MoonDragon's Women's Health Procedures Information
(Surgical Delivery of Infant)
For "Informational Use Only".
For more detailed information, contact your health care provider
about options that may be available for your specific situation.
Cesarean Delivery Description Reasons For Cesarean Procedure Cesarean Procedure Risk Factors Cesarean Procedure Description Cesarean Expected Outcome Cesarean Complications Tips & Treatments Cesarean Post Procedure Care Medication Activity Recommendations & Restrictions Diet & Nutrition Notify Your Health Care Provider Recommended Nutritional Products
CESAREAN DELIVERY DESCRIPTION
A cesarean section is the delivery of a baby through an incision in the mother's lower abdominal and uterine walls.
REASONS FOR CESAREAN PROCEDURE
A Cesarean is usually performed when there is danger to the mother or baby from one or more of may causes, including:
Baby's head too large to pass through the birth canal (cephalopelvic disproportion).
This is actually very uncommon unless the mother has a serious pelvic deformity caused by disease or fracture, small maternal bone structure and pelvis, or possibly a fetal deformity that may prevent the head (or body) from engaging into the pelvic region. More commonly found is the baby's head may need to be "readjusted slightly" [asynclitic] to present a more favorable presentation and/or better pressure on the dilating cervix. The baby may need to be rotated around from facing forward (facing the mother's pubic bone) to facing backward (facing the mother's tailbone-sacrum) in a posterior to anterior rotation. More often this diagnosis is made when medical staff gets bored or impatient with a long labor and decide to remedy the problem with a cesarean delivery.
Baby in the wrong presentation to pass through the birth canal. This could include breech presentation (butt-first), transverse lie (crossways, shoulder first), posterior presentation (head down facing toward the mother's pubic bone), face presentation (face first), multiple births (twins, triplets or more - one or more of the multiples may be in a breech or other unfavorable position for vaginal delivery).
Some practitioners would believe that this is any position but a head-down-facing-backward [vertex-occiput-anterior] presentation. Breeches and occiput-posterior [forward-facing-head-down] would be in this category. Other practitioners would state that if the baby is in a vertical position [up and down, whether it be head first or butt first in a breech presentation] it can be birthed vaginally, sometimes with a little skill and lots of patience on the part of both the mother and the practitioner. The only true malpresentation with this latter point-of-view would be a shoulder presentation where the baby is laying crossways in a horizontal position [transverse lie]. Another exception is a labor that has been allowed to progress too far, wedging a baby into a malpresentation [getting stuck] to prevent any readjustment of the baby's position. This may happen when twins become "locked together" and unable for either of the babies to be able to move down into the birth canal. Another case would be when a baby might have an arm positioned in front of (above) the head, preventing the descent of the baby into the birth canal or inadequate pressure on the cervix for dilation. Sometimes, this can be remedied by the practitioner internally moving the arm (or other malpositioned body part) out of the way to allow the baby to present normally.
MoonDragon's Pregnancy Information: Twins
Cord prolapse. This may occur with a breech position (or other malposition) position when the amniotic bag breaks releasing amniotic fluid and the cord. The amniotic fluid flows out and the cord may drop down through the dilated cervix into the vaginal area and possible even falling out past the vaginal opening into the outside of the mother's body. This may result in fetal distress as the cord is exposed to air and/or compressed by the baby's presenting body part. This is an emergency situation with immediate attention and surgery needed to deliver the infant.
Insufficient or inadequate strength of the contractions of the uterus.
Allowing the mother to become undernourished and exhausted is a major cause of this problem. Also inducing a labor before the mother and baby are ready to go through the birth process may cause this problem. The mother needs to be "ripe" with a cervix that is ready to dilate. She also needs to be kept well hydrated and nourished through out her labor. Something which many medical institutions still deny their mothers. Sometimes getting up and walking around, changing positions, taking a warm shower or bath and introducing other relaxation techniques may help a labor that has slowed down. Even having the mother take a break and get some sleep helps to remedy exhaustion. Other techniques are nipple stimulation and simple "loving" between the mother and her partner, releasing hormones that will stimulate labor.
Abnormal placenta location (partial or complete) obstructing the birth canal (placenta previa).
This can be a medical emergency if allowed to progress possibly causing hemorrhage in the mother and possible hypoxia (lack of oxygen) to the baby, resulting in brain damage or fetal death and life-threatening volemic shock for the mother.
MoonDragon's Pregnancy Information: Placenta Previa
Placenta breaks away from uterus (partially or completely) resulting in maternal hemorrhage and possible serious fetal distress (depending on how much of the placenta has become detached). Death can quickly occur for mother and infant if not attended to by emergency surgical team. This is known as placental abruption.
MoonDragon's Pregnancy Information: Placenta Abruption
Failure of normal labor in a patient who had a previous cesarean section.
Unless there is a physical-medical reason for this problem, the problem may be an emotional one with the mother resulting from her previous negative experience with birth and her cesarean. If this is the case, it will take a great deal of emotional, physical, and psychological support from all of her birth attendants and her family for her to overcome her fears and lack of confidence in herself and her body.
Fetal Distress (necessitating immediate delivery).
True fetal distress is not a common experience in healthy moms and healthy babies. Fetal distress may be caused from a cord tightly wrapped around the baby's neck, knots in the cord, or a long and difficult labor causing excessive stress on both mother and baby. Sick babies or babies addicted to drugs, etc., are another story... these can have serious problems and need to be monitored carefully.
Careful monitoring of the mother and baby during labor using non-intrusive hands-on methods (taking fetal heart tones with a fetoscope, for instance) of assessment are more reliable that being hooked up to an electronic fetal monitor (which are notorious for inaccuracies). Sometimes fetal distress may be a result of medical intervention, such as drugs given for pain relief that cross the placenta (and they all do!...none of them are totally safe for the mother or the baby!), maternal stress and fear, maternal positioning, lack of maternal nutrition during labor resulting in lowered blood glucose for mom and baby), fetal monitoring (especially the internal monitor that screws into the fetal scalp... this would send me into distress!), labor augmentation using pitocin causing overstimulated labor contractions.
Acute herpes genitalis infection.
Any active outbreak that could come in contact with the baby during the birth process is usually considered a contraindication for a vaginal birth. Everything should be tried to prevent an outbreak at the time of birth, or to clear one up prior to birth.
MoonDragon's STD Information: Genital Herpes
There are some unscrupulous surgeons encourage normal, healthy moms delivering normal, healthy babies to "choose" a cesarean delivery instead of a vaginal delivery for their babies. Cesareans are major abdominal surgeries that have all the risks involved with them as any other major surgery. Unless there is a real need for a surgical delivery, they should be avoided. The current 30 percent cesarean national rate is much too high and may have more to do with avoiding malpractice lawsuits than it does with actual emergencies resulting in the need for a cesarean surgical delivery.
The decision about whether to have a vaginal birth or a cesarean section can impact the mother and her baby in many ways. It is essential that expectant women and their partners understand the expected benefits along with the full range of possible risks to both the mother and the baby.
The information required to make an informed decision covers a broad range of outcomes - physical as well as emotional aspects effecting mothers and infants. Short and long term risks for the mother and baby need to be reviewed when making decisions, which includes the possibility of any future pregnancies.
Even if the mother does not plan on having any more children, she should be aware of the risks for future pregnancies. Many women change their mind about becoming pregnant again or decide to continue with an unplanned pregnancy.
Why Does the National U.S. Cesarean Section Rate Keep Going Up?
(For more valuable information regarding Cesareans and Childbirth, please feel free to visit their website.)
Recent studies reaffirm earlier World Health Organization recommendations about optimal cesarean section rates. The best outcomes for mothers and babies appear to occur with cesarean section rates of 5 to 10 percent. Rates above 15 percent seem to do more harm than good (Althabe and Belizan 2006).
The national U.S. cesarean section rate was 4.5 percent and near this optimal range in 1965 when it was first measured (Taffel et al. 1987). In more recent years, large groups of healthy, low-risk American women who have received care that enhanced their bodies' innate capacity for giving birth have achieved 4 percent cesarean section rates and good overall birth outcomes (Johnson and Daviss 2005, Rooks et al. 1989). However, the national cesarean section rate is much higher and has been increasing steadily over the past decade. When a national rate is available for 2007, we will find that about one mother in three is now giving birth by c-section, a record level for the United States.
Most mothers are healthy and have good reason to anticipate uncomplicated childbirth. Cesarean section is major surgery and increases the likelihood of many short- and longer-term adverse effects for mothers and babies (some of these harms are listed below). There are clear, authoritative recommendations for more judicious use of this procedure (U.S. Department of Health and Human Services 2000).
So why does a pregnant woman's chance of having a cesarean section keep going up?
TWO MYTHS ABOUT THE RISING CESAREAN SECTION RATE
To explain this steady rise, health professionals and journalists often point the spotlight on mothers themselves. Many assume that leading factors in the trend are: 1) more and more women are asking for c-sections that have no medical rationale, and 2) the number of women who genuinely need a cesarean is increasing. Neither appears to account for a large portion of the increase.
Despite a lot of talk about "maternal request" cesareans, few women appear to be taking this step. Childbirth Connection's national Listening to Mothers survey of women who gave birth in hospitals in 2005 was the first study to poll women about these decisions in the United States. When we asked mothers who had a cesarean why they had it and who had initiated it, just one woman among nearly 1600 survey participants reported that she had a planned first c-section with no medical reason at her own request (Declercq et al. 2006a). Those who have looked at this question in other countries have found similar results (McCourt et al. 2007).
Many have also pointed to changes in the population of childbearing women, such as more older women who have developed medical conditions and more women with extra challenges of multiple births. While there are some overall changes in this population, researchers have found that cesarean section rates are going up for all groups of birthing women, regardless of age, the number of babies they are having, the extent of health problems, their race/ethnicity, or other breakdowns (Declercq et al. 2006b). In other words, there is a change in practice standards that reflects an increasing willingness on the part of professionals to follow the cesarean path under all conditions. In fact, one quarter of the Listening to Mothers survey participants who had cesareans reported that they had experienced pressure from a health professional to have a cesarean (Declercq et al. 2006a).
REASONS FOR THE RISING CESAREAN SECTION RATE
The following interconnected factors appear to be pushing the cesarean rate upward.
- Low priority of enhancing women's own abilities to give birth - Care that supports physiologic labor, such as providing continuous support during labor through a doula or other companion and using hands-to-belly movements to turn a breech (buttocks- or feet-first) baby to a head-first position, reduces the likelihood of a cesarean section. The decision to switch to cesarean is often made when caregivers could use watchful waiting, positioning and movement, comfort measures, oral nourishment and other approaches to facilitating labor progress. The cesarean section rate could be greatly lowered through such care.
- Side effects of common labor interventions - Current research suggests that some labor interventions make a c-section more likely. For example, labor induction among first-time mothers when the cervix is not soft and ready to open appears to increase the likelihood of cesarean birth. Continuous electronic fetal monitoring has been associated with greater likelihood of a cesarean. Having an epidural early in labor or without a high-dose boost of synthetic oxytocin ("Pitocin") seems to increase the likelihood of a c-section.
- Refusal to offer the informed choice of vaginal birth - Many health professionals and/or hospitals are unwilling to offer the informed choice of vaginal birth to women in certain circumstances. The Listening to Mothers survey found that many women with a previous cesarean would have liked the option of a vaginal birth after cesarean (VBAC) but did not have it because health professionals and/or hospitals were unwilling (Declercq et al. 2006a). Nine out of ten women with a previous cesarean section are having repeat cesareans in the current environment. Similarly, few women with a fetus in a breech position have the option to plan a vaginal birth.
- Casual attitudes about surgery and cesarean sections in particular - Our society is more tolerant than ever of surgical procedures, even when not medically needed. This is reflected in the comfort level that many health professionals, insurance plans, hospital administrators and women themselves have with cesarean trends.
- Limited awareness of harms that are more likely with cesarean section - Cesarean section is a major surgical procedure that increases the likelihood of many types of harm for mothers and babies in comparison with vaginal birth. Short-term harms for mothers include increased risk of infection, surgical injury, blood clots, emergency hysterectomy, intense and longer-lasting pain, going back into the hospital and poor overall functioning. Babies born by cesarean section are more likely to have surgical cuts, breathing problems, difficulty getting breastfeeding going, and asthma in childhood and beyond. Perhaps due to the common surgical side effect of "adhesion" formation, cesarean mothers are more likely to have ongoing pelvic pain, to experience bowel blockage, to be injured during future surgery, and to have future infertility. Of special concern after cesarean are various serious conditions for mothers and babies that are more likely in future pregnancies, including ectopic pregnancy, placenta previa, placenta accreta, placental abruption, and uterine rupture (Childbirth Connection 2006).
- Providers' fears of malpractice claims and lawsuits - Given the way that our legal, liability insurance, and health insurance systems work, caregivers may feel that performing a cesarean reduces their risk of being sued or losing a lawsuit, even when vaginal birth is optimal care.
- Incentives to practice in a manner that is efficient for providers - Many health professionals are feeling squeezed by tightened payments for services and increasing practice expenses. The flat "global fee" method of paying for childbirth does not provide any extra pay for providers who patiently support a longer vaginal birth. Some payment schedules pay more for cesarean than vaginal birth. A planned cesarean section is an especially efficient way for professionals to organize hospital work, office work and personal life. Average hospital charges are much greater for cesarean than vaginal birth, and may offer hospitals greater scope for profit.
All of these factors contribute to a current national cesarean section rate of over 30 percent, despite evidence that a rate of 5 to 10 percent would be optimal.
Althabe F, Belizan JF. Caesarean section: The paradox. The Lancet 2006;368:1472-3.
Childbirth Connection. What Every Pregnant Woman Should Know About Cesarean Section, 2nd ed. New York: Childbirth Connection, December 2006. Available at www.childbirthconnection.org/cesareanbooklet/.
Declercq ER, Sakala C, Corry MP, Applebaum S. Listening to Mothers II: The Second National U.S. Survey of Women's Childbearing Experiences. New York: Childbirth Connection, October 2006a. Available at www.childbirthconnection.org/listeningtomothers/.
Declercq E, Menacker F, MacDorman M. Maternal risk profiles and the primary cesarean rate in the United States, 1991-2002. Am J Public Health 2006b;96:867-72.
Johnson KC, Daviss B-A. Outcomes of planned home births with certified professional midwives: Large prospective study in North America. BMJ 2005;220:1416. Available at www.bmj.com/cgi/content/full/330/7505/1416.
McCourt C, Weaver J, Statham H, Beake S, Gamble J, Creedy DK. Elective cesarean section and decision making: A critical review of the literature. Birth 2007;34:65-79. Available at www.blackwell-synergy.com/toc/bir/34/1.
Rooks JP, Weatherby NL, Ernst EK, Stapleton S, Rosen D, Rosenfield A. Outcomes of care in birth centers: The National Birth Center Study. New Engl J Med 1989;321:1804-11.
Taffel SM, Placek PJ, Liss T. Trends in the United States cesarean section rate and reasons for the 1980-85 rise. Am J Public Health 1987;77:955-9.
U.S. Department of Health and Human Services. Maternal, infant and child health. In: Healthy People 2010, 2nd ed. Washington DC: U.S. Government Printing Office, November 2000, pp. 16-30-31. [Objective 16-9] Available at www.healthypeople.gov/Document/tableofcontents.htm#Volume2.
A version of this article appears in the second edition of The New York Guide to a Healthy Birth (New York: Choices in Childbirth, 2007).
CESAREAN RISK FACTORS
Risk Factors that may increase the risk of a cesarean delivery:
- Prior cesarean section.
- Poor nutrition.
- Excess alcohol consumption.
- Placenta previa with excessive blood loss.
- Preeclampsia or eclampsia in pregnancy.
- Chronic heart or lung disease.
- Use of drugs, such as antihypertensives; cortisone; diuretics; or insulin.
- Use of mind-altering drugs.
VAGINAL BIRTH VS CESAREAN DELIVERY RISKS
A summary of various medical studies regarding the comparison of birth/delivery methods have been collected into two lists:
- 33 areas where cesarean section was found to involve more risk than vaginal birth.
- 4 areas where vaginal birth was found to involve more risk that cesarean section.
If a woman is considering a cesarean delivery, it is important to weight any benefits the surgery is expected to offer against the risks involved. The benefits may depend on the mother's specific situation and the reason why her health care provider or midwife may be recommending a cesarean instead of a vaginal delivery. It is important these issues are discussed with the health care provider or midwife.
CESAREAN SURGICAL RISKS & DISADVANTAGES
There are extra risks associated with cesareans. Current research suggests that cesarean section has the following disadvantages in comparison with vaginal birth:
- Physical Problems In Mothers: Compared with vaginal birth, a cesarean delivery increases a woman's risk for a number of physical problems. These range from less common but potentially life-threatening problems including:
- Hemorrhage (severe bleeding).
- Blood clots.
- Bowel obstruction.
To much more common concerns such as:
- Longer-lasting and more severe pain and infection.
- Scarring and adhesion tissue increasing the risk for ongoing pelvic pain and for twisted bowel.
- Hospitalization of Mothers: If a woman has a cesarean, she is more likely to stay in the hospital longer and is at greater risk of being re-hospitalized.
- Emotional Well-being Of Mothers: A woman who has a cesarean delivery may be at greater risk for poorer overall mental health and some emotional problems. She is also more likely to rate her birth experience poorer than a woman who has had a vaginal birth.
- Early Contact With, Feelings Toward Babies: A woman who has a cesarean usually has less early contact with her baby and is more likely to have initial negative feelings about her baby. Interference with mother-infant bond may be a problem.
- Breastfeeding: Recovery from surgery poses challenges for getting breastfeeding initiated and established. A baby born by cesarean is less likely to be breastfed and get the benefits of breastfeeding.
- Health of Babies: Babies born by cesarean are more likely to:
- Be Cut during the surgery (usually minor).
- Have Difficult Breathing Problems around the time of the birth.
- Experience Asthma in childhood and in adulthood.
- Future Reproductive Problems for Mothers: A cesarean in the current pregnancy puts a woman at risk for future reproductive problems in comparison with a woman who has had a vaginal birth. These problems may involve serious complications and medical emergencies. The likelihood of experiencing some of these conditions goes up sharply as the mother of previous cesareans increases. These problems include:
- Ectopic Pregnancy: These are pregnancies that develop outside the uterus or within the scar.
- Reduced Fertility: Due to either less ability to become pregnant again or less desire to become pregnant again.
- Placenta Previa: The placenta attaches near or over the opening of the cervix.
- Placenta Accreta: The Placenta grows through the lining of the uterus and into or through the muscle of the uterus.
- Placenta Abruption: The placenta detaches from the uterus before the baby is born.
- Concerns About Babies In Future Pregnancies: A cesarean in the current pregnancy can affect the babies of future pregnancies. Studies have found that they are more likely to:
- Be Born Too Early: Preterm or premature birth.
- Weigh Less Than Normal: Low birthweight for their gestational age.
- Have A Physical Abnormality or Injury: Injury to the infant's brain or spinal cord.
- Death: Infant death before or shortly after the birth.
- Planned Cesarean Compared With Unplanned Cesarean: A planned cesarean offers some advantages over an unplanned cesarean (a cesarean that occurs after labor is initiated). An example may be fewer surgical injuries and fewer infections. The emotional impact of a cesarean that is planned in advance appears to be similar to or somewhat worse than a vaginal birth. By contrast, unplanned cesareans can take a greater emotional toll.
- Planned Cesarean Compared With Vaginal Birth: A planned cesarean still involves the risks associated with major surgery. And both planned and unplanned cesareans result in a uterine scar and internal scarring (adhesions). This means women with planned and unplanned cesareans face similar risks in future pregnancies and for problems related to scarring and adhesions at any time.
VAGINAL BIRTH RISKS & DISADVANTAGES
Extra Risks Associated With Vaginal Birth: In a few areas, mothers or babies with vaginal birth have poorer outcomes in comparison with cesarean birth.
- Perineal Pain: While a woman with a cesarean birth is more likely to experience more intense and longer-lasting pain overall, a woman with a vaginal birth is more likely to experience pain in the vaginal area in the weeks and months after birth.
- Incontinence: A woman with a vaginal birth is more likely to leak urine (urinary incontinence) and to leak gas or, more rarely, feces (bowel incontinence). Pregnancy itself and other factors such as the woman's weight play a role in these problems. Few women experience troubling symptoms beyond the recovery period in the weeks and months after birth.
- Nerve Injury In Babies: In comparison with a baby born by cesarean section, a baby who is born vaginally is more likely to have a nerve injury that affects the shoulder, arm or hand. (Nerve injuries are often related to the inappropriate use or misuse of forceps or other mismanagement during an assisted delivery by an unskilled practitioner.)
Relationship between care during birth and pelvic floor problems: More and more research finds that some practices used at the time of pushing increase the likelihood of pelvic floor injury. Many women experience one or more of these during vaginal birth. You can lower your risk by choosing a caregiver and birth setting with low rates of intervention. These practices include:
- Cutting an episiotomy.
- Using vacuum extraction or forceps to help bring the baby out.
- Having women give birth while lying on their backs.
- Using caregiver-directed pushing, which is often more forceful than having the woman and her own reflexes guide pushing.
- Pressing on the woman's abdomen to help move the baby out.
Of hundreds of studies examined to compare vaginal and cesarean birth, not one attempted to avoid or limit the use of practices that can injure a woman's pelvic floor to try to determine whether vaginal birth itself is responsible. It is wrong to conclude at this time that the cause of pelvic floor problems is giving birth through the vagina.
MoonDragon's Procedures: Kegel Exercises for Strengthening Pelvic Floor Muscles
PHYSICAL EFFECTS OF CESAREANS
There are some concerns about physical effects of cesareans on mothers around the time of birth and having a cesarean section rather than a vaginal birth increases risk for the following problems:
Maternal Death : Some studies found that cesarean surgery itself, not any problems that led to surgery, appeared to cause additional maternal deaths compared with vaginal birth. The risk and likelihood for a woman with a cesarean is LOW to VERY LOW for maternal death (1-9 to less than 1 of every 10,000 mothers).
Emergency Hysterectomy: A woman with a cesarean is more likely than a woman with vaginal birth to have emergency surgery to remove her uterus (hysterectomy) in the early weeks after birth. The added likelihood for a woman with a cesarean is MODERATE for emergency hysterectomy (10-99 of every 10,000 mothers).
Blood Clots & Stroke: A woman with a cesarean appears to be more likely than a woman with vaginal birth to have blood clots, including clots blocking blood vessels in the lungs (pulmonary embolism) and blocking blood flow to the brain (stroke). The added likelihood for a woman with a cesarean is LOW for blood clots and stroke (1-9 of every 10,000 mothers).
Injuries From Surgery: All women who have a cesarean have a wound; a woman with a cesarean may also be injured from accidental cuts to nearby organs such as the bladder or bowel or ureter (the tube that carries urine from the kidney to the bladder), especially if the surgery is done in haste. The added likelihood for a woman with a cesarean is VERY HIGH for abdominal wound (1,000-10,000 of every 10,000 mothers). The added likelihood of accidental cuts from surgery cannot be determined from the studies examined.
Longer Time In Hospital: A woman who has a cesarean usually stays in the hospital a day or two longer than a woman who has a vaginal birth for post-operative monitoring and care, and this stay may be extended if she has complications. The added likelihood for a woman with a cesarean is VERY HIGH for a longer time in the hospital (1,000-10,000 of every 10,000 mothers).
Going Back Into The Hospital: A woman who has a cesarean is more likely than a woman with vaginal birth to be re-admitted to the hospital in the weeks after birth. The added likelihood for a woman with a cesarean is MODERATE for going back to the hospital (10-99 of every 10,000 mothers).
Infection: A woman with a cesarean is at risk for wound infection and may be much more likely than a woman with vaginal birth to have an infected uterus; women with a cesarean generally receive routine antibiotics to try to prevent infection. The added likelihood for a woman with a cesarean is HIGH for infection (100-999 of every 10,000 mothers).
Pain: In the first days and weeks after birth, a woman who has had a cesarean is likely to have more intense and longer-lasting pain than a woman with vaginal birth; most women with a cesarean use pain medication after birth and consider pain at the cesarean wound to be a problem. The added likelihood for a woman with a cesarean is VERY HIGH for more severe and longer-lasting pain (1,000-10,000 of every 10,000 mothers).
PSYCHOLOGICAL EFFECTS OF CESAREANS
There are some concerns about psychological effects of cesareans on mothers around the time of birth. Having a cesarean section rather than a vaginal birth increases risk for the following problems:
Poor Birth Experience: A woman with a cesarean tends to give lower ratings to her birth experience than a woman with a vaginal birth, both early on and over time; she may be less likely to have her partner or other support people present; and to feel that she had control. The added likelihood for a woman with a cesarean is VERY HIGH to HIGH for poor birth experience (1,000-10,000 to 100-999 of every 10,000 mothers). Unplanned cesarean is worse than planned cesarean. Vaginal birth with vacuum extraction or forceps is worse than vaginal birth without these procedures.
Maternal-Infant Bonding: There is less early contact with her baby. A Woman with a cesarean is less likely to see and hold her baby soon after birth than a woman with vaginal birth. The added likelihood for a woman with a cesarean is VERY HIGH for seeing and holding the baby later (1,000-10,000 of every 10,000 mothers).
Unfavorable Early Reaction To Her Baby: Early on, a woman with a cesarean is more likely to have negative feelings about her baby and to evaluate her baby less favorably than a woman with vaginal birth. The added likelihood for unfavorable early reaction to babies cannot be determined from studies examined.
Depression: A woman who has had a cesarean may be at higher risk for depression than a woman with vaginal birth. Current evidence is mixed on whether cesarean increases likelihood of depression.
MoonDragon's Pregnancy Information: Postpartum Depression
Psychological Trauma: A woman who has an unplanned cesarean during labor is at higher risk than other mothers for having traumatic symptoms (such as fear and anxiety) and for meeting criteria of Post-Traumatic Stress Disorder (PTSD). The added likelihood for a woman with an unplanned cesarean is HIGH for having traumatic symptoms and for meeting criteria of PTSD. Unplanned cesarean or vaginal birth with vacuum extraction or forceps pose HIGH extra risk in comparison with planned cesarean or vaginal birth with no vacuum/forceps (100-999 of every 10,000 mothers).
Poor Overall Mental Health & Self-Esteem: A woman who has a cesarean section may be at greater risk for poorer overall mental health and lower self-esteem than a woman with vaginal birth. The added likelihood for poor overall mental health and self-esteem cannot be determined from studies examined.
Poor Overall Functioning: A woman who has a cesarean section may face greater challenges than a woman with vaginal birth for physical and social functioning and carrying out daily activities in the early weeks after birth. The added likelihood for poor overall functioning cannot be determined from studies examined.
LONG TERM EFFECTS & CONCERNS OF CESAREANS ON MOTHERS
There are some concerns about ongoing effects of cesareans on mothers. Having a cesarean section rather than a vaginal birth increases risk for the following problems:
Ongoing Pelvic Pain: A woman who has had a cesarean may have ongoing pelvic pain, possibly due to scarring and the growth of adhesion tissue. The added likelihood for ongoing pelvic pain cannot be determined from studies examined.
Bowel Obstruction: A woman who has had a cesarean may develop twisted and blocked intestines in the years after surgery as a result of scarring and adhesion tissue in the abdomen. The added likelihood for a woman with a cesarean: MODERATE for bowel obstruction (10-99 of every 10,000 mothers).
CONCERNS & EFFECTS OF CESAREANS ON BABIES
When mothers experience physical or emotional problems as a result of a cesarean birth (see above), it may interfere with their ability to take care of their babies. In addition, having a cesarean section rather than a vaginal birth increases risk for the following problems in babies:
Surgical Cuts: A baby born by cesarean section may be accidentally cut (usually minor) during the surgery. The added likelihood for a baby born by cesarean is HIGH for accidental surgical cuts (100-999 of every 10,000 infants).
Respiratory Problems: A baby born by a planned cesarean before the 39th week of pregnancy is at higher risk for mild to serious lung and breathing problems than other babies born at the same time. The added likelihood for a baby born by cesarean is HIGH to MODERATE for respiratory problems with a planned cesarean before 39 weeks (100-999 to 10-99 of every 10,000 infants).
Not Breastfeeding: A mother who has had a cesarean faces extra challenges in getting breastfeeding under way, and her baby is less likely to be breastfed than a baby born vaginally. The added likelihood for a baby born by cesarean is VERY HIGH to HIGH for not breastfeeding (1,000-10,000 to 100-999 of every 10,000 infants).
Asthma: A person who is born by cesarean section appears to be at higher risk than a person born vaginally for asthma, both in childhood and in adulthood. The added likelihood for a person born by cesarean is HIGH for greater risk for asthma (100 to 999 of every 10,000 infants).
MoonDragon's Health & Wellness: Disorders - Asthma
CONCERNS & EFFECTS ON MOTHERS IN FUTURE PREGNANCIES & BIRTHS
All pregnant women should be aware of these risks. Many women who do not expect to have more children change their mind or decide to continue with an unplanned pregnancy. In future pregnancies, the placenta, embryo and fetus that grow in a uterus with a cesarean scar may not function as well as those that develop in an unscarred uterus. The likelihood of the following problems may increase as the number of previous cesareans increases. Having a cesarean section rather than a vaginal birth increases risk for the following problems for in future childbearing:
Infertility: A woman who has had a cesarean is more likely than a woman with a previous vaginal birth to have difficulty conceiving another baby and is less likely to ever have another baby. The added likelihood for a woman with a previous cesarean is VERY HIGH to HIGH for unchosen infertility (1,000-10,000 to 100-999 of every 10,000 mothers).
Reduced Fertility: A woman who has had a cesarean is more likely than a woman with a previous vaginal birth to have negative feelings and attitudes about childbirth, to decide not to have additional children, and to point to these feelings and attitudes as the reason for this decision. The added likelihood for a woman with a previous cesarean is HIGH for reduced fertility by choice (100-999 of every 10,000 mothers).
Maternal Death: In future pregnancies and births, a woman whose uterus has a cesarean scar is more likely than a woman with a previous vaginal birth to have life-threatening problems with the placenta and the scar. The added likelihood for a woman with a previous cesarean has not been measured well, may be VERY LOW for maternal death related to scar (less than 1 of every 10,000 mothers).
Ectopic Pregnancy: A woman whose uterus has a cesarean scar is more likely than a woman with an unscarred uterus to have an embryo grow outside her uterus, including a cesarean scar pregnancy; in such cases, the pregnancy must be ended to save her life, and she may have severe bleeding, emergency surgery, which may include emergency removal of her uterus (hysterectomy), and other complications. The added likelihood for a woman with a previous cesarean is MODERATE for ectopic pregnancy (10-99 of every 10,000 mothers).
MoonDragon's Pregnancy Information: Ectopic Pregnancy
Placenta Previa: A woman whose uterus has a cesarean scar is more likely than a woman with an unscarred uterus to have a future placenta attach near or over the opening to her cervix; this increases her risk for serious bleeding, shock, blood transfusion, blood clots, planned or emergency delivery, emergency removal of her uterus (hysterectomy), placenta accreta, and other complications. The added likelihood for a woman with a previous cesarean is MODERATE (10-99 of every 10,000 mothers) for placenta previa in a future pregnancy after having one cesarean; HIGH (100-999 of every 10,000 mothers) for placenta previa in a future pregnancy after having more than one cesarean.
MoonDragon's Pregnancy Information: Placenta Previa
Placenta Accreta: A woman whose uterus has a cesarean scar is more likely than a woman with an unscarred uterus to have a future placenta grow through the uterine lining and into or through the muscle of the uterus; this increases her risk for a ruptured uterus, serious bleeding, shock, blood transfusion, emergency surgery, emergency removal of her uterus (hysterectomy), and other complications. The added likelihood for a woman with at least one previous cesarean is MODERATE for placenta accreta in a future pregnancy (10-99 in every 10,000 mothers).
Placental Abruption: A woman whose uterus has a cesarean scar is more likely than a woman with an unscarred uterus to have a future placenta detach from her uterus before the baby is born; this increases her risk for severe bleeding, shock, blood transfusion, blood clots, planned or emergency cesarean delivery, and other complications, and it may reduce oxygen and nutrients to her baby. The added likelihood for a woman with a previous cesarean is MODERATE for placental abruption (10-99 of every 10,000 mothers).
MoonDragon's Pregnancy Information: Placenta Abruption
Uterine Rupture: A woman whose uterus has a cesarean scar is more likely than a woman with an unscarred uterus to have the wall of the uterus give way in a future pregnancy or labor, especially at the site of the scar; this increases her risk for severe bleeding, shock, blood transfusion, blood clots, planned or emergency cesarean delivery, emergency removal of the uterus (hysterectomy), and other complications; whether a woman plans a repeat cesarean or a VBAC (vaginal birth after cesarean), she is at greater risk for a ruptured uterus than a woman with no previous cesarean. The added likelihood for a woman with a previous cesarean is MODERATE for rupture of the uterus (10-99 of every 10,000 mothers).
CONCERNS & EFFECTS OF CESAREANS ON FUTURE BABIES
There are some concerns about effects of cesareans on future babies (when a baby grows in a uterus with a cesarean scar). A placenta that grows in a uterus with one or more scars from a previous cesarean section may not do as well at providing oxygen and nutrients to the developing fetus compared with a placenta growing in an unscarred uterus. This may cause life-threatening problems. The likelihood of the following problems may increase as the number of previous cesareans increases.
In comparison with a baby that develops in a uterus with no cesarean scar, a baby that develops in a uterus with a cesarean scar is at increased risk for the following problems:
Death: A baby who develops in a uterus with a cesarean scar appears to have an increased risk of dying before (stillbirth) or shortly after birth compared with a baby who develops in an unscarred uterus. The added likelihood for a baby who grows in a uterus with a cesarean scar is MODERATE for death of the baby (10-99 of every 10,000 infants).
Low birthweight & Preterm Birth: A baby who develops in a uterus with a cesarean scar may be at higher risk for being born too small (low birthweight) and for being born too soon (preterm birth) than a baby who develops in an unscarred uterus. The added likelihood for low birthweight and preterm birth cannot be determined from studies examined.
Malformation: A baby who develops in a uterus with a cesarean scar may be at higher risk for having a physical malformation that develops before birth than a baby who develops in an unscarred uterus. The added likelihood for malformation cannot be determined from studies examined.
Central Nervous System (CNS) Injury: A baby who develops in a uterus with a cesarean scar may be at higher risk for having a brain or spinal cord injury than a baby who develops in an unscarred uterus. The added likelihood for central nervous system injury cannot be determined from studies examined.
VAGINAL BIRTH EFFECTS & CONCERNS ON MOTHER
Having a vaginal birth rather than a cesarean section increases risk for the following problems:
Painful Vaginal Area: A woman who has a vaginal birth is more likely than a woman who has a cesarean to have a painful vaginal area in the weeks and months after birth. The added likelihood for a woman with vaginal birth: VERY HIGH (1,000-10,000 of every 10,000 mothers) for a painful perineum in the weeks and months after birth.
Urinary Incontinence: A woman who has a vaginal birth is more likely than a woman who has a cesarean to leak urine. The added likelihood for a woman with vaginal birth: depends on how this is defined, time elapsed since the birth, and procedures and practices used during vaginal birth.
Bowel Incontinence: A woman who has a vaginal birth is more likely than a woman who has a cesarean to have leakage of gas or, more rarely, of feces. The added likelihood for a woman with vaginal birth: depends on how this is defined, time elapsed since the birth, and procedures and practices used during vaginal birth.
CONCERNS & EFFECTS OF VAGINAL BIRTH ON BABIES
Vaginal birth poses the following risk for babies:
Birth Injury: in comparison with cesarean birth, a baby born by vaginal birth may be at higher risk for nerve injury affecting the shoulder, arm or hand (brachial plexus injury); although most of these injuries are temporary, some are permanent. The added likelihood for a baby born with vaginal birth is LOW for brachial plexus injury (1-9 of every 10,000 infants).
REFERENCE: Childbirth Connection. Comparing risks of cesarean and vaginal birth to mothers, babies, and future reproductive capacity: a systematic review. New York: Childbirth Connection, April 2004. The following study documents are available as PDF files from the Childbirth Connection website: description of methods and sources (including full bibliography), list of main questions and outcomes (a table of contents for evidence tables), first file of evidence tables, and second file of evidence tables.
Website: Childbirth Connection: Description of Methods & Resources (Including Full Bibliography)
DESCRIPTION OF CESAREAN PROCEDURE
An incision is made in the abdomen. Another incision is made in the uterus. Baby and placenta are removed. The uterus is closed and the abdominal contents are replaced. Connective tissue, muscles, and skin are closed. The skin is closed with sutures or clips, which usually can be removed about 1 week after surgery.
MoonDragon's Pregnancy Information: Cesarean Pictorial
MoonDragon's Pregnancy Information: Unexpected Cesarean
This is a graphic presentation of a cesarean surgical delivery. This is presented here as an informational educational tool for women who may be considering an elective cesarean delivery vs a vaginal birth. Again... this is major abdominal surgery!! This should ONLY be considered an option in a dire emergency when the baby or mother or both are at life-threatening risk. This should NEVER be a "routine" procedure for healthy moms and healthy babies.
YouTube: Cesarean (C-Section) Birth Animations
CESAREAN EXPECTED OUTCOME
No complications expected (but they often do occur... remember, this is MAJOR ABDOMINAL SURGERY!). Allow about 6 to 8 weeks for recovery from surgery.
CESAREAN POTENTIAL COMPLICATIONS
Excessive bleeding or surgical wound infection. Postoperative anemia. Endomyometritis (inflammation of lining and muscle of uterus).
This list will be added to as more research is gathered. See Risk Factors above.
TIPS & TREATMENT
Cesarean birth can be life saving for both mothers and unborn babies in a small proportion of situations, but for most women and babies at the end of pregnancy, the overall risks of surgical birth outweigh benefits. If you do not have a clear and compelling need for a cesarean, a vaginal birth is likely to be the safest and most satisfying option for you.
While there are no guarantees, if you want to have a vaginal birth, you can take steps to increase the likelihood of reaching this goal. Advance preparation in pregnancy can make all the difference. The most important things you can do may be to arrange for:
- A caregiver who shares your goals and has a conservative practice style.
- A birth setting with low rates of cesarean section and other labor interventions.
- Access to continuous labor support from a trained or experienced woman who will be available for you in labor.
Below you will find detailed guidance about these and many other tips. Most are clearly supported by high-quality research. Sometimes, though, you and your caregiver may have made an informed decision to plan a cesarean, and while you may plan a vaginal birth, no one can be sure what labor may bring. For these reasons, this page concludes with tips for having a safer and more satisfying cesarean birth.
WHEN PLANNING A VAGINAL BIRTH, BASIC TIPS TO USE DURING PREGNANCY TO INCREASE CHANCES FOR A VAGINAL BIRTH
- Find a health care provider or midwife with low rates of intervention: Some caregivers have much lower rates of intervention than others. Although there are many exceptions, family physicians tend to have lower rates than obstetricians, and midwives generally have the lowest rates of all. Styles of practice can also vary widely within each of these groups even when the women being cared for are at similar risk.
- Discuss your birth plan with your caregivers: Find out how they will work with you to meet your goals and preferences. If their response does not satisfy you and you have other options, seek a better match.
- Choose a birth setting with low overall rates of intervention: Some hospitals have far lower rates of intervention than others. In general, rates of intervention are much lower for out-of-hospital birth centers and at home births, compared with hospitals.
- Create your own birth statement: Writing down your values, preferences, and goals can help you clarify your own thinking and feelings. Moreover, this type of birth plan will prepare you to discuss these issues with your partner and your caregivers.
- Arrange for continuous labor support from someone with experience: Arrange for someone other than your partner to provide continuous support during labor. You can work with a trained labor support companion (doula) or invite a female friend or family member to be with you. If you decide to invite a friend or relative, try to choose someone experienced and comfortable with birth. Care that "mothers the mother" in this way lowers your risk for cesarean section (and for dissatisfaction with your birth experience). Having such a person with you can also help your partner by sharing the work and seeing that your partner's needs are also met.
- Explore your options for pain relief: Avoiding epidural analgesia can increase your chances for vaginal birth without vacuum extraction or forceps. If this is your goal, it would be wise to consider your options and make arrangements for other ways of coping with labor pain well before labor. Many women find that tubs, showers, large inflatable "birth balls" and other drug-free measures are quite helpful for comfort during labor. Doulas can offer many "comfort measures."
SPECIAL SITUATION TIPS DURING PREGNANCY TO CHANCES OF VAGINAL BIRTH
- If a cesarean is proposed and you're not in an urgent situation: Ask your caregivers about (1) what is involved in having cesarean surgery (2) the benefits that c-section is expected to offer in your case, (3) potential problems, and (4) pros and cons of vaginal birth and of waiting longer before deciding to have a cesarean. If you aren't in labor when the cesarean is proposed, you will probably have time to do your own research and talk things over with your partner and caregivers before making a decision.
- If you had a cesarean with a previous birth: Become informed about pros and cons of VBAC (vaginal birth after cesarean) versus repeat cesarean. Talk with your caregivers and do your own research to learn about the many issues. Although the research supports VBAC as a reasonable choice for nearly all women, you may have to search to find a caregiver and hospital that offer this option.
- If your baby is in a buttocks- or feet-first position (breech): First, ask your caregiver about turning the baby to a head-first position (external version) when you reach "term" (about the 37th week of pregnancy). Many babies can be safely turned and born head-first through the vagina. You may need to search to find a caregiver who has skills and experience with this hands-on-belly technique.
MoonDragon's Pregnancy Information: Breech Birth Presentation
MoonDragon's Pregnancy Information: Breech Birth At Home
MoonDragon's Pregnancy Information: Breech Birth At Hospital
MoonDragon's Pregnancy Information: Breech, How To Assist
MoonDragon's Pregnancy Information: Breech Turning Ideas
MoonDragon's Pregnancy Information: Breech Labor What To Expect
- If you are not able to get the baby turned to a head-first position, learn about the risks and benefits of planning a vaginal breech birth versus planning a cesarean. There are important advantages to cesarean in this situation in comparison with typical hospital ways of handling vaginal breech births, especially lower likelihood of death or serious problems with your baby. On the other hand, vaginal birth avoids the risks of surgery for mothers and babies in the present pregnancy and has many advantages for mothers and babies in future pregnancies. Be sure to talk your situation over with your caregiver before making your decision. If you make an informed decision to plan a vaginal breech birth, it may be difficult to find a caregiver who has skills and experience and will support you in this choice.
- If you wish to plan a cesarean due to an intense fear of childbirth: Consider a series of psychotherapy sessions with someone who is informed about childbirth and has good counseling skills. About half of the women with deep fears who undertake therapy are able to reduce their fears and plan a vaginal birth. If you are especially anxious or fearful, the continuous presence of a trained labor support companion (doula) during labor may make a big difference for you.
LABOR TIPS TO INCREASE CHANCES OF VAGINAL BIRTH
- Work with your caregivers to delay going to the hospital: If you are having a hospital birth and have no medical concerns that make hospital admission in early labor preferable, wait until you are in "active labor" with regular, well-established contractions and your cervix open (dilated) 4 to 5 centimeters. If you arrive before this, explore going home and returning later.
- Receive good support throughout labor: Support from a doula (trained labor companion), or a female friend or family member who is comfortable with birth, reduces the risk for cesarean section and for vaginal birth with vacuum extraction or forceps.
- Avoid continuous electronic fetal monitoring when possible: Continuous electronic fetal monitoring (EFM) increases the likelihood of cesarean section and of vaginal birth with use of vacuum extraction or forceps, with no clear benefit for babies. Talk with your caregiver and check hospital policies to find out whether they will check your baby's heart beats with a hand-held device or occasional use of EFM instead of continuous EFM. With some types of intervention that involve increased risk (for example, epidural analgesia), you may be required to use continuous EFM.
MoonDragon's Womens Health Procedures Information: Fetal Monitors
- Avoid routine use of medical interventions when possible: In addition to concerns about EFM, you can lower your chances of having a cesarean by avoiding whenever possible labor induction (use of drugs or techniques to try to start labor). Also be sure that your bag of waters is not broken by a caregiver (artificial rupture of membranes) before or in early labor. It is also good to avoid arbitrary time limits for your labor. There is no need to turn to a cesarean if you and your baby are doing well. Talk with your caregivers about these practices and how to avoid them.
- If a cesarean is proposed and you are not in an urgent situation: Ask your caregivers about (1) what is involved in having cesarean surgery (2) the benefits that c-section is expected to offer in your case, (3) potential problems, and (4) pros and cons of vaginal birth and of waiting longer before deciding to have a cesarean. You will want to consider any expected benefits of a cesarean along with results of research comparing risks of cesarean and vaginal birth.
MoonDragon's Pregnancy Information: Labor & Delivery - Vaginal Birth
TIPS FOR A SAFER CESAREAN DELIVERY
Discuss these options with your caregiver even if you plan vaginal birth. If an unexpected problem arises at the end of pregnancy or during labor, it may be much more difficult or impossible to obtain them.
- Schedule a planned cesarean after the 39th week of pregnancy if there is no urgent reason to deliver the baby sooner: Babies born before the 39th week of pregnancy are more likely to have breathing problems.
- Use epidural or spinal anesthesia: Regional anesthesia (you are numbed from your ribs down) is safer for you and your baby than general anesthesia (being "put to sleep").
MoonDragon's Pregnancy Information: Epidurals
- Request antibiotics at the time of the cesarean: Antibiotics reduce the chance of infection. You do not need them afterwards unless you develop an infection.
- Ask for your uterus to be closed with two layers of stitching (double-layer uterine suturing): In recent years, many health care providers have begun closing the uterus with one layer of stitches instead of two. Some studies suggest that this may lead to the scar giving way more often during a future labor. Research that established that there was a very low likelihood of the scar opening during labor was done when double-layer stitching was the norm. Until this controversy is resolved, it may be wise to request the older technique.
- Request care after surgery to reduce the chance of blood clots: Depending on how likely you are to have this problem, preventive care may include getting you up and walking soon after the operation, having you wear elastic support stockings, or prescribing medication.
TIPS FOR A SATISFYING CESAREAN BIRTH EXPERIENCE
Having a birth experience that is as much like a satisfying vaginal birth as possible and good pain control after the surgery are keys to having a satisfying cesarean birth experience. Discuss these options beforehand even if you plan vaginal birth. If an unexpected problem arises at the end of pregnancy or during labor, it may be much more difficult or impossible to obtain them.
MoonDragon's Womens Health Procedures Information: Surgical Preparation General Guidelines
Some of these options may be readily available; others may require some effort on your part. Still others may not be available at all. In that case, you will have to decide whether they are important enough to you to seek care elsewhere. You may wish to choose a health care provider and/or hospital based on your preferences.
- Participate fully in decisions about the birth: The difficulty or ease of the birth and whether the baby was born vaginally or by cesarean have little to do with how women feel about the birth. Women are most likely to feel satisfied with their births when they feel a sense of accomplishment and personal control and when they have a good relationship with caregivers. A good relationship includes such elements as being treated with kindness and respect, getting good information, and having the opportunity to participate in decisions about care.
- Have an epidural or spinal anesthesia (regional anesthesia): Epidural or spinal anesthesia allows you to be awake and aware to greet your baby and to hold and breastfeed your baby in the recovery area.
- Have the bladder catheter inserted after the epidural or spinal is administered: Then you will be numb for this somewhat uncomfortable procedure.
- Keep your partner and any labor companions with you throughout: You can benefit from the support of your partner and any other labor companions during what may be an anxious and stressful time. This is particularly true during the preparation for surgery and administration of the epidural or spinal anesthesia, which many women find more stressful than the surgery itself. Your partner and support team will also have the opportunity to share in moment of birth and to greet the baby.
- Keep your baby with you after the birth, in skin-to-skin contact: Unless your baby has problems at the birth that require care in the nursery - and few babies do - there is no reason not to keep your baby with you so that you and your partner can enjoy and begin to get to know your baby, and you and your baby can get breastfeeding off to a good start. Skin-to-skin contact can contribute to breastfeeding success and your early relationship.
- Work with your caregivers to carry out your preferences: For example, you may wish to:
- Videotape, or at least videotape after the baby is delivered.
- Play the music of your choice.
- Not have your arms strapped down.
- Have the drape that screens your view of the surgery placed low enough that the baby can be laid on your chest; if your arms are free, you can hold and touch your baby.
- Have a health care provider or nurse explain what is happening throughout.
- Have the drape lowered or have a mirror at the time of the delivery (your belly will be covered so you will basically see your baby lifted out of an opening in the sheet).
- Announce or have your partner announce the sex of the baby or be the first to speak to the baby.
- Take the placenta home (some people bury the placenta and plant a tree or bush over the site; if of interest, bring a sealable container to contain the blood and relieve staff concerns about contamination in this time of HIV/AIDS).
- Have a narcotic (opioid) medication injected into the epidural tubing catheter at the end of the operation: This provides sufficient pain relief that you will feel comfortable enough to hold and breastfeed your baby in the first hours after the surgery.
- Have your baby and your labor companions with you in the recovery area: Holding and breastfeeding your baby soon after delivery helps both you and your baby get started on the right foot and may avoid problems with breastfeeding.
- Have your partner able to be with your baby in the nursery: This includes the newborn intensive care nursery. If your baby must be separated from you because of concerns about the baby's health, it will be comforting to know that your partner can provide a reassuring presence and can bring you word of your baby's condition.
- Control your pain medication: A new alternative is patient-controlled analgesia (PCA). With this technique, you can give yourself a small dose of medication through the intravenous (IV) line when you need it by pushing a button. A lockout mechanism keeps you from going beyond a preset dose. Since narcotics can make you feel sleepy and nauseous, you may wish to combine narcotic with non-narcotic pain medications. This can reduce or even eliminate your need for narcotics.
- Begin drinking and eating again when you feel ready: Access to food and drink when you feel ready will help you feel more normal and can avoid hunger and thirst.
- Get help with breastfeeding: Breastfeeding can be more difficult right after surgery and with a healing incision. A knowledgeable person can help you find ways to make yourself more comfortable during breastfeeding sessions. Your partner or others can help with switching sides, burping, and diaper changing.
- Get plenty of help at home: You will be recovering from major surgery with all that entails in terms of how you may feel, as well as restrictions on lifting and driving. At the same time, unlike the usual experience of recovering surgical patients, you will have the demands of caring for a newborn and possibly other children.
CESAREAN POST PROCEDURE CARE
You will be given post-surgical care information at the time you are released from the hospital after a cesarean delivery. Read them and discuss any questions or concerns with your health care provider about your specific situation.
A hard ridge should form along the incision. As it heals, the ridge will recede gradually. Use an electric heating pad, a heat lamp or a warm compress to relieve incisional pain. Shower as usual. You may wash the incision gently with mild unscented soap. Resume tub baths after 2 to 3 weeks. Do not douche unless advised to by the health care provider.
Prescription medication may be prescribed for 2 to 7 days following the procedure. You may use non-prescription medication, such as acetaminophen, for minor pain.
ACTIVITY RECOMMENDATIONS & RESTRICTIONS
Resume daily activities and work as soon as you are able. Full recovery normally takes about 6 to 8 weeks. Resume driving 3 weeks after returning home. Avoid sexual intercourse for 4 to 6 weeks or as directed by your health care provider.
DIET & NUTRITION
No special diet. However, if you are breastfeeding your baby, continue to take your Prenatal Supplements and Folic Acid supplements. Continue with your pregnancy diet for adequate nutrition for you and your baby. Be sure to drink plenty of fluids to maintain your breastmilk volume. A good nutritional plan will aid in reovery from not only childbirth, but proper nutrition will also help you to heal from your surgery. See Products for a list of nutritional supplements.
Prenatal Multivitamin & Mineral Supplement Products
MOONDRAGON'S PREGNANCY TEA RECIPE
Four of these herbs are found in MoonDragon's Pregnancy Tea. Others can be added if desired or as needed for therapeutic purposes. The recipe is:
2 parts Red Raspberry Leaf (dried)
1 part Alfalfa Leaf (dried)
1 part Nettle Leaf (dried)
1 part Peppermint Leaf (dried)
Mix dried bulk herbs together until well blended and store in a glass quart, half-gallon, or gallon jar in a cool, dark place and use as needed. Light will deplete the nutrients in the leaves. The herbal blend can be placed loose in hot water and strained after brewing or in a tea strainer or tied up in gauze squares and dropped into hot water for brewing, depending upon quantity of tea being made. It can be made by the cupful or by the gallon. It can be consumed hot or cold as ice tea. It makes a great sun-tea that can be placed in a sunny window and allowed to steep until it has a rich color and then chilled in a refrigerator to be consumed throughout the day. It is very rich in vital nutrients helpful for pregnancy. This tea can be consumed throughout pregnancy and is helpful towards the end of pregnancy to prepare for the birth. It is a good base tea to add benefical labor tinctures or other remedies to during the labor and it can also be made into iced cubes and ice chips to be used by the mother during her labor. It makes a great sun tea and can be consumed cold or hot.I usually recommend about a quart a day of prepared tea. This gives the mom help with her fluids and her nutrition. It can be used unsweetened or with a little honey added for sweetener, if desired. Mountain Rose Herbs is a reliable herbal merchant that has quality bulk herbal products. Starwest Botanicals is a good second choice for bulk herbals.
RECOMMENDED HERBAL RESOURCES
Amazon: Wise Woman Herbal For The Childbearing Year By Susun S. Weed, Janice Novet is a highly recommended book for midwives and expectant moms. This is a complete herbal pharmacopoeia for dealing with every problem that might arise before, during and after pregnancy and childbirth. Simple, safe, remedies for pregnancy, childbirth, lactation, newborns. Includes herbs for fertility and birth control.
MoonDragon's Pregnancy Information: Prenatal Vitamins
MoonDragon's Nutrition Information: Pregnancy Diet
MoonDragon's Nutritional Guidelines & Recommendations
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER
If pain, swelling, redness, drainage or bleeding increase in the surgical area. If bleeding soaks more than one pad or tampon each hour. If nipples become sore or cracked. If the urge to urinate frequently persists longer that one month. If vaginal discharge persists more than one month after surgery. If you develop signs of infection: headache, muscle aches, dizziness or a general ill feeling and fever/chills.
MoonDragon's Birth Concerns Index
MoonDragon's Articles Index
MoonDragon's Alternative Health Index
MoonDragon's Professional Guidelines Index
MoonDragon's Birth Index
MoonDragon's Pregnancy Information & Survival Tips
MoonDragon's Gestational Diabetes Index
MoonDragon's Birthing Services Information
MoonDragon's Breastfeeding Problems
PRENATAL SUPPLEMENTS & PRODUCTS
These recommended supplements are quality, all natural supplements from reliable resources. Other helpful products are included for use during pregnancy, birth, post partum, reastfeeding and baby care. For other products or bulk herbs not listed here, please click on the product banners listed near the bottom of this page and do a store search for products you would like to purchase. MoonDragon.org has been very selective about our product resources and only provide links to quality products. Our merchants have a fine selection of nutritional supplements and products. Mountain Rose Herbs has a fine selection of organic bulk herbs and oils.
QUALITY SUPPLIES & PRODUCTS
PRENATAL NUTRITIONAL SUPPLEMENT PRODUCTS
Acidophilus Supplement Products Alfalfa Herbal Products Amino Acid Complex Products Barley Grass Herbal Products Beta Carotene Products Bifidus Supplement Products Bioflavonoid Supplement Products Calcium Supplement Products Carotene Complex Products Chamomile Herbal Products Chlorophyll Herbal Products Coenzyme Q-10 Supplement Products ConcenTrace Supplement Products Fiber Supplement Products Floradix Supplement Products Folic Acid Supplement Products Greens Herbal Products Iron Supplement Products Kelp Herbal Products Kyo-Dophilus Products
Kyo-Green Products Magnesium Supplement Products Multimineral Complex Products Multivitamin Supplement Products Nettle Herbal Products Oatstraw Herbal Products Peppermint Herbal Products Prenatal Supplement Products Protein Supplement Products Quercetin Supplement Products Red Raspberry Herbal Products Rosehips Herbal Products Spirulina Products >Vitamin B-Complex Products Vitamin C Products Vitamin D Products Vitamin E Products Vitamin K Products Wheatgrass Herbal Products Zinc Supplement Products
AROMATHERAPY: ESSENTIAL OILS DESCRIPTIONS & USES
Allspice Leaf Oil Angelica Oil Anise Oil Baobab Oil Basil Oil Bay Laurel Oil Bay Oil Benzoin Oil Bergamot Oil Black Pepper Oil Chamomile (German) Oil Cajuput Oil Calamus Oil Camphor (White) Oil Caraway Oil Cardamom Oil Carrot Seed Oil Catnip Oil Cedarwood Oil Chamomile Oil Cinnamon Oil Citronella Oil Clary-Sage Oil Clove Oil Coriander Oil Cypress Oil Dill Oil Eucalyptus Oil Fennel Oil Fir Needle Oil Frankincense Oil Geranium Oil German Chamomile Oil Ginger Oil Grapefruit Oil Helichrysum Oil Hyssop Oil Iris-Root Oil Jasmine Oil Juniper Oil Labdanum Oil Lavender Oil Lemon-Balm Oil Lemongrass Oil Lemon Oil Lime Oil Longleaf-Pine Oil Mandarin Oil Marjoram Oil Mimosa Oil Myrrh Oil Myrtle Oil Neroli Oil Niaouli Oil Nutmeg Oil Orange Oil Oregano Oil Palmarosa Oil Patchouli Oil Peppermint Oil Peru-Balsam Oil Petitgrain Oil Pine-Long Leaf Oil Pine-Needle Oil Pine-Swiss Oil Rosemary Oil Rose Oil Rosewood Oil Sage Oil Sandalwood Oil Savory Oil Spearmint Oil Spikenard Oil Swiss-Pine Oil Tangerine Oil Tea-Tree Oil Thyme Oil Vanilla Oil Verbena Oil Vetiver Oil Violet Oil White-Camphor Oil Yarrow Oil Ylang-Ylang Oil Aromatherapy
Healing Baths For Colds
Using Essential Oils
AROMATHERAPY: HERBAL & CARRIER OILS DESCRIPTIONS & USES
Almond, Sweet Oil Apricot Kernel Oil Argan Oil Arnica Oil Avocado Oil Baobab Oil Black Cumin Oil Black Currant Oil Black Seed Oil Borage Seed Oil Calendula Oil Camelina Oil Castor Oil Coconut Oil Comfrey Oil Evening Primrose Oil Flaxseed Oil Grapeseed Oil Hazelnut Oil Hemp Seed Oil Jojoba Oil Kukui Nut Oil Macadamia Nut Oil Meadowfoam Seed Oil Mullein Oil Neem Oil Olive Oil Palm Oil Plantain Oil Plum Kernel Oil Poke Root Oil Pomegranate Seed Oil Pumpkin Seed Oil Rosehip Seed Oil Safflower Oil Sea Buckthorn Oil Sesame Seed Oil Shea Nut Oil Soybean Oil St. Johns Wort Oil Sunflower Oil Tamanu Oil Vitamin E Oil Wheat Germ Oil
HELPFUL RELATED MOONDRAGON NUTRITION BASICS LINKS
MoonDragon's Nutrition Basics Index MoonDragon's Nutrition Basics: Amino Acids Index MoonDragon's Nutrition Basics: Antioxidants Index MoonDragon's Nutrition Basics: Enzymes Information MoonDragon's Nutrition Basics: Herbs Index MoonDragon's Nutrition Basics: Homeopathics Index MoonDragon's Nutrition Basics: Hydrosols Index MoonDragon's Nutrition Basics: Minerals Index MoonDragon's Nutrition Basics: Mineral Introduction MoonDragon's Nutrition Basics: Dietary & Cosmetic Supplements Index MoonDragon's Nutrition Basics: Dietary Supplements Introduction MoonDragon's Nutrition Basics: Specialty Supplements MoonDragon's Nutrition Basics: Vitamins Index MoonDragon's Nutrition Basics: Vitamins Introduction
NUTRITION BASICS ARTICLES
MoonDragon's Nutrition Basics: 4 Basic Nutrients MoonDragon's Nutrition Basics: Avoid Foods That Contain Additives & Artificial Ingredients MoonDragon's Nutrition Basics: Is Aspartame A Safe Sugar Substitute? MoonDragon's Nutrition Basics: Guidelines For Selecting & Preparing Foods MoonDragon's Nutrition Basics: Foods That Destroy MoonDragon's Nutrition Basics: Foods That Heal MoonDragon's Nutrition Basics: The Micronutrients: Vitamins & Minerals MoonDragon's Nutrition Basics: Avoid Overcooking Your Foods MoonDragon's Nutrition Basics: Phytochemicals MoonDragon's Nutrition Basics: Increase Your Consumption of Raw Produce MoonDragon's Nutrition Basics: Limit Your Use of Salt MoonDragon's Nutrition Basics: Use Proper Cooking Utensils MoonDragon's Nutrition Basics: Choosing The Best Water & Types of Water
RELATED MOONDRAGON HEALTH LINKS & INFORMATION
MoonDragon's Nutrition Information Index MoonDragon's Nutritional Therapy Index MoonDragon's Nutritional Analysis Index MoonDragon's Nutritional Diet Index MoonDragon's Nutritional Recipe Index MoonDragon's Nutrition Therapy: Preparing Produce for Juicing MoonDragon's Nutrition Information: Food Additives Index MoonDragon's Nutrition Information: Food Safety Links MoonDragon's Aromatherapy Index MoonDragon's Aromatherapy Articles MoonDragon's Aromatherapy For Back Pain MoonDragon's Aromatherapy For Labor & Birth MoonDragon's Aromatherapy Blending Chart MoonDragon's Aromatherapy Essential Oil Details MoonDragon's Aromatherapy Links MoonDragon's Aromatherapy For Miscarriage MoonDragon's Aromatherapy For Post Partum MoonDragon's Aromatherapy For Childbearing MoonDragon's Aromatherapy For Problems in Pregnancy & Birthing MoonDragon's Aromatherapy Chart of Essential Oils #1 MoonDragon's Aromatherapy Chart of Essential Oils #2 MoonDragon's Aromatherapy Tips MoonDragon's Aromatherapy Uses MoonDragon's Alternative Health Index MoonDragon's Alternative Health Information Overview MoonDragon's Alternative Health Therapy Index MoonDragon's Alternative Health: Touch & Movement Therapies Index MoonDragon's Alternative Health Therapy: Touch & Movement: Aromatherapy MoonDragon's Alternative Therapy: Touch & Movement - Massage Therapy MoonDragon's Alternative Health: Therapeutic Massage MoonDragon's Holistic Health Links Page 1 MoonDragon's Holistic Health Links Page 2 MoonDragon's Health & Wellness: Nutrition Basics Index MoonDragon's Health & Wellness: Therapy Index MoonDragon's Health & Wellness: Massage Therapy MoonDragon's Health & Wellness: Hydrotherapy MoonDragon's Health & Wellness: Pain Control Therapy MoonDragon's Health & Wellness: Relaxation Therapy MoonDragon's Health & Wellness: Steam Inhalation Therapy MoonDragon's Health & Wellness: Therapy - Herbal Oils Index
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MOONDRAGON'S REALM - WEBSITE DIRECTORY
A website map to help you find what you are looking for on MoonDragon.org's Website. Available pages have been listed under appropriate directory headings.