Delivery dilemma

TAHSEEN IS in her eighth month of pregnancy. Her best friend just had a baby and underwent a Caesarean section. Tahseen is keen on having a normal delivery. She wants to know if there is anyway she can ensure that.

What is a Caesarean section?

A Caesarean section is an abdominal operation performed to deliver a baby when vaginal delivery is not possible or safe. The doctor makes a cut in the mother's abdomen and uterus to remove the baby. This procedure is also called a C-section. Caesarean sections can save the lives of new-borns and their mothers or prevent the potential complications of a delayed vaginal birth. In India, the rate of Caesarean section has climbed drastically. Recent articles in professional journals have placed the rate as high as 45 per cent. Health care professionals in India have been alarmed by the rising rate of Caesareans and efforts are on to curb it.

When is it performed?

Elective Caesarean section:

A Caesarean section may be performed before labour begins if there are medical reasons for not allowing labour or a vaginal delivery. For example, the health of the mother or the baby may be in danger if the pregnancy continues, or vaginal delivery might be impossible or unsafe. This is called a planned or elective Caesarean section.

Emergency Caesarean section:

A Caesarean section may also be done when labour begins or during labour if certain problems occur. A Caesarean section may be indicated in the following situations:

* If at the time of delivery the lowest part of the baby, instead of the head, is the buttocks (breech), face, brow (forehead), or shoulder, a caesarean section is usually necessary.

* For many women in labour, the cervix (mouth of the uterus) begins to dilate and then stops before it is fully dilated. A drug called oxytocin may be given to make the contractions stronger. Despite this drug, however, many women do not dilate fully and cannot deliver vaginally.

* Other women may dilate fully but may not be able to push their babies far enough down the birth canal for a safe vaginal birth. This may happen because the baby is too large for the woman's birth canal.

* At any time during labour a baby may develop problems that cause the baby's heartbeat to slow down. These problems may indicate that the baby cannot tolerate further labour and a Caesarean section may be necessary.

What happens during the procedure?

You are given a regional (spinal or epidural) or general anaesthetic. A regional anaesthetic numbs part of your body, preventing you from feeling the pain while you remain awake. A general anaesthetic relaxes your muscles, puts you to sleep, and also prevents you from feeling the pain.

The obstetrician makes a cut below your navel and into the lower part of the uterus to remove the baby. The obstetrician then removes the baby, placenta, and birth sac and then sews the uterus and the abdomen is closed.

What happens after the procedure?

You may stay in the hospital for about 4-6 days, depending on your condition.

After you return home, you can gradually resume normal work so that by one month after the operation you should be able to perform most of your normal housework.

You will be on a normal diet for one or two days after the operation. There are no food restrictions. You should concentrate on taking a balanced diet with a good amount of proteins. Avoid pure fat such as ghee because it has no dietary benefit and the weight that is gained during pregnancy and immediately afterwards is difficult to shed.

Avoid lifting heavy things for six weeks. Intercourse also should be avoided for at least six weeks.

After 4-6 weeks you may begin an exercise programme to regain abdominal muscle tone. Ask your doctor what other steps you should take and when you should come back for a check-up.

What are the risks associated with this procedure?

Most Caesarean sections are safe. Occasionally there can be complications, which are inherent in any surgery.

* You may develop an infection or bleeding.

* Rarely, the cut in the wall of the uterus may leave a weak part in the wall. This may result in an incisional hernia.

* You may still be allowed to have a vaginal delivery with your next pregnancy. However, chances for a repeat Caesarean section increase, depending on why the Caesarean was done.