Delivery by an Operation

For the health and safety of both mother and baby, it is sometimes necessary to deliver the baby by an operation. There are two types of operations most commonly performed: Caesarean section and symphysiotomy.

Figure 12.2: Caesarean Section

A Caesarean section is an operation in which the abdomen and womb are cut open and the baby and placenta are removed. The womb and abdomen are stitched up and left to heal.

"Classical" or Vertical Incision

If a previous Caesarean section was done with a vertical cut in the uterus, the woman should have a Caesarean section with all future deliveries.

Transverse Incision

If a previous Caesarean section was done with a transverse or horizontal cut in the lower part of the uterus, it may be possible for the woman to deliver normally. However, she should deliver in a hospital in case an operation is necessary.

CAESAREAN SECTION: A Caesarean section is a major operation in which the abdomen and womb are cut open and the baby and placenta are removed. The womb is not removed; it is stitched up and left to heal (see Figure 12.2). The operation has to be performed under general or local anaesthesia to make sure the woman does not feel anything. Such an operation should be performed only in a fully equipped hospital and by someone who has been well trained to perform the procedure. There are several reasons why a Caesarean section might become necessary:

· Prolonged labour - that is, labour that has lasted more than 12-18 hours without any sign that the baby is going to come out safely. This could be due to several reasons, but the most frequent cause of prolonged labour is when there is an obstruction (see Chapter 11).

· Abnormal presentation (see Chapter 11).

· Heavy bleeding before delivery (see Chapter 9) or, occasionally, heavy bleeding during labour (see Chapter 11).

· Severe hypertension, pre-eclampsia, or full eclampsia (see Chapters 9 and 11).

· Signs that the baby is in distress, such as a slow or irregular heartbeat.

· A previous Caesarean section. Depending on the type of Caesarean section that was done and the reason it was done, it may be necessary to repeat the Caesarean section. It may be possible for the woman to have a normal delivery through the vagina if the baby is a normal size and is lying head-down, if the woman had only one previous Caesarean section, and if the scar was in the lower part of the womb. Even if a normal delivery is being attempted, it should take place in a hospital in case another Caesarean section becomes necessary.

· Previous pregnancies that have ended in a stillbirth, or diabetes or severe heart disease in the woman.

The risk of dying from a Caesarean section is higher than for a normal delivery, largely because of an increased risk of infection. A Caesarean section should be carried out only if it is really necessary.

SYMPHYSIOTOMY: When labour is obstructed, a symphysiotomy is sometimes performed. In this operation, a small cut is made at the top of the pubic bone so that the bones around the birth canal can be opened a little more to allow the baby to pass through. The operation is performed with anaesthesia.