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C-Sections: Not Just One Small Cut

As per the title, this blog is all about Cesarean Sections, or C-Sections.

I don’t know about you, but I love learning and researching. I seek to understand and to be understood. It’s this part of me that had me diving head first into all the C-Section education fairly soon after having Lucca. I didn’t know as much about the entire surgery as I thought, and I was looking for answers to piece together everything that happened.

Here’s the basics:

When it comes to C-Sections there are two options for incision: midline (classical/traditional/the OG of C-Sections) and transverse (the new, better way).

It’s pretty rare to see a midline C-Section these days. The very large vertical incision up the center of the abdomen leaves a greater risk of infection, increases the instance of an incision hernia, and excludes the mother from a vaginal birth after Cesarean.

The preferred methods are transverse Pfannenstiel incision and Joel-Cohen (JC) incision.

The Pfannenstiel incision - Slightly curved, 2-3 cm above the symphysis pubis.

The Joel-Cohen (JC) incision - Straight, 3 cm below the line that joins the anterior superior iliac spines (hip bones).

Both of these incisions leave a crazy small scar, begging the question “HOW did my almost 9 pounder fit through that?!

*Maylard incision is a transverse cut on the rectus abdominis, 5-8 cm above the pubic symphysis, but is not common.

Let’s go through the steps of a C-Section.

After you’ve done all your intake stuff, received a giant bag of fluids and your prophylactic antibiotics, and have been shaved, you’ll head into the OR with your nurse. Your husband or partner will wait outside until it’s go time.

The anesthesiologist will perform your Spinal or Epidural. Spinals are typically used for planned C-Sections, and epidurals usually when the C-Section happens after you are in labor.

The medication will be injected into one of the layers of your spinal canal and cause numbness from the breastbone down.

While the spinal or epidural is doing its thing, the nurses and surgical staff are in and out setting everything up and sterilizing the incision site.

Right before "go time," they'll pull your support team in to sit by your head/side behind that little blue, sterile drape.

The surgeon will then make a transverse 10 cm long incision through the skin, the subcutaneous tissue (fat), and the fascia. A retractor to keep the abdomen open is placed.

Continuing on, the rectus abdominis are separated vertically up the linea alba (the muscles are not typically cut), the peritoneum is cut vertically (the membrane lining the cavity of the abdomen and covering the abdominal organs), and then finally a transverse incision of the uterus. This allows access to the amniotic sac to be opened and baby to pulled and pushed out. Lots of pressure!

The placenta follows after baby and then the repair starts, but not before the surgeon takes a look at each ovary and fallopian tube.

The uterus is often exteriorized (taken out of the body) to repair using stitches and then placed back inside. Each layer is stitched back.

The final repair method varies. The interior of the skin is stitched and the exterior is either stitched, stapled or glued.

The whole surgery is crazy quick barring any unforeseen issues.

Other things you might not know:

Narcotics and nausea medication are given via the IV in mom’s arm by the anesthesiologist. If you had a C-Section, this is why you were loopy after. You can ask that the anesthesiologist not give you the narcotics if you don’t want them. They are given as extra pain medication for when the spinal or epidural wears off and also used to keep mom calm.

You still bleed. The bleeding after baby is caused by the dinner plate sized wound inside your uterus where the placenta was attached. As this heals, and the uterus shrinks back down to size, bleeding will occur just like in a vaginal birth.

Your bladder might feel bruised. The bladder is moved out of the way to access the uterus and baby. In the push and pull of the entire ordeal, the bladder can become bruised. This can cause extreme discomfort when the bladder gets too full, so be sure to drink lots of water after and pee frequently.

All the pain medication and spinal or epidural can cause constipation and gas. Stool softeners and a squatty-potty (along with adequate fluids and easy to digest foods) will help you go. Gas can sometimes manifest as sharp pain in the back or shoulder blade. Deep diaphragmatic breaths and getting up to move a tiny bit each day helps.

Your abdominals were not cut, this is true, but all the layers above were and these neural connections play a big role in abdominal function. So trying to do anything that activates the core will likely cause discomfort. Get help sitting up, standing, lowering to sit on the toilet, and more. Exhale through discomfort instead of bracing or holding the breath and use a belly binder that provides bottom to top support.

This was a quick overview and there is so much more that goes into each cut of each layer (more to come on this), but the takeaway here: it’s not just one small cut. You had a baby AND you went through major abdominal surgery!

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