Caesarean section • Scar, risks & procedure


The caesarean section is one of the oldest surgical procedures. It is not only carried out in an emergency, but also today as a planned Caesarean section. However, the intervention is still associated with risks for both mother and child.

With a caesarean section, the baby is born quickly, safely and gently.

The Caesarean section (Latin: Sectio caesarea, often called Sectio for short) is an operative procedure in which the child is not delivered naturally through the birth canal, but via an abdominal incision. In Germany, around