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Current time:0:00Total duration:11:28

Video transcript

a c-section or cesarean section is a type of surgery that's used to deliver a baby basically the surgery begins with the mom receiving anesthesia whether that's local anesthesia so she remains awake or general anesthesia that puts her to sleep then the surgeon makes an incision on the abdomen so usually the incision is horizontal or transverse so it goes across the abdomen about one to two inches above the pubic hair and the reason why we tend to prefer that horizontal incision is because it tends to cause less post-operative pain and the wound from it tends to heal better and it tends to be stronger and also because it results in a better cosmetic appearance since the scar from the horizontal incision kind of blends in with the crease at the bottom of the abdomen so it's not as noticeable sometimes though if the surgeon needs to get in more quickly either because the mom is bleeding a lot or or because the baby is in danger the incision that's made will be vertical so up and down the abdomen kind of like this since that's a quicker way of getting in and generally vertical incisions cause less bleeding now after the incision is made the surgeon then makes his way through all the layers of the abdomen to access the uterus he then makes an incision in the uterus to remove the baby then the umbilical cord is clamped and cut the placenta is removed and then finally when everything's done the uterus and the abdomen are stitched and stapled to close and generally speaking most women provided that everything goes well are able to go home in about three days so how common is this and and why would a woman need to have a c-section rather than a vaginal delivery well one in every three babies born in the u.s. is born through a c-section and that's not even the highest rate in the world the highest rate in the world is actually seen in China at 46 percent of all births so that's quite a bit now in terms of cool it's a c-section I guess you can split things off into two groups so they're the women the group of women who have planned c-section so they know from before they're going to get a c-section so there's planned c-section versus the group of women who have unplanned or emergency c-section so there's plenty sections versus unplanned or emergency c-sections so sometimes c-sections are planned in advance several weeks before the mom goes into labor and the most common reasons for planning a c-section include for example if the mom has had a c-section in the past that's a pretty common reason to have a c-section if she has a history of a c-section in the past if the baby is very large so that's called fetal macrosomia fetal macro macrosomia macro for large and Soma for body so the baby has a really large body which tends to make vaginal delivery pretty difficult so in that case we opted for a c-section another indication is if the mom has an infection such as herpes or or HIV so infections that can spread to the baby as the baby's passing through the vaginal canal so we attempt to avoid that transmission of infection by delivering the baby through a c-section if the moment is carrying more than two babies two babies or more or if the mom has a condition called placenta previa so a condition called placenta placenta previa in which case the placenta blocks the way to the vagina so the baby can't act exit through the vagina its path is blocked and and speaking of that any type of mechanical obstruction to delivery such as a uterine fibroid or or displaced pelvic fracture anything that would block the way of the baby through the vagina would be an indication for a c-section in other cases the mom plans on having a vaginal delivery and she goes through with the vaginal delivery but plans change during labor and she needs to have a urgency c-section so some of the reasons for an unplanned and an emergency c-section include contractions that are not strong enough to get the baby out so labor isn't progressing as quickly and as effectively as it should which if labor lasts too long that can be detrimental to the baby it could be to the baby not getting enough oxygen so we decide to go in through an emergency c-section to get the baby out as quickly as we possibly can another indication is if the moms pelvis is too small and that's a discovered during labor again because the labor isn't progressing as it should and if the baby is in an odd position such as sideways or or chin first or feet first whatever it might be if the baby is in an odd position that's that's a good reason to do an emergency c-section and also if the baby's life is in danger so for example if its heart is beating too slow or if a mom's life is in danger so for example if she's bleeding too much those are both very good reasons to have an emergency c-section and these are just the most common reasons for having a c-section by no means are they the only situations in which a c-section is necessary okay so c-sections just like all surgical procedures are not without complications so for example with each c-section one of the biggest complications that you'll hear about the risk of placental attachment disorders increases so the risk of placental placental attachment disorders increases so there's some disorder something's going wrong with the way that the placenta attaches and this is in subsequent pregnancy so pregnancies following that c-section so a lot of that has to do with the fact that each c-section causes scar tissue to form in the uterus and that scar tissue can cause the placenta to attach to the uterus incorrectly so the placenta can attach in the wrong location such as with placenta previa right or the placenta can adhere to or stick to the uterus too strongly too firmly which is called placenta accreta so the risk of placenta previa and placenta accreta which are two types of placental attachment disorders increases with future pregnancy following a c-section and there are some other complications including complications related to anesthesia which of course occurs with any major surgery there can also be damage to the bladder the the blood vessels or the intestines during surgery and generally c-sections do involve longer healing time than vaginal deliveries do and of course there's also the risk of infection as a result of all that instrumentation inside the body that's occurring throughout the c-section so pretty standard surgery related complications but let's talk about a couple of issues unique to c-sections so firstly there's a lot of thought and and some pretty decent evidence to suggest that c-sections are associated with an increased risk of respiratory problems in the baby and perhaps with an increased risk of death of the baby as well and also keep in mind that with a c-section we're making an incision into the uterus a pretty large incision and then we're sewing that incision up after delivering the baby and sure these incisions tend to heal pretty well but imagine that with future pregnancies the uterus stretches out and during delivery it contracts with with great pressure and because a scarred area of the uterus isn't as strong as the rest of the uterus that portion that scarred portion is really prone to rupture so uterine rupture is a grave potentially fatal complication of c-section and it's this fear of uterine rupture that's led to a greater than 100 year long debate over how to deliver a woman who's had a c-section in the past this is a really controversial issue in medicine so if you think about it there are three possibilities for a pregnant laboring woman who's had a c-section in the past she can choose from the very GetGo to have a planned elective c-section that's that's kind of the first possibility right she can plan from the very beginning to have an elective c-section so that's the first possibility she could also attempt to to labor right which is called a toe Lac so T o tol AC which stands for a trial of labor after cesarean so she could try to labor and that toe Lac could be successful so it could end with a vaginal delivery everything could go well after she Labor's and the baby could be delivered vaginally or the toe Lac could fail and would have to be followed by an emergency c-section so those are kind of the three possibilities either she could choose from the very GetGo to have a planned elective c-section or she could try to labor which could end with a vaginal delivery could all go great and be successful and end with a vaginal delivery or the tolai could fail and it would have to be followed by an emergency c-section and I'll tell you up until about 30 ish years ago every woman who had ever had a c-section in the past was told that every delivery of hers in the future would have to be a c-section but considering all the complications that we just talked about associated with c-section in the 80s we really sat down and really thought about whether that's necessary and we realized that in some women who had a c-section in the past it's worth it to attempt a toe Lac to avoid the complications of a c-section because the toll that could proceed successfully right and we would in that case avoid the complications of a c-section whereas in other women mainly those women who have a really high risk of uterine rupture where the toe Lac it's necessary to stick to c-sections for every delivery after the woman's first c-section and deciding which of those categories a woman falls into is really no easy feat so there's no real standardized way of deciding which women are good candidates for toe Lac and which aren't we really currently we really do things on a case-by-case basis which hopefully will change in the future as we gather more data on the topic but currently as it stands it's a very controversial issue and we tend to manage things on very case-by-case basis so in a nutshell those are some details about c-section