Caesarian section

Once the anaesthetist has administered the anaesthetic, the midwife next to you will help you get comfortable on the operating table, after which your legs will be fixed to it to avoid the risk of falling. This is followed by a thorough disinfection of the surgical field and covering your body with sterile surgical linen. One end of it will be raised and a screen will be constructed using a special stand to restrict your view of the surgical field.

Anaesthesia is now in effect and you have no sensation or ability to move from the diaphragm downwards. Don’t be afraid that the operation will start before the anaesthetic has ‘caught’ you – the anaesthetist and operator will carry out appropriate tests. The anaesthetist and midwife will be by your head – please contact them with any questions and if you have any complaints.

Usually operative labour is performed with regional anaesthesia, but in some more special cases it may be necessary to use a general anaesthesia. Regional anaesthesia numbs you and dulls sensation in the area of surgery, you will feel touch, pressure and pulling but no pain. Except in the rare cases where general anaesthesia is required, you will be conscious during the Caesarean section and will be able to hear the team talking, as well as yourself talking to the anaesthetist who is close by your side at all times. You will also hear your baby’s first cry!

Caesarean sections used to be performed with a long vertical incision from the navel to the pubic bone. Nowadays, this technique is reserved for special cases, and the usual practice is much more discreet – the incision site is low down, just below the bikini line, right where we expect your baby’s head to be positioned. It is usual not to cut the muscles of the anterior abdominal wall, but to pull them aside and, on reconstruction, to attach them carefully with a few light stitches in their usual position. The baby is removed from the uterus with gentle effort – there is a maximum approximation of the process to normal birth and passage through the natural birth canal.

The birth of the baby takes place at the very beginning of the operation – around the fifth minute. What happens to the newborn and when you will get acquainted we will tell in a minute. Now two words about what happens in the remaining minutes on the operating table. After the baby is born, the placenta needs to be delivered – it has already fulfilled its functions and cannot remain in the uterus. In a normal birth, its separation from the walls of the uterus occurs naturally under the influence of the hormone oxytocin within a few minutes after the baby is born. In a Caesarean section, this process is simulated by the operator using a small dose of intravenously administered oxytocin to stimulate easier and more complete separation of the placenta.

After the placenta is removed and the uterine cavity is cleaned, the recovery of all layers of tissue proceeds in sequence. Sometimes this happens slowly – with bleeding, with old adhesions creating difficulties, with removal of cysts, small myomas, etc.  We know you can’t wait to get you out of the operating room, but careful execution of this part of the surgery is key to a normal recovery period afterwards, as well as for a normal subsequent pregnancy. Aesthetic suturing is not always possible – sometimes single sutures are preferred to better drain the wound.