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01-Oct-2019
A C-section is a surgical procedure in which one or more incisions are made through a mother’s abdomen (Laparotomy – Incision in the abdominal wall) and uterus (hysterotomy – Incision in the uterus) to deliver one or more babies.
Incidence – Around 21% of all deliveries are from C-Section.
This is the most common type of surgery that women have.
In UK, about 1 in 4 pregnant women has a baby by c-section every year. (Data obtained no. of caesarean section performed in 137 countries accounting for 95% of global births of that year)
When it is essential to go for a C-section –
1. Cervical dystonia – Failure of cervix to dilate inspite of strong contraction of uterus (Pelvic stenosis).
2. Placenta Abruption – Placenta lining has separated from uterus prior to delivery.
3. Placenta Previa – Inflammation of the placenta in lower uterine segment
4. Abnormal fetal presentation
5. Pre-rupture of uterus
6. Fetal Malformation – Such as congenital twins
7. After repair operation of reproduction organ
8. Scar of uterus and vagina/ Abnormalities of soft tissues.
Relatively – When C-section isn’t essential but can be recommended –
1. Cephalopelvic disproportion – The head of the fetus is too large to come through the pelvis.
2. Fetal distress
3. Pregnancy complications –Cardiac disease or liver disease or Renal disease
4. Uterine Inertia – Insufficient uterine contraction
Type of Abdominal Incision –
1. Vertical –
a. It is important where speed is essential
b. Very rare
c. Almost bloodless
d. No muscle fibers and no muscles are injured
2. Pfannenstiel incision – Bikini line incision
a. Approximately 5 cm above pubic symphysis.
b. Less noticeable as compared to vertical incision
c. Scar can hide in abdominal folds or under pubic hairs
d. Heels faster than any other incision
3. Classical – Mid Line Incision
a. Incidence - Performed 1 in 100
b. Here the upper portion of uterus is opened by an incision and the body is than extracted.
c. Not preferred – Higher incidence of complications
d. Only prefer in unusual circumstances Like –
- Very pre mature baby
- Transverse lining fetus with ruptured membrane
- Some type of non-cancerous growth
- Placenta previa
- In emergency – When lower segment is abnormally vascular.
- In emergency where C-section is performed after mother’s death (Cases requiring rapid delivery).
- Disadvantages – More prone to chest infections, Intestinal distention, Scar more liable to rupture.
4. Lower Segment transverse – In this case, the uterus is opened in the lower segment and mostly the breach presentation deliveries take place.
a. Most commonly used procedure now a days.
b. It involves transverse cut just above the edge of the bladder and result in less blood loss and is easier to repair. (As the lower uterine segment is thin and poorly vascularized)
c. Location of lower segment C-section is beneficial because –
- Peritoneum is loosely attached to uterus
- Contraction is less than the upper part of the uterus
- Healing is more efficient
- Less problem with suture loosening
According to no. of operations –
1. Primary C-section
2. Repeated C-section
According to the opening the peritoneal cavity –
1. Trans peritoneal C-section
2. Extra peritoneal C-section – Mainly indicated in infected uterine content. By planned vaginal birth and after PCS revision.
According to Timing –
1. Emergency – When life threat is there to the mother or the baby
2. Elective (Planned) – Who all tend to plan
a. When child is in breach position
b. Large babies
c. Mother suffering from Chronic disease like – Diabetes or Cardiac disease
d. Repeated C-section
After the birth of the baby Lochia is there i.e. The Vaginal discharge after giving birth which contains blood and the mucous and continues till 4-6 weeks.
Physiotherapy treatment before and after delivery plays a very important role in smooth functioning labor and delivery process and afterwards. In view of physiotherapy – It is very essential to strengthen pelvic floor muscles and guide appropriate posture to the women.
During pregnancy, Regular physiotherapy follow ups can help you resolve your problems before delivery. Like – Headache, breast pain, Leg pain, Muscle cramps, back ache etc. It is very important to stay active during the tenure.
We have a team of experts to make you understand better about the exercises and relaxation. We make you learn -
1. Comfortable resting positions, relaxation exercises and stretching.
2. Prepares you for the labor procedure.
3. Appropriate way to get in and out of the bed
4. Correct posture while sitting, driving or feeding
Role of Physiotherapy specific to C-Section-
1. To maintain good circulation after the surgery
2. Improve respiratory function as it becomes painful for the women to cough after C-section.
3. Assistance and guidance for changing positions
4. Teaching forced expiratory maneuver & huffing techniques to avoid painful coughing.
5. Prevent from circulatory problems like DVT or pulmonary embolism.
At Makino healthcare we recommend you to keep moving and do ankle pumps several times a day to increase venous return. Stiffness and soreness of the legs and buttocks can also be treated with effective treatment measures.
Coughing & sneezing – It is very important for you to keep your chest clear. You can do this by performing few respiratory exercises. Like – Deep breathing exercises to stretch your lungs.
Correct Posture – Try to stand tall straight. Avoid twisting or bending for a long interval of time in one go. Do take care while changing nappies and try to keep the baby on a surface at appropriate height that you need not to bend over.
After delivery now a days the most common concern of the woman is to reduce weight and bring the body shape and activity level back to the same that was before delivery. We at MAKINO HEALTHCARE have bought the solution for you. Contact us today to reduce your extra inches increased because of pregnancy. Make yourself fit and healthy with us & live the way freely you were living it before getting pregnant.