Maternity at IU Health North Hospital offers a wide range of procedures relating to childbirth and birth control. It is best to consult a physician if you have any questions about the procedures listed below.
A cesarean section, or c-section, is the surgical delivery of an infant through an incision in the mother's abdomen and uterus.The incision may be made across the bottom of the abdomen above the pubic area (transverse) or, in certain situations, in a line from the navel to the pubic area (vertical).
In many cases, a woman delivering by cesarean can remain awake during the childbirth and be with her newborn soon afterward.
What are the risks of cesarean section?
While many infants benefit from surgical rather than vaginal delivery, a mother who delivers by cesarean has a higher risk of complications and a longer recovery period than with a routine vaginal birth. Possible complications include infection, heavy blood loss, gallbladder problems, and surgery-related injury to the mother or infant.
If she becomes pregnant again, a woman with a cesarean scar has slightly less chance of being able to safely deliver her baby vaginally, because there is some risk of the scar tearing open during labor (uterine rupture).
When is a cesarean section necessary?
During the 1970s and early 1980s, cesarean deliveries increased from about 5 percent to nearly 25 percent of all births. Since then, public health experts have expressed concern that cesarean has been overused by obstetricians. Today, doctors have more guidelines to help them determine when cesarean section is necessary.
- Unplanned cesarean - Up to 30 percent of cesareans are performed after a slow, difficult labor (dystocia). Many cesareans are quickly performed when the fetus or mother is showing signs of distress or when labor complications develop, such as umbilical cord problems or placenta problems like placenta eruption.
- Planned cesarean - When a known pregnancy problem or risk factor makes vaginal birth unsafe, a cesarean section is planned ahead of time. Examples of such known problems are a fetus in bottom-down breech position, a placenta that is blocking the cervix (placenta previa), a mother's chronic illness, preeclampsia, and in some cases, factors linked to a past cesarean delivery.
About one-third of cesarean deliveries are planned ahead of time for women who have had a cesarean before. Medical reasons for scheduling a repeat cesarean include:
- Presence of a problem that has led to difficult labor and cesarean before, such as a narrow pelvis and a large fetus (cephalopelvic disproportion).
- Factors that increase the risk of a uterine scar rupturing during labor, such as having a vertical scar, three or more cesarean scars, triplets or more, or a very large fetus thought to weigh to.
- No access to constant medical supervision by a cesarean-trained doctor during active labor, or no available facilities for an emergency cesarean.
In some cases, a woman who has had a cesarean may subsequently be able to deliver a baby vaginally. This is called vaginal birth after cesarean (VBAC).
Dilation & Curettage
A dilation and curettage (D&C) is a procedure that is done to remove tissue from inside the uterus. During a D&C, the vagina is spread open, and a scraping or suction instrument is passed through the cervix and into the uterus to remove tissue from the lining of the uterus (endometrium).
A D&C may be done to:
- Remove tissue that remains after a woman has had a miscarriage.
- Remove tissue that may be causing abnormal vaginal bleeding. The tissue can then be examined for any abnormalities.
- End a pregnancy.
A D&C is usually done in a hospital without requiring an overnight stay. Pain medication is given before the procedure. Many women choose to have a general anesthetic that makes them unconscious during the procedure.
Tubal ligation is a surgical procedure that makes a woman unable to become pregnant (sterile). A tubal ligation blocks the fallopian tubes so that eggs cannot travel down the tubes to be fertilized by the sperm. If a woman conceives after having a tubal ligation or tubal ligation reversal, she has an increased risk of ectopic pregnancy.
There are several kinds of tubal ligation. The fallopian tubes can be:
- Cut and sealed.
- Tied off with a surgical clip or ring.
- Sealed by the use of a device that sends out an electric current to burn (cauterize) each tube. The scars that form after the cauterization seal the tube.
- Tubal ligations are not 100 percent effective. Some women become pregnant after undergoing tubal ligation because:
- The surgery did not completely block or cut off the fallopian tubes.
- The tubes grew back together or a new passage formed (recanalization) that allowed eggs to be fertilized by sperm.
Tubal Ligation Reversal
If a woman decides to reverse the tubal ligation in an attempt to become pregnant, the fallopian tube can be reopened to allow sperm through. However, scar tissue may prevent an egg or a fertilized egg (either of which is larger than a sperm cell) from passing through the tube to the uterus. A fertilized egg trapped anywhere other than the uterus results in an ectopic pregnancy. Therefore, a tubal ligation reversal puts a woman at high risk for an ectopic pregnancy.
A vaginal delivery is the birth of a fetus through the mother's birth canal, or vagina.
A few hours after an uncomplicated vaginal delivery, you can get up and move around. If you had an episiotomy, you may feel the need to spend a day resting before you start moving around too much. An episiotomy incision will heal in one to three weeks. The vaginal area is sore for several days.
Women are generally advised to avoid having sex for four to sex weeks after giving birth in order to allow the vagina and the area around it to fully recover.
Recovery from a vaginal delivery is usually easier and quicker than from a cesarean section.