As soon as pregnancy occurs, the mother begins to think about her next child and the way he will come into the world. Caesarean section has become more common than natural birth in the world, either because the doctor believes that it is the best option for the mother and fetus or because of the mother’s personal preferences. However, some women are afraid of Caesarean section because it is ultimately a surgical operation, and if you are pregnant and would like to know more about Caesarean section, we will explain more information about it in the article.

What is a caesarean section?

Caesarean section is a surgical procedure performed to deliver the baby, and it is done by making an incision in the abdomen and uterus to remove it.

Some cesarean sections are planned, others are performed when unexpected problems occur during or before delivery.

In the past, Caesarean section was performed through a longitudinal incision, but now it is performed through a horizontal incision directly below the bikini line.

Although a caesarean section, like any other surgical procedure, may involve some risks, it may be the ideal option to preserve the health of the mother and fetus.

Who is a candidate for a caesarean section?

A planned caesarean section is usually performed if there is a problem that hinders a natural birth, such as the mother’s pelvic measurements not being suitable for the fetus’s head to pass through, either due to the large head of the fetus or the small size of the pelvis, or when the mother prefers from the beginning a caesarean section.

Caesarean section is also performed in the following cases:

• Abnormal fetal heart rate.
• An abnormal position of the fetus during birth, such as a breech position in which the baby’s feet are down (the normal position is for his head to be down and facing the mother’s back).
• Trouble with labor progressing or prolonged mucus.
• The fetus is large in size and cannot be delivered vaginally.
• Placental problems, such as placenta previa, which may block the cervix.
• Certain conditions in the mother, such as diabetes or high blood pressure.
• Active herpes virus infection of the vagina or cervix.
• Pregnancy with twins.
• Having had a previous caesarean section.
• A fetus suffering from abnormalities detected during pregnancy.
• Cervical obstruction due to fibroids.
• Wrapping the umbilical cord around the baby's neck or body.
• The umbilical cord prolapses from the cervix before the baby is born.

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Disadvantages and advantages of caesarean section

The comparison between caesarean section and natural birth still exists and is confusing for women, especially since caesarean section may be associated with some advantages that make it a preferred option for many mothers. And from her:

Advantages of cesarean section

• Avoid feeling anxious about natural birth.
• Less chance of urinary incontinence and pelvic organ prolapse (such as uterine prolapse) compared to women who give birth naturally.
• The possibility of determining the date of the caesarean section in advance, which makes the woman not worry about premature birth or sudden labor. The date of the child’s birth can also be determined to be suitable for the mother.
• Saving the baby’s life in difficult births, prolonged labor, or if the umbilical cord is wrapped around the fetus’s head, etc.
• Saving the mother's life in cases such as preeclampsia.
• The mother waking up during childbirth in a state of spinal anesthesia makes her receive her baby as soon as he is born and is also able to breastfeed him with breast milk, which has many benefits for the child.
• Less delivery time, as it usually takes 15 to 45 minutes.
• Avoid the risks of natural birth, such as oxygen deprivation, which poses a great risk to babies and has long-term effects.
• Not feeling pain during childbirth because it is performed under general or general anesthesia.

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Disadvantages of cesarean section

Caesarean section, like any surgical procedure, is associated with some risks and drawbacks For example:

• Longer hospital stay time of two to four days on average, compared to one or two days for vaginal delivery.
• A longer recovery period, as the surgical incision in the skin and muscles requires recovery time that may reach two months, in addition to the annoying symptoms associated with it, such as pain.
• Increased risk of complications such as infection at the surgical site.
• Increased chances of bleeding, injury to the intestine or bladder during childbirth, or the formation of a blood clot.
• The risk of death during a cesarean section is three times greater than during a vaginal delivery due to blood clots, infection, and anesthesia complications.
• Undergoing a cesarean section in future births if the first birth was a cesarean section.
• Risks of complications in future pregnancy, such as: placental abnormalities and uterine rupture at the suture site from a previous cesarean section.
• Babies born by Caesarean section are more likely to develop breathing problems at birth and even during childhood, such as asthma.
• There is a slight risk of the child being scratched by the scalpel during surgery and being exposed to injury.
• The need to suture the uterus and abdomen.

Types of caesarean section

Caesarean section is a surgery performed to remove the fetus from the mother’s womb through an incision in the abdomen and uterus. Therefore, we find that it is divided into several types based on the reason for performing the operation and the method of incision in the abdomen and uterus. In the following lines, we explain its different types in detail.

First: Types according to timing of birth

1. Planned (elective) caesarean section

It is performed based on a prior decision agreed upon between the doctor and the mother, and is usually performed for medical or non-medical reasons, including:

• Placental problems such as placenta previa or placental abruption.
• Inappropriate fetal position such as breech or transverse position.
• Medical conditions for the mother, such as high blood pressure or diabetes.
• Mother's choice to avoid natural birth.

