Dr. Manny in the operating room.
Millions of children are born in the U.S. every year, but some of them, either for fetal reasons or medical complications, must be delivered via caesarean section. The field of surgery in obstetrics in the U.S. has advanced dramatically over many decades, leading to procedures with minimal complications, few side effects and very low mortality.
Still, a caesarean section is an important operation in terms of quality control. Here are five things you need to be aware about before undergoing a C-section:
1. You will be put under anesthesia.
The type of anesthesia used in a C-section is usually a spinal or epidural. The anesthesiologist inserts a small needle in your back and injects a local anesthetic that will go in the space of your spine and numb the nerve roots. Immediately after this procedure, you will feel numbness from your waist down. You may still feel the sensation that someone is touching you, but you will not feel pain. Surgeons always make sure the anesthesia is working before an operation, so have no fear.
In a number of cases general anesthesia is required, in which case the surgeon will be ready to extract the baby from the uterus within a reasonable amount of time from when the patient falls asleep, so that the general anesthesia does not cross over to the baby. Usually pediatricians are always in attendance for these kinds of deliveries.
2. Your surgery team is accountable.
All of the individuals that are going to be performing or assisting in the surgery must be present in the room when the surgery begins. This is something called “time out,” when the operating room nurse in charge identifies the patient, explains why the patient is there, and any risk factors are disclosed to the team. Team members also have an opportunity to ask questions if necessary so that at the end of the time out, they all are in agreement and the procedure can continue.
A time out is held so that everybody is aware of what’s going on in surgery and what needs to be done. It also minimizes the opportunity for complications such as operating in the wrong side of the body or missing a procedure that needs to be done at the time of the surgery.
3. The scrub tech is very important.
One of the most important members of the team is the scrub tech. He or she is responsible for counting all of the instruments at different times during the surgery. There is an initial count of how many needle holders, clamps, retractors, sponges, and equipment tags are present at beginning of surgery. The scrub tech is then responsible for re-counting the instruments in middle of operation, and also counting them for a final time before the abdomen is closed.
This is very important because a small sponge or equipment tag can be lost inside the body and be left there, which could only create more problems down the road for the patient. If for some reason the count is not correct, then the belly is not closed and every effort is made to locate the missing item. If necessary, an X-ray may be taken to help locate the item.
4. Delayed cord clamping may be performed.
When the baby is born, depending on the gestational age, the pediatricians may ask for delayed cord clamping. This is something that is done to allow the baby to transition while still attached to the placenta. Usually there’s a count of 30 seconds to allow all of the blood flow that is in the residual space in the placenta to transmit itself into the child.
Studies have shown that in premature babies this technique enhances the quality of child in reducing complications like respiratory distress and intracranial hemorrhages. Once the baby is delivered and cord is clamped and cut, there is a bassinet with a heating lamp and either a nurse or pediatrician then will transition the baby, clean him or her up, swaddle them, take their temperature and monitor their heart rate and respiration before giving the child to the parents.
5. You’ll be monitored after the operation.
Finally, once the operation is completed, you’re moved into the stretcher and taken to a recovery room with your Foley catheter still inserted. This will allow you to transition as the team monitors your blood pressure and any excessive vaginal bleeding. It allows the anesthesia to wear off slowly so you can gain some mobility in your lower extremities. Once that happens, you’re on your way to your room so you can enjoy the good news with your family and your little one!
I know that there are many controversies regarding C-sections and a lot of unnecessary C-sections are perhaps performed in the U.S. However, in many cases it is a specified operation. Under today’s guidance, they’re performed under the most optimal conditions, ensuring the safety of both you and your baby.
For more, visit my archive of Dr. Manny’s notes.