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Caesarean Operation

When Yvonne, 32, was wheeled into the labor ward at 10.30pm, her contractions.- two minutes apart - were coming hard and fast. It seemed that she and her husband, first-time parents, would soon be meeting their baby daughter face-to-Face. "I asked for an epidural after about two hours of labor because I couldn't take the pain.

But after a couple more hours, my cervix was still only 1cm dilated:" At 9am the next morning, she still wasn't fully dilated so her gynaecologist broke her water bag. By 5.30pm, more than 18 hours into the labor, Yvonne's doctor ordered an emergency Caesarean operation, or C-section. "When she told me, I was shocked and a little reluctant as I wanted to deliver my baby naturally.

Sensing my emotions, she reassured me that it was necessary because my daughter's head was 'moulding'. That meant that after being stuck in the both canal for so long, my baby's skull was moulding to the shape of the birth canal so she had to be taken out by C-section." So Yvonne agreed to the operation and an hour later, was holding her newborn baby in her arms.

Generally, an estimated one in-10 women expecting a vaginal delivery will have an emergency C-section,.The most common reasons for a C-section include Previous Caesarean section, breech babies, failure to progress and non-reassuring fetal status, says Dr Judy, consultant obstetrician and gynaecologist. 

For instance, when there are sub-optimal contractions in labor, a C~section may be recommended after other options to help the progress of labour fail. "When the pregnant mother is in labour but the contractions are weak, stowing the progress of the labor, an oxytocin infusion drop can be started 'to increase the frequency of the contractions:' says Dr Wang.

However, when there are signs that the baby may be experiencing distress, or show other indicators of non-reassuring fetal status during labor, an emergency C-section is almost always necessary to remove the baby from the womb as soon as possible. In fact, pregnant mothers should start monitoring the baby's movements from the seventh month of pregnancy onwards.

"Generally, babies in the womb should move at least 10 times a day," she says. An unusually quiet spell warrants a check with your doctor. A C-section may be necessary in life-threatening medical emergencies, such as placental abruption (abruptio) when the placenta separates from the uterine wall before the baby is born. Warns the doctor: "This can be sudden and unexpected, potentially endangering the lives of the baby and mother.

When this happens, the mother will often present with a sudden onset of intense and unremitting abdominal pain. This may or may not be associated with bleeding from the vagina. This is an obstetric emergency and the mother must go to the hospital immediately." pregnant women are advised to go to the hospital immediately once their water bag bursts.

While most parents-to-be accept the urgency and necessity of an emergency C-section in life-saving circumstances, there are still fears that plague women who suddenly find themselves in this situation. One of the most common worries patients have about having a Caesarean section is that it will be very painful. Says Dr Wong: "It doesn't hurt because there will be sufficient pain relief to ensure you are kept comfortable. In fact, the great majority of patients get out of bed the next day after a C-section."

There are two types of anaesthesia for a C-section operation: General, where the patient is asleep during the operation and regional, where the patient, is awake during the operation. In this case, the patient is numbed, usually with an epidural, from the waist down so she experiences no pain during the procedure. "During labour, you can opt for an epidural analgesia. If you are unable to have a vaginal delivery, and subsequently require an emergency C-section, this can be carried out under epidural as well," says Dr Wong.

Yvonne had the surgery performed under an epidural so that she would be conscious when her baby finally arrived. "Since I could not deliver naturally, the least I could do was to stay awake while they took my baby out. It was important to me that I was conscious when she entered the world."

What To Know If It Happens To You. Can I Wait And See Before Deciding On A Emergency C-Section?

There are some circumstances under which a mother can wait and see before deciding on an emergency C-section. Says Dr Wong, "One example is when labor progress is poor, but the mother wants to wait a little longer rather than opting for an emergency C-section straight away. As long as the baby's condition is reassuring and the mother is not in jeopardy, she can wait a little longer. However, it is certainly best to discuss this with your obstetrician."

What Is A C-Section Operation?

Even if you're awake during the operation, there will be a sheet blocking your view. Here's what's going on behind the curtain: The moss common incision used is a horizontal incision made low on the abdomen, near the pubic hair line. The uterine wall is opened, the membranes ruptured and the baby delivered. The umbilical cord is cut, the placenta is removed and the uterine wall closed. The operation itself usually takes no more than an hour. In an emergency, the baby may be delivered within minutes from the skin incision.

What Is The Recovery Like?

A mother who has delivered by C-section stays a few extra days in hospital. "After a Caesarean section, mothers are advised to gradually bend and stretch their legs to prevent deep vein thrombosis (also known as 'economy class syndrome'). They are also advised to sit out of bed and start ambulation the next day,' says Dr Wong.

The mother must return for a check-up one month after discharge, to check on the wound healing, as well as to do a Pap smear. For the next few weeks, she should focus on caring for herself, as well as the baby, and get plenty of rest to recover from the surgery. There may be numbness around the incision as certain superficial nerves in the skin may have been cut.

These should regenerate over the next six to nine months. The incision site may sometimes be uncomfortable especially when the mother coughs, laughs or sneezes. She can help ease the discomfort by pressing a pillow gently against the wound when she coughs, laughs or sneezes.

Will My Baby Have To Stay In Hospital Longer If He Or She Was Delivered Via Emergency C-Section?

Not necessarily. Explains Dr Wong: "It depends on the maturity of the baby (premature babies stay longer) and the reason for the emergency Caesarean section:"

Will I Have To Have C-Section Delivers For Subsequent Pregnancies?

Probably not. Many women can have a vaginal delivery after a C-section. Says Dr Wong: "After one previous uncomplicated lower segment Caesarean section, you have about a 70 per cent chance of a vaginal delivery the next time." However, if you have had two previous Caesarean sections, then you will need an elective C-section the next time you deliver. The maximum recommended number of procedures a woman can have is three.


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