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November 10, 2014

Planned Cesarian Caesarean

Planned Caesarean
If you are having a planned caesarean done under a general anaesthetic, you will be told not to eat anything for at least six hours before the operation. You will only be allowed sips of water. If you happen to need a general anaesthetic during an emergency c-section, the contents of your stomach will be pumped out through a rubber tube.

Your husband is usually not allowed to go with you into the operating theater. Even in the rare hospital that permits this, if your caesarean section turns into a true emergency, or if you need a general anaesthetic, your husband will be asked to leave.

Before the surgery, you'll be prepared in the following ways:
o    You'll be asked to change into a sterilized hospital gown.
o    You'll have to take off all your jewellery.
o    If you have a brace or false teeth, you'll need to remove them, too.
o    If you are wearing any make-up and nail varnish, they will also be removed. This is so your skin tone can be monitored during the operation.
o    You won't be able to wear contact lenses or glasses.
o    At some hospitals, a sample of your blood will be taken to check that your iron levels are high enough and you haven't got anaemia. If are anaemic and happen to have huge blood loss, you will need a blood transfusion. The hospital will make preparations for this.
o    You'll be made to lie on your back on an operating table. The table may be tilted or wedged to the left so the weight of your uterus doesn't reduce the blood supply to your lungs and make your blood pressure drop.
o    A drip will be inserted into a vein in your arm. This will give you fluids and make it easy to give you drugs if you need them during the operation or later.
o    You'll be given an anaesthetic. Depending on the type of anaesthesia used, your position on the operation table may be changed. Regional anaesthesia - a spinal or an epidural - may be used. This type of anaesthesia numbs your bottom half and is safer for you and your baby than a general anaesthetic, which puts you to sleep.
o    A thin tube, or catheter, will be inserted into your bladder via your urethra. This will make sure your bladder is empty.
o    The area on your tummy where the cut will be made will be shaved and cleaned with an antiseptic. Then it is covered with special sterile sheets, which are cut in the centre, so that only the part to be operated on remains exposed.
o    You may be given blood-thinning injections to reduce the risk of a clot forming in one of your leg veins.
o    You'll have a cuff put on your arm to monitor your blood pressure.
o    Your anesthesia expert will monitor your heart rate at all times, before, during and after the operation. Your heart rate may be monitored manually or electronically. If you are being monitored electronically, electrodes will be put on your chest. You may have a finger-pulse monitor attached, too.
You'll be given:
o    an injection of antibiotics to ward off infection
o    anti-sickness medicine to stop you from vomiting
o    strong pain relief during and just after the caesarean
o    pain relief for lasting soreness
o    oxygen through a mask, if your baby is in distress.
o    You may be surprised by how many people are needed to perform a caesarean section; the operating theatre will be full of people all busy doing their specific jobs.

What happens during a caesarean?
Once your lower body is completely numb, the doctor will make a small horizontal cut into your skin, about two fingers' width above your pubic bone. This type of cut is called a bikini cut.

Less commonly, the doctor may make a vertical cut, extending from two fingers' width above your pubic bone to an inch below your belly button. Bikini cuts are favoured more nowadays, as they tend to heal better.

The layers of tissue and muscle are opened to reach your uterus. Your tummy muscles are parted, rather than cut. Your bladder will be moved down to expose the lower part of your uterus.

Your doctor then makes a second cut, in the lower section of your uterus. This cut is usually small. Your doctor will make it bigger using scissors or fingers, so that it is torn. This causes less bleeding than a sharp cut. These days the opening is usually made in the lower part of the uterus. This is why the operation is sometimes called a lower segment caesarean section (LSCS).

The bag of membranes is opened, and you may hear fluid gushing out. Your baby is then lifted out. You may be aware of the assistant pressing on your belly to help your baby be born. If your baby is breech, he will be born bottom first. It only takes a few minutes to take your baby out. 

Your baby will be quickly checked over by the paediatrician, if he or she is available. At some hospitals the paediatrician may have to be summoned, or your doctor may hand over your baby to one of her trained and experienced assistants or staff. Your baby is then shown to you.

After your baby is born, your doctor will gently tug the umbilical cord to pull out the placenta. 

What happens when my baby is born?
After your baby is born, his cord is clamped and cut. He is cleaned and his initial checks are made. He is given Apgar scores at one minute, 5 minutes and 10 minutes after birth. The scores measure your baby's wellbeing.

If your baby is well, he is simply kept covered and warm. But if your baby is very small or unwell, he may need more attention from the paediatrician. He may need to go straight to the paediatric intensive care unit.

Your doctor will concentrate on stitching you up. Each layer of muscle and skin needs to be closed using clamps, staples, or sutures. Your doctor will probably use a double layer of stitches to repair your uterus. Finally, your skin wound will be closed with stitches or staples.

When you're ready, you'll be moved to your ward where you, your husband and, if all is well, your baby (or babies) can be together. You may start shivering, because your body temperature drops during the operation. Your nurse will warm you up with blankets and help you breastfeed your baby. You may find it more comfortable if you both lie on your side and face each other. It often takes some time to find comfortable feeding positions after a caesarean, but it's worth persevering, and it does get easier. 

How will I feel after a cesarean delivery?

Like any new mother, you'll probably feel both euphoric about and overwhelmed by the new person in your arms. But you'll also be recovering from major abdominal surgery while dealing with typical postpartum issues such as engorged breasts, mood swings, and vaginal discharge.

C-section patients typically stay in the hospital for two to four days before going home. But your recovery will be measured in weeks, not days, so you'll need help taking care of yourself and your new baby.

How will I feel right after surgery

You may feel groggy and possibly nauseated right after surgery. Nausea can last up to 48 hours, but your caregiver can give you medication to minimize your discomfort. Many moms also feel itchy all over, particularly those who received narcotics in their epidural or spinal. If this happens to you, let your caregiver know so you can get medication to relieve the itchiness.

When will I be able to breastfeed?

If you plan to breastfeed, you can start in the recovery room right after surgery. Ask the nurse to show you how to nurse in the side-lying position or using the football hold, so there won't be pressure on your incision.
Breastfeeding can be challenging in the days after a c-section because of the pain from a healing incision. Ask to see a lactation consultant as soon as possible to help you position your baby comfortably so you don't end up with sore nipples. If the hospital doesn't have a lactation consultant, ask for the nurse who's the resident expert.

What's recovery like during the first few days?

You may feel numbness and soreness at the incision site, and the scar will be slightly raised, puffy, and darker than your natural skin tone. Your doctor will come by daily to see how you're doing and check that the wound is healing properly.
Anything that puts pressure on the abdominal area will probably be painful at first, but you'll feel a bit better day-by-day. Be sure to use your hands or a pillow to support your incision when you cough, sneeze, or laugh.
Your nurse will come by every few hours at first to check on you and help you. She'll take your vital signs, feel your belly to make sure your uterus is firm, and assess the amount of vaginal bleeding. Like any woman who just delivered a baby, you'll have a vaginal discharge calledlochia, which consists of blood, bacteria, and sloughed-off tissue from the lining of your uterus. For the first few days, this discharge will be bright red.
Your nurse will also instruct you on how to cough or do deep breathing exercises to expand your lungs and clear them of any accumulated fluid, which is particularly important if you've had general anesthesia. This will reduce the risk of pneumonia.
If everything's okay, your nurse will remove your IV and urinary catheter soon after surgery, usually within 12 hours.
Depending on your situation, you may be able to drink fluids – and start eating a light diet if you feel like it – within six to eight hours after your surgery. In some cases, though, your doctor may recommend waiting longer before eating.
You might have some gas pain and bloating during the first two days. Gas tends to build up because the intestines are sluggish after surgery. Getting up and moving around will help your digestive system get going again.
If you're in great discomfort, the nurse may give you some over-the-counter medication that contains simethicone, a substance that allows gas bubbles to come together more easily, making the gas easier to expel. Simethicone is safe to take while breastfeeding.
You will be encouraged to get out of bed at least a couple of times the day after surgery – or even the day of surgery – to walk. (Do not, however, attempt to get up by yourself. The nurse should be at your side the first few times.) In the meantime, get the blood going in your legs by wiggling your feet, rotating your ankles, and moving and stretching your legs.
Just walking to the bathroom may seem impossible at first, but moving around is important for your recovery. It will help your circulation and make it much less likely that you'll develop blood clots. What's more, it will make your bowels less sluggish, which will help you feel a whole lot more comfortable a lot sooner.
For these reasons, you'll be encouraged to walk each day. Try to take your walks a short time after you've taken pain medication, when you're likely to feel more comfortable.
It's also important to get to the bathroom to urinate regularly. A full bladder makes it harder for the uterus to stay contracted and increases pressure on the wound.
Your doctor will probably remove your sutures or staples on the third or fourth day. This takes just minutes, and you may feel a small pinch but you shouldn't feel any pain. This is usually done before discharge from the hospital, or it may be done later in your doctor's office. This might be the case if you elect to go home on the second day after surgery or if your doctor feels that you need extra time to heal (for example, if you're obese or you have diabetes).
Finally, before you leave the hospital, you'll get any necessary vaccines that you haven't had already (such as rubella, Tdap, chicken pox, and a flu shot). And your practitioner will check in with you (if she hasn't already) to make sure you have a plan for birth control.

What's recovery like after I leave the hospital?

Expect to need help – and lots of it – once you get home. If nobody offers, ask for support from your partner, parents, in-laws, and friends. If you're worried that you may not have enough support, hire paid help if you can afford it.
You'll likely be given a prescription for more painkillers and a stool softener before you leave the hospital. You may need prescription painkillers for up to a week after surgery, gradually transitioning to over-the-counter pain relievers. (If you're breastfeeding, don't take aspirin or drugs containing acetylsalicylic acid.)

Drink plenty of fluids to help you avoid constipation. Your incision will likely feel better day-by-day, quite noticeably so after several days, though it may continue to be tender for several weeks.
Call your caregiver if you have signs of an infection, including:
·         warmth, redness, swelling, or oozing at the incision site
·         worsening pain or sudden onset of pain
·         any fever (even if your incision looks fine)
·         foul smelling vaginal discharge
·         pain or burning when urinating, the urge to pee frequently when not a lot comes out, or urine that is dark and scanty or bloody
Your vaginal bleeding and discharge should be diminishing, though it may last up to six weeks. It should gradually turn from bright red to pink and then yellow-white. If menstrual-type bleeding continues past the first four days after delivery or comes back after slowing, call your healthcare provider.
You'll also need to call your caregiver without delay if you have any signs of a blood clot, such as severe or persistent pain or tenderness and warmth in one area of your leg, or one leg that is more swollen than the other.

How active should I expect to be?

While it's essential to get plenty of rest once you're home, you also need to get up and walk around regularly. Walking promotes healing and helps prevent complications such as blood clots.
Of course, you shouldn't overdo it. Start slowly and increase your activity gradually. Since you're recovering from major abdominal surgery, your belly will feel sore for some time. Take it easy and avoid heavy household work or lifting anything heavier than your baby for eight weeks.

What will my scar be like?

At first, the scar will be slightly raised, puffy, and darker than the rest of your skin, but it'll start to shrink significantly within six weeks of surgery.
A c-section incision is only 4 to 6 inches long and about 1/8 inch wide. As the incision site continues to heal, your scar will more closely match your skin color and will narrow to about 1/16 inch wide. It might be itchy while it's healing.
C-section scars are usually very low on the abdomen. A low-lying horizontal scar will eventually be hidden by your pubic hair, probably way below the waistband of your underwear or bikini bottom.

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