Childbirth surgery

Childbirth (also called labor, birth, partus or parturition) is the culmination of a human pregnancy or gestation period with the expulsion of one or more newborn infants from a woman's uterus. The process of normal human childbirth is categorized in three stages of labour: the shortening and dilation of the cervix, descent and birth of the infant, and birth of the placenta. In many cases, with increasing frequency, childbirth is achieved through caesarean section, the removal of the neonate through a surgical incision in the abdomen, rather than through vaginal birth. In the U.S. and Canada it represents nearly 1 in 3 (31.8%) and 1 in 4 (22.5%) of all childbirths, respectively. Some women take epidurals just before childbirth to avoid any pain. A Caesarean section, (also C-section, Caesarian section, Cesarean section, Caesar, etc.) is a surgical procedure in which one or more incisions are made through a mother's abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies, or, rarely, to remove a dead fetus. A late-term abortion using Caesarean section procedures is termed a hysterotomy abortion (not to be confused with hysterectomy) and is very rarely performed. The first modern Caesarean section was performed by German gynecologist Ferdinand Adolf Kehrer in 1881. A Caesarean section is usually performed when a vaginal delivery would put the baby's or mother's life or health at risk. More recently it has been performed upon request for childbirths that may otherwise have been natural. In recent years the rate has risen to a record level of 46% in China and to levels of 25% and above in many Asian and European countries, Latin America, and the United States. The Roman Lex Regia (royal law), later the Lex Caesarea (imperial law) of Numa Pompilius (715–673 BC), required the child of a mother dead in childbirth be cut from her womb. This seems to have begun as a religious requirement that mothers not be buried pregnant, and to have evolved into a way of saving the fetus, with Roman practice requiring a living mother be in her 10th month of pregnancy before the procedure was resorted to, reflecting the knowledge that she could not survive the delivery. Speculation that the Roman dictator Julius Caesar was born by the method now known as C-section is apparently false. There are several types of Caesarean section (CS). The type of incision used is dependent upon a number of factors and will be either (longitudinal or latitudinal). The incision on the skin may be different from the one used internally. There are two main types of incision used:

The classical incision involves a midline longitudinal cut in the uterus which allows a larger space to deliver the baby. However, it is rarely performed today, as it is more prone to complications and is only typically used in situations where the baby needs to be delivered very quickly and the latitudinal cut cannot be used for some reason The lower uterine incision involves a transverse cut just above the edge of the bladder and results in less blood loss and is easier to repair. It is the procedure most commonly used today. The external cut is most typically horizontal too and is often referred to as the bikini cut as the skin incision is typically below the bikini line just above the pubic hair

The space around this sac is the epidural space (see section on 'Regional anesthesia'). When making the incision. epidural or combined spinal and epidural anaesthesia) are acceptable for use during Caesarean section. The procedure can be used as a form of birth control Both general and regional anaesthesia (spinal. Typically. The abdominal muscles (the "abs") are two muscles that . Epidurals involve the injection into the space outside the sac (epidural space). Though terminology varies from one hospital or one practitioner to the next. Other advantages of regional anesthesia include the absence of typical risks of general anesthesia: pulmonary aspiration (which has a relatively high incidence in patients undergoing anesthesia in late pregnancy) of gastric contents and oesophageal intubation. Epidural anesthesia takes a little longer to establish desired affect.e. repeated doses of medicine can be given to maintain anesthesia as long as needed. also serves as a floor for the fatty layer just cut into. Because a small tube (catheter) can easily be placed in the epidural space. the effect is immediate. Spinals and epidurals have the same effect (i. Scheduled and Elective – These are pre-arranged caesareans. This rare operation may be performed in cases of intractable bleeding or in which the placenta cannot be separated from the uterus. the skin is thin and the blade is so sharp that the underlying yellow fat layer almost bursts out. Further maintenance of the anesthesia is achieved through the epidural catheter. Unplanned. Critical and Crash – These refer to situations where a vaginal birth is planned but events have taken over before or during labour and the baby is delivered by caesarean [  Additional relevant terms:   Repeat caesarean . A combined spinal-epidural involves a spinal injection followed by the insertion of an epidural catheter. Spinals are usually the first choice of anesthetic for women who are not in labor but need a Cesarean delivery.A caesarean followed by the removal of the uterus.A delivery which ends with another caesarean (planned or emergency) when a patient has had one for a previous birth. numbs a large region of the body) because they both involve numbing of the nerves as they branch off the spinal cord. Emergency. the following categories hold:  Planned. In this instance you may have requested the caesarean or had it recommended by a practitioner and labour has not usually begun.[The spinal cord and the nerves are contained in a sac of cerebrospinal fluid. which lies over the abdominal muscles. Spinal anesthesia involves the injection of numbing medicine directly into the fluid sac. a repeat caesarean is performed through the existing scar Caesarean hysterectomy . Regional anaesthesia is preferred as it allows the mother to be awake and interact immediately with her baby.There are planned caesareans and emergency caesareans. Since the spinal injection is more “direct”. The fascia. Epidurals are the primary way of relieving pain in women that request analgesia for labor.

the uterus is allowed to fall back into the pelvis. is gently brought together and stapled and steri-stripped. it is actually opened up and down. since it is anchored into the pelvis by ligaments that attach to it near it's bottom. Pulling gently on the head then allows the rest of the delivery. the bladder pushed down and away. The fascia repair is the most important. too. Usually a retractor called a "bladder blade" is used to pull the lowest part of the opening downward (toward the patient's feet) so as to protect it from the rest of the procedure. horizontally toward each side. care is taken not to take this peritoneal incision down toofar. This closure stops the bleeding from the edges of the incision. Once a small opening is made in the peritoneum. or it can be. This next layer is called the peritoneum. It is opened very carefully with a sharp thin scissors. like the abs. is therefore covered with peritoneum as well. It's still flimsy and filmy here. is easily tilted through all of the incisions and laid on the mother's belly. A small cut is made in it and an excision extended horizontally on either side. Physicians like to put that together with thicker and more durable suture. .run up and down from the upper abdomen down to the pubic bone.The uterus. which is actually the floor of the abdomen. so when a pair of scissors is used to cut this fascia. The fat layer can be skipped. Now with the uterus exposed. If there is no further bleeding at this reapproximated incision line. There's another layer of peritoneum over it. They are joined together at the midline. The uterine incision is then closed by using a suture designed to melt away in several weeks. "reminded" how it falls together with a few isolated absorbable sutures. or the bladder may be accidentally damaged. The uterus. The placenta is removed by separating it gently from the inside of the uterine wall. The skin. which is a departure from the direction of all ofour openings so far. these muscles are easily seen. Because the bladder wraps itself under the lower most portion of this lining. actually lying under this floor of the abdomen (called "retroperitoneal"). By this time everyone can hear the baby crying. the weakest reapproximation of the whole repair. The patient's uterus (womb) is enlarged to a great extent. The fascia ("grizzle" to those who need a real life reference) is the main supporting layer of the abdomen. an incision can be made across this lower portion of the womb. Where they meet can be easily separated with a gentle pushing away at the midline. The umbilical cord is clamped in two places and cut between the two clamps. allowing the pediatrician to attend the infant at the warmer nearby. the pediatrician is waiting to suction the throat and nose of the new-born.