2. Emergency caesarean section

This caesarean section is performed urgently when complications arise during pregnancy or labor, and their reasons are as follows:

• Complications during labor, such as difficult labor or failure to progress.
• Fetal suffering such as low heartbeat.
• Uterine rupture or umbilical cord problems.

Second: Types according to surgical incision

1. Horizontal incision (Bekenstein incision)

• Also called the transverse incision.
• It is most common and runs horizontally in the lower abdomen.
• Preferred because it reduces bleeding and speeds up healing.
• Scars are also less noticeable.
• It also allows for the possibility of natural birth in the future.
• Least risky in terms of complications.

2. Vertical incision (classic)

• Also called longitudinal or vertical incision.
• Rarely used.
• It runs vertically from the navel to the lower abdomen.
• It is performed in emergency situations or when there are complications such as placenta previa or the fetus in an unusual position.
• More susceptible to complications.
• Leaves more visible scars.

Third: Types according to the number of cesarean sections

1. First cesarean section

• Usually for reasons specific to the pregnancy, the mother or the fetus.
• It is performed as a result of emergency health conditions, such as a narrow pelvis or a large fetus.
• It is also performed when natural labor fails or cervical dilation stops.
• In some cases, it may be at the request of the mother due to fear of natural childbirth or to avoid pain.

2. Repeated cesarean section

• It is performed on a mother who has undergone a previous caesarean section and whose uterus is not suitable for natural childbirth.
• It may be planned if there is a risk of uterine rupture in a vaginal VBAC delivery.
• It is performed when a short period of time passes between two pregnancies, less than 18 to 24 months.

Fourth: Types according to anesthesia

1. Spinal anesthesia (local or spinal)

It includes two common types:

• Spinal anesthesia

It is injected directly into the cerebrospinal fluid at the base of the spine and takes effect within minutes. It is often used in planned or emergency caesarean sections that do not require extreme speed.

•  Epidural anesthesia

It is widely used during natural birth, and the dose can be increased if the birth turns into a cesarean section, as it is injected into the area surrounding the spinal cord, and it takes a little longer to take effect.

2. General anesthesia

• During which the mother is completely anesthetized using intravenous medications and inhaled anesthetic gases.
• This method is only used in emergency cases or when spinal anesthesia cannot be used for medical reasons.
• It is relied upon when the operation takes longer or when complications are expected.
• It is also used if the mother suffers from a blood clotting disorder or spinal problems.

Stages of caesarean section

The stages of cesarean section include several steps that must be followed carefully in the operating room.

First: Preparation before the operation

• By inserting an IV line to give fluids and medications.
• Insertion of a urinary catheter to empty the bladder.
• Cleaning and sterilizing the abdominal area.

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• Spinal anesthesia is often used to numb the lower part of the body while keeping the mother awake.
• In emergency cases, general anesthesia may be used.

Third: Performing the operation

• Abdominal incision: The doctor makes a horizontal incision in the lower abdomen, or vertical in rare cases, where layers of skin, fat and muscle are cut to reach the uterus.
• Incision in the uterus: Then an incision is made in the uterine wall, which is often horizontal in the lower part of the uterus.
• Removal of the fetus: The doctor carefully removes the fetus from the uterus, cuts the umbilical cord, and in some cases the placenta is removed at the same time.
• Fetal examination: The child is handed over to a medical team, usually to a pediatrician;
• Closing the incisions: Suturing the uterus with dissolvable stitches, then closing the abdominal layers with stitches or medical staples, covering the wound with a sterile bandage.

Fourth: Post-operative care:

• The mother is taken to the recovery room to monitor vital signs, such as blood pressure, pulse, and breathing, to ensure she is stable.
• The mother is also given painkillers intravenously or orally.
• The mother can start breastfeeding or skin-to-skin contact, but only if her condition is stable.
• After a cesarean section, the urinary catheter is removed, usually after 12 to 24 hours.

Fifth: Recovery and discharge from the hospital

• The mother remains in the hospital for 2 to 4 days, depending on her health condition.
• It is recommended to rest and avoid lifting heavy weights.
• Caring for the wound and changing dressings to prevent infection.
• Follow up with the doctor to ensure the wound is healed and the mother is healthy.

According to these stages;

Which is better, renal or spinal anesthesia for caesarean section?

To answer this question, let us explain to you the advantages and disadvantages of each in the table below.

