section?

usually, 24-48 hours but might be longer depending on the case itself

wound care after cesarean section:

• Daily showers with water and soaps to keep the wound clean
• Avoid excessive sweating
• Wear loose cotton clothing
• Avoid heavy lifting or straining
• Take antibiotics as prescribed
• Monitor for any change in wound color or foul-smelling discharge

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist