Bavina Sookdeo
Caesarean sections (C-sections) are the most common surgical procedure worldwide, with approximately 21.1 per cent of births occurring this way. Rates vary regionally, with Latin America and the Caribbean reporting as high as 42.8 per cent of births via C-section.
A C-section is a surgical procedure that allows the delivery of one or more babies through an incision in the mother’s abdomen and womb.
April is C-section Awareness Month, during which the complexities, benefits, and challenges of this widely performed surgical procedure are highlighted.
Dr Reiaz Mohammed, a medical doctor with 24 years of experience and a member of the Royal College of Obstetricians and Gynaecologists since 2008 said a C-section is performed when vaginal delivery poses a higher risk to the mother or baby. It can be elective (planned before labour) or an emergency procedure.
“Elective reasons include if the baby is in the wrong position, is too big, multiple pregnancy, if the placenta is too low down, if there is any obstruction to the cervix (for example, from a fibroid) and if the mother has certain medical conditions or infections that will make a vaginal delivery riskier.”
He said the most common reasons for an emergency C-section are when the baby is in distress or if labour is not progressing as it should.
“A small but increasing number of Caesarean sections are also done for 'maternal request', in the absence of a medical indication,” he noted.
Mohammed, a UWI graduate, works out at Gulf View Medical Centre in La Romaine. Since performing his first Caesarean in 2003, he has successfully carried out hundreds of these procedures throughout his career.
He said there are two types of anaesthesia used in C-sections – general, where the patient is asleep; and regional, where the patient is awake but is administered an injection into the spine through the back. Regional anaesthesia is generally preferred as it reduces blood loss and minimises breathing problems in the baby.
“It also has the advantage that the patient is awake to witness the birth of the baby and breast feeding can start earlier.
“The patient is also pain free for a few hours after the surgery until the effects of the anaesthesia wears off. General anaesthesia can be done more quickly than regional anaesthesia, so in certain cases when the baby needs to be delivered immediately, this type of anaesthesia may be used.
"Each patient and each case is different, so the anaesthetist will guide you as to which form of anaesthesia is safer for you.”
The procedure
A C-section takes place in an operating theatre under sterile conditions and involves:
- Insertion of an intravenous line and urinary catheter. The catheter is removed about 24 hours after the surgery.
- Cleaning and draping of the abdomen.
- A ten to 20 cm transverse incision (left to right) in the lower abdomen is made, in some cases a mid-line vertical (up and down) incision may be needed to gain access to the baby. “Several layers of tissue are cut through before the