Difference	Total anesthesia	Hemianesthesia
Mother's condition	It makes the mother completely unconscious during the procedure.	Only the lower part of the body is numbed, while the mother remains awake.
Features	Used in emergency situations; It is preferred if there are contraindications to spinal anesthesia, such as spinal problems or critical emergency situations. The mother does not feel pain and does not see anything during the operation.	It is considered safer for the mother and fetus; It allows the mother to see her baby immediately after birth, and participate in the moment of birth. Reduces postoperative complications, such as nausea or difficulty breathing. An epidural may be used;
Disadvantages	Increases respiratory risks, such as difficulty breathing or aspiration pneumonia. The mother may experience nausea, dizziness, or confusion after waking up. The mother does not witness the moment of birth, nor does she see the child immediately. The medications used may temporarily affect the fetus, such as slowing breathing.	It may cause a temporary drop in blood pressure, requiring close monitoring. Not suitable if the mother suffers from blood clotting disorders, or is allergic to local anesthesia. It may take longer to prepare than with general anesthesia.

Accordingly, spinal anesthesia is preferable;

Is it possible to give birth naturally after a cesarean section?

Yes, natural birth is possible after a cesarean section in many cases, and this is known as VBAC - Vaginal Birth After Cesarean, but it depends on several factors that must be carefully evaluated by the doctor, and here are the comprehensive details about them.

When can a natural birth be performed after a cesarean section?

• If the previous cesarean section was with a low transverse incision, rather than a longitudinal incision in the uterus.
• Sufficient time passes between two pregnancies, usually more than 18 months.
• There are no problems that prevent natural birth, such as a narrow pelvis or inappropriate fetal position.
• Not having more than two previous caesarean sections.
• Close follow-up with a specialized doctor for rapid intervention when needed.

When should it not be done?

• If there was a previous cesarean section with a longitudinal incision or a previous uterine rupture.
• The presence of complications in the current pregnancy, such as placenta previa.
• If the mother has undergone more than two consecutive caesarean sections without a natural birth in between.

What are the danger signs after a cesarean section?

It is normal for a woman to feel pain after a cesarean section and difficulty performing normal tasks such as going to the bathroom, breastfeeding the baby, changing the sleeping position, etc., but some signs may not be normal and indicate that there is a potentially serious problem, so if you encounter any of the following symptoms, you should: consultation Doctor immediately:

• Chest pain or difficulty breathing.
• Fever over 38°C.
• Severe or persistent bleeding around the surgical site.
• Heavy vaginal bleeding (changing the sanitary pad more than once every hour or bleeding through the vagina that is larger than the size of a plum).
• Acute or severe pain around the surgical site.
• Pus, swelling, or redness around the wound.
• Severe depression and severe mood swings.
• Severe physical pain.
• Sudden and unexplained weight gain (more than one kilogram per week).
• Foul-smelling discharge from the vagina.
• goosebumps.
• ألم في الساق.

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Tips after a cesarean section

Taking care of your wound and following your doctor's instructions is an essential part of recovery after a cesarean section, and helps avoid many potential risks.

If you undergo a cesarean section, follow the following tips To care for your birth wound and your health:

• Gently clean and dry the wound every day.
• Wear loose, comfortable clothing and cotton underwear.
• Take painkillers if the wound is painful, such as paracetamol or ibuprofen.
• Monitor for signs of infection (fever, pus, or pain and swelling) and consult a doctor immediately if any of these appear.
• Change sanitary pads regularly.
• Take antibiotics recommended by the doctor in the first period after birth.
• Take nutritional supplements such as: iron and calcium, which are usually recommended by the doctor throughout the breastfeeding period.
• Drink plenty of water to prevent dehydration and constipation.
• Eat plenty of vegetables, fruits and foods rich in fiber;
• Get enough rest to speed up recovery.
• Do not carry heavy objects or do strenuous work during the first period after giving birth.
• Walking moderately to speed up wound healing, stimulate blood circulation, and reduce the chances of blood clots.

In summary, caesarean section has its advantages and disadvantages, and personal preferences should not be the primary factor in choosing the method of delivery, but the decisive factor is the doctor’s opinion, which determines the best and safe method of delivery for both the mother and the fetus.

Frequently asked questions

How many hours does a cesarean section take?

The procedure itself takes approximately 30 to 60 minutes, but the time may vary depending on the mother's condition, previous cesarean sections, or any other complications.

How long does the pain of a cesarean section last?

The pain usually lasts one to two weeks after surgery, but gradually decreases as the wound heals, but some mild pain may last for several weeks.

What is the correct way to sit after a cesarean section?

It is preferable to sit upright with your back supported using a pillow, avoiding bending forward or putting pressure on the wound site.

When does the abdomen return to normal after cesarean section?

The abdomen needs several weeks or months to return to normal, as this depends on nutrition, movement, and body care, and it may take longer if the mother does not practice appropriate exercises.

Sources and references

Recovering from a C-section – unmhealth

Caesarean section – nhs