CESAREAN SECTION (2): HOW IS THE INTERVENTION CARRIED OUT?
Dr Claude Allouche, gynecologist
Ahuza Clinic, Raanana
058 726 02 64
How will the planned cesarean take place?
A cesarean section is a surgical procedure, therefore carried out in the operating room.
- From your room, or from the emergency department, you are transferred, with the future father or your companion, to the operating room.
ENTRANCE TO THE BLOCK
- Entrance to the operating room is via an entrance hall where the healthcare team will take care of you.
- The future father or accompanying person is asked to wait a few moments before being redirected to the changing rooms to change. Only one person is allowed to accompany you inside the operating room. You must choose this person.
- For your safety, the operating room team made up of the gynecologist, the anesthesiologist, and the operating room nurse carries out a final check of the data in your file (last name, first name, allergy, type of anesthesia, etc. ). This step is called check out.
- The operating room staff is composed
- the gynecologist,
- the operating assistant, generally an intern,
- 2 operating room nurses,
- an anesthetist, sometimes assisted by an intern,
- from the midwife
- and the pediatrician.
- Once in the operating room, you are placed on the operating table.
- The necessary monitoring equipment is put in place: scope and blood pressure monitor to check your good health.
ANESTHESIA
- Anesthesia, generally spinal anesthesia, is carried out in a seated position by the anesthesiologist assisted by the nurse and midwife who helps you adopt the correct position to properly round your back during the procedure.
PRE-OPERATIVE PREPARATION
- Once done, you lie on your back, partially undressed, arms "crossed", the left side of the pelvis slightly elevated to avoid cave syndrome.
- The nurse then places a bladder catheter in the bladder, a completely painless procedure, since the anesthesia has already started to take effect.
- The gynecological surgeon, previously sterilely dressed, will then carefully coat your abdomen with an antiseptic and install sterile operating fields.
THE FATHER OR ACCOMPANIMENT
- As a general rule, the father or accompanying person can, if he wishes, attend the cesarean section.
- In this case, he must wear appropriate clothing.
- Entry into the operating room takes place when the procedure is ready to start, once the sterile fields have been installed. It is the midwife or nurse who will come and pick him up and bring him into the operating room.
- The future father or companion is installed at your head, this proximity allowing you to experience together this intense moment that is the birth of your child.
THE INTERVENTION ITSELF
- It is carried out by the gynecologist assisted by an intern and an instrument nurse.
- Typically, a horizontal incision is made on the skin, just above the pubis.
- The gynecologist then gradually opens different “thicknesses” before accessing the uterus to open the water bag and extract the fetus.
During this extraction, pressure is placed on your stomach, which may cause an unpleasant but not painful sensation.
- In general, between the moment of the skin incision and the extraction of the baby only a few minutes have passed.
- Once the baby is out, the gynecologist proceeds to clamp the cord and the newborn is directly entrusted to the midwife who presents him to you before going to the pediatrician.
- The placenta is then removed and the different layers that have been incised are sutured.
This is what takes the longest, on average 30 minutes.
- The skin is closed with thread or staples. According to medical practice, steri-strips and a dressing cover the scar.
THE NEWBORN
- The examination of the newborn is carried out by a pediatrician, during the first minutes of life, who checks the baby's good adaptation to extra-uterine life.
- When the pediatrician considers that the newborn has adapted to his new conditions, the midwife carries out the usual examinations (weight, height, head circumference, etc.).
- If conditions permit, the midwife returns to the operating room and places the baby against you, while remaining close by during these first moments of discovery as a threesome.
AFTER THE INTERVENTION
- Post-operative monitoring takes place for 2 hours in the birthing room or recovery room.
- This is carried out jointly by a nurse-anesthesiologist and a midwife.
- In addition to obstetric monitoring, the state of consciousness and the lifting of spinal anesthesia are closely monitored.
This time is also used to:
- perform skin-to-skin contact with baby,
- find the spouse or accompanying person,
- breastfeed for the first time or give the first bottle.
Monitoring in the recovery room can be carried out in the following cases:
- your state of health requires special monitoring. At this time, the newborn enters the nursery to have skin-to-skin contact with dad.
- the condition of the newborn requires close monitoring in an incubator
- significant occupation of the delivery room: in this case, mother-baby monitoring cannot be carried out in optimal conditions.
- The transfer to the room is carried out with medical approval (it is the doctor who authorizes the transfer of the patient to her room).
It generally takes one hour between entering and leaving the operating room.
CESAREAN SECTION (5): WHAT HAPPENS AFTER?
- After 2 hours of close monitoring, you return to your room with your baby and your partner.
- During the few days that you will spend in the maternity ward, you will be able to recover from the procedure and prepare for returning home with your baby.
- During the first 24 hours, the nursing staff carries out regular checks of your general condition in order to assess various parameters such as:
*pain,
* lochia and uterine involution,
* the operating wound;
* diuresis,
* ongoing infusions,
*the resumption of transit.
- This monitoring is reduced in the following days depending on the evolution of your state of health.
- Pain management
* Pain relief is one of the priorities of the healthcare team.
* The pain protocol established in the recovery room is followed according to medical prescription.
* Mobilization may be limited and difficult for the first 24 hours; the first lever is carried out, with the help of the caregiver, on the first day or the next morning after the intervention.
- Uterine monitoring
After childbirth, whether vaginally or by cesarean section, the uterus gradually regains its volume and its initial position thanks to contractions. This phenomenon (uterine involution) can last up to 6 weeks.
- Also, blood loss called lochia occurs. Less in quantity after a cesarean section, compared to a vaginal delivery, they increase over the days.
- These two phenomena are normal and reflect a natural process put in place by your body to recover from childbirth. However, these two parameters are regularly monitored by the healthcare team.
- Monitoring and care of the operating wound
Typically, the scar is covered with a bandage. The nurse will monitor the possible occurrence of depressions around this dressing.
* It will be removed in all cases on the second day to allow you to take a shower,
* If steristrips have been placed, they will be modified in the event of contamination and the wound disinfected
* if the closure of the skin was carried out by an intradermal stitch using an absorbable suture, there will be nothing more to do, the sutures will fall off on their own after 2 to 3 weeks.
* if they are non-absorbable staples or sutures, half will be removed on the day of departure on the 4th or 5th day and the other half after discharge by a home nurse.
- Monitoring of diuresis
Diuresis is controlled until the bladder catheter is removed (approx. 2 to 4 hours post-operatively).
- Monitoring of infusions
The infusions generally remain in place for a few hours after the procedure. Permeability and the puncture point are regularly checked by caregivers.
After the catheter is removed (24 hours after the cesarean section), most medications can be given orally.
- Monitoring the resumption of transit
* The emission of the first gases often announces the resumption of normal transit.
* It may take several days for normal stools to return. If you experience difficulties, do not hesitate to speak to the caregivers.
* Resumption of feeding depends on your gynecologist, but in general it is recommended early refeeding a few hours after the cesarean section
Generally, you can start drinking 2 hours after the procedure. If all goes well (no nausea and/or vomiting), you will be served a light meal in the hours that follow.
- Monitoring of thromboembolic risk
This monitoring consists of:
* clinical monitoring of the lower limbs (search for redness, edema, pain, etc.);
* prevention (various preventive measures);
* the installation of compression stockings already before the intervention;
* early leverage;
* in certain cases, need for an injection of an anticoagulant once a day subcutaneously.
- The length of hospital stay depends on your state of health and that of your baby.
- It is often between 4 and 6 days.
- The discharge date is a joint decision of the gynecologist and the pediatrician.
- You should know that the recovery time after a cesarean section is longer than for a vaginal birth.
Other publications on the same subject:
- Caesarean section (1) What is a cesarean section?
- Caesarean section (2): advantages and disadvantages
- Caesarean section (3): planned or emergency? What indications?
- Caesarean section (4): how is the procedure carried out?
- Caesarean section (5): what happens afterwards?