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Delivery

CAESAREAN SECTION

A caesarean section or a caesarean delivery is a surgical procedure used to deliver the baby. It is done under anaesthesia. It can be done under epidural or spinal or general anaesthesia. The choice of the anaesthesia will depend on various factors and the anaesthetist will decide after consultation with the patient and the gynaecologist.

A caesarean section may be done as a planned procedure well in advance even before the labour pains start. This is called Elective Caesarean Section. It may be done when a woman is already in labour but for some reasons vaginal delivery is not possible (eg. Non progress of labour, foetal distress, cephalopelvic disproportion ) and then it is important to do the surgery. This is called an Emergency Caesarean Section.

The common reasons for Elective Caesarean section are:

Breech presentation. Previous Caesarean scar, Transverse presentation, Twin pregnancy, Presence of a pelvic mass such as Fibroid, presence of active infection like Herpes or HIV in the mother, placenta is covering the os, the baby is very large as is common in diabetics and sometimes it is done purely on the request of the mother.

Some of the common reasons for an Emergency Caesarean Section are:

The labour is not progressing as it should. This is common if pains are weak. The baby is too big or the pelvis is too small or the position of the baby is such that it does not allow baby to come down.The heart rate of the baby is showing changes that are not good which means baby is not tolerating the pains.

Procedure

Once the decision is made then the patient is shifted to operation theatre. In case of elective procedure, the patient is prepared in advance. It is advisable to have about 8 hours of fasting. In Emergency procedure. The patient is given antacids and fluids intravenously.
The anaesthesia is given as per choice and situation. The abdomen is opened in layers. Commonly a transverse bikini line cut is taken. In some special situations one may need to take a vertical incision on the abdomen.
The uterus is also cut and usually this incision is also transverse. The baby and the placenta are delivered. The uterus and the abdomen is then stitched in layers. The surgery may take 30 minutes to an hour on an average.
After the surgery the patient may be in the hospital for 3 days and then allowed home. In case there are some problems like infection, bleeding, or medical problems like blood pressure and diabetes then one may need to stay longer.

The wound will need one dressing after 3 to 4 days and then one dressing during the follow up visit which can be in next 8 to 10 days. Just as all surgeries have benefits and risks, Caesarean section also has certain risks, such as

  • Recovery takes longer than with vaginal delivery
  • There can be some delay in mother-infant interaction as mother may be in pain or drowsy.
  • During Surgery there can be injury to abdominal organs, excessive bleeding, and infection in immediate post-operative period
  • In the next pregnancy there can be increased risk of the placenta being adherent to the scar, increased chance of a repeat Caesarean section, and a small but true possibility of uterine rupture in future pregnancy.
  • The stiches will heal over a period of 6 to 12 weeks. It is safe to walk and climb stairs after the surgery. One can start abdominal exercises after 12 weeks. In India most women like to get body massage done post-delivery. So you can go pamper yourself once the stiches have healed


Vaccum Delivery

A vacuum extraction is a procedure sometimes done during the course of vaginal childbirth.
During vacuum extraction, a health care provider applies the vacuum — a soft or rigid cup with a handle and a vacuum pump — to the baby's head to help guide the baby out of the birth canal. This is typically done during a contraction while the mother pushes.
Your health care provider might recommend vacuum extraction during the second stage of labor — when you're pushing — if labor isn't progressing or if the baby's health depends on an immediate delivery.

Why it's done

A vacuum extraction might be considered if your labor meets certain criteria — your cervix is fully dilated, your membranes have ruptured and your baby has descended into the birth canal headfirst, but you're not able to push the baby out. A vacuum extraction is only appropriate in a birthing center or hospital where a C-section can be done, if needed.

Your health care provider might recommend vacuum extraction if:

If you've never given birth before, labor is considered stalled if you've pushed for a period of two to three hours but haven't made any progress. If you've given birth before, labor might be considered stalled if you've pushed for a period of one to two hours without any progress.

If your health care provider is concerned about changes in your baby's heartbeat and an immediate delivery is necessary, he or she might recommend vacuum extraction.

If you have certain medical conditions — such as narrowing of the heart's aortic valve (aortic valve stenosis) — your health care provider might limit the amount of time you push.

Keep in mind that whenever vacuum extraction is recommended, a C-section is typically also an option.

EPISIOTOMY

This word suddenly becomes familiar when you are pregnant. Pregnant women here this word from their friends and have a lot of worries and queries.
An episiotomy is a cut that is given to you when the baby is ready to come out of the vaginal opening. It is given on the right or left side in the area between the vagina and the anus.
The doctor will give a local anaesthetic and then give the cut once the area is numb. In case you already have an epidural then there is no need of a local anaesthetic.
Once the placenta delivers then the doctor will suture the cut in layers with a suture material that does not need to be removed. i.e. the thread will dissolve on its own.
Most patients will need an episiotomy.

First time delivery, big baby, prolonged labour, if you need ventouse of forceps to deliver the baby, in case the heartbeat of the baby is slowing down and various such situations.

It is safer to allow the doctor to do an episiotomy than to try delivery without the cut especially if the perineum is not stretched. If the perineum is not well stretched, then the muscles may tear leading to a tear through important structures like the anal sphincter and that will not only be difficult to repair but also affect function in the future.

The episiotomy is safe and once stitched and healed, will not have any long term implications. In some cases, there may be swelling, excess bleeding, infection and delayed healing. This may happen in anaemia, diabetics, instrumental delivery, and where vaginal manipulation may have been done eg manual removal of placenta.

After the delivery you must look after the episiotomy. You must keep the area clean and dry. You can apply a simple anti-septic cream in the area. Hot or cold fomentation and sitz bath can help reduce the pain and the swelling in the first few days.

You must avoid sex till the stitches have healed and ideally till the bleeding has stopped. It is advisable to avoid tampons in the post delivery period.

Episiotomy is safe, helps to deliver the baby and in most cases, heals well.

Breast Feeding

Breast feeding is an art and a pleasure that every woman looks forward to doing.

Breast feeding is beneficial for the mother
  • It is convenient
  • It helps build a bond between the mother and the baby.
  • Helps reduce weight
  • Provides contraception when exclusive breast feeding is done in the first 6 months
  • Decreases risk of certain cancers in the mother
  • It releases a hormone called oxytocin that not only squeezes the breast but also squeezes the uterus so that it contracts and returns to its pre-pregnancy size. Breast milk is good for the baby.


There are some advantages such as
  • The breast milk is easily available, at the correct temperature
  • The protein and the fat content of the breast milk is in appropriate concentrations for the baby and therefore is easy to digest as that compared to the cow’s milk or formula milk.
  • Colostrum is the yellow watery pre-milk and it helps the newborn’s digestive system
  • It has antibodies that help the immune system of the baby fight infection and allergies
  • Breast fed babies have less chances of gas, constipation, diarrhea and allergies.


Whilst you are breast feeding it is advisable to have a healthy well balanced diet, drink plenty of water, take the supplements and avoid foods that can cause diarrhea / gas and distension in the baby.

It is important to look after the breast and the nipples. One should cleanse and wipe them dry after the feed. Keep the nipples well moisturized so that they do not crack. If a crack develops then one can use a nipple shield. It is easily available at the chemist. It is important to note that if the breast has a lump that persists, or it feels red hot tender to touch then one must report to the doctor.

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