For medical reasons, your doctor has recommended a cesarean (c-section) delivery. Whether planned or a decision that’s made during the labor process, Texas Health Resources wants to help moms-to-be understand what to expect during this major surgery.
Getting expectant mothers emotionally and physically prepared for the procedure is a role that Jill Johnson, RN, MSN, LCCE, IBCLC, childbirth education coordinator at Texas Health Presbyterian Hospital Dallas, knows well. Here, she provides some insights on all things cesarean beginning with the pre-surgery activities that commonly take place.
“The preparation process can vary depending on why you are having a c-section but typically pre-op consists of the cleansing and sterilizing of the abdominal surgical area, the placement of a catheter tube into your bladder to collect urine and the placement of an IV in your hand or arm to provide fluid and medication,” Johnson said. “You might be given an antacid as well, to reduce the risk of an upset stomach during the procedure and you will be hooked up to a monitor that will continuously report vital signs such as blood pressure and heart rate to the attending staff throughout the surgery.”
Most c-sections are done under regional anesthesia, which numbs only the lower part of your body, allowing you to remain awake during the procedure. A common choice is a spinal epidural, which effectively delivers pain relief medication directly to the fluid area that surrounds the spinal cord.
“To prepare for an epidural insertion, part of the lower back will be cleaned and sterilized with antiseptic. The anesthesiologist will have you sit on the side of the bed and lean over with the help of a support person or nurse so that an epidural catheter may be placed and secured with tape. Numbing medication will be delivered through the epidural catheter for as long as needed. Most moms find that the medication becomes fully effective in about 10 to 20 minutes,” Johnson said.
On To Surgery
In the operating room, your designated support person will suit up in scrubs and a mask in preparation for accompanying you through the procedure. According to Johnson, the role of the support person during a cesarean delivery is just as important as the role of a significant other during a vaginal birth.
“Whether the cesarean birth was planned or not, you will need verbal reassurance and moral support during the birth. This is where your support person becomes so important. This person will be seated at the head of the table next to you and a drape will be pulled across your midsection so that in addition to not feeling the procedure, you won’t see it either. In many hospitals, moms do have the choice to request a gentle c-section which means you can have a clear drape through which to view the birth,” Johnson said.
So what happens on the other side of the drape? Garrett Garner, M.D., an OB/GYN at Northlake Obstetrics & Gynecology and a member of the medical staff at Texas Health Presbyterian Hospital Plano, provided this additional insight: “You’re likely to hear a fair amount of activity in the room: a scrub nurse, another nurse or two, the anesthesiologist, your obstetrician and perhaps a pediatrician. The obstetrician will make an incision in your abdomen about as long as your middle finger and then more internal incisions to allow for baby’s delivery. Your doctor will clear your baby’s mouth and nose of fluids once delivered, then clamp and cut the umbilical cord. The placenta will be removed from your uterus and the incisions will be closed with sutures. The entire procedure generally takes less than an hour.”
A recovery room will be home to you and your newborn for the first 2 hours after surgery. During this time, your pain level and vital signs will continue to be monitored by the Labor & Delivery (L&D) nursing staff. Pain management is an important part of the recovery process and oral pain medication may be offered once the epidural is removed.
“During the recovery-room period, we also encourage moms to initiate skin-to-skin contact with their babies to begin the bonding process,” Johnson said. “Your bedside nurse will stay with you in L&D until you are transferred to a postpartum room to continue your recovery for several more days. You will be encouraged to get up and walk around soon after your c-section to help promote healing and prevent constipation and potential blood clots. Your bedside nurse will be on hand to support you through breastfeeding as well, or to facilitate a meeting with a lactation consultant if needed.”
As with any major surgical procedure, there can be some side effects. With a cesarean, you might experience shivering, backache, soreness or itching where the epidural was inserted, nausea and/or some postpartum swelling. Johnson noted that the most common side effect is a headache that can result from the use of anesthesia. Oral pain medications and a 24-hour liquid diet are often prescribed to alleviate the side effects and get mom on her way to recovery.