What Happens in a Cesarean Section?

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Cesarean Section

You have waited all of these weeks. Your partner has waited too, and he has learned about the birthing process. You may even have attended birthing classes together, so you have learned to breathe, push, and relax. But now, your obstetrician breaks the news. You need to delivery your baby surgically. The procedure is called a cesarean section –“C-section” or “C/S” for short. Despite urban myth, the procedure is not named for the Roman leader Julius Caesar, but his name and the operation both come from the same root, the Latin word for cut. They will be cutting an incision through your abdomen, then through the muscles that comprise the bulk of the wall of the uterus where the fetus is developing.

Most likely –almost certainly, if the C-section is planned—the surgical approach will be through a low transverse incision, what most people know it as a ‘bikini cut’, since it runs horizontally around the same level where many bikinis reach. Sometimes, for a premature infant, the obstetrician will make vertical incision instead, and there are two kinds. There is a low vertical incision, which starts around the same level as a low transverse, but running up and down, instead of side to side. Also, there is a classical incision, which means vertical, but higher up the abdomen compared with the low vertical. The classical incision can be extended longer than the low vertical and gives the surgeon quick access to the womb, which could be critical in an extreme emergency, or placenta previa if the placenta is blocking the low region where the transverse cut would go.

Similar to the Julius Caesar myth, there is also an historical misconception that surgeons learned and performed the classical approach, before the transverse approach. After all, it is called “classical” and it seems logical that surgeons would try this route first. It may very well be that vertical incision was more common in the early days, but as I learned from interviewing medical historian Dr. Stanley Burns last year in connection with the Cinemax television series The Knick (about surgery at the turn of the 20th century), there were no standards for surgical procedures in the time period when C-section emerged as a procedure that save both mother and child. Prior to the 20th century, and probably back to antiquity, it was possible for a surgeon to enter the womb and get the baby out alive, but without saving the mother, though in many cases, the fetus died as well. The early 20th century is when surgeons experimented with C-section, finally achieving the ability to save both mother and child. Working toward this goal, they used more than one kind of incision, a conclusion that is supported by photographic evidence taken during operations.

Over the course of time, the C-section procedure has become very routine and safe. Compared with vaginal birth, C-section actually offers certain advantages, which we will cover in a future post. As with vaginal birth, you can be awake as your child enters the world, so in the even that you need a C-section, don’t worry. Everything will be fine.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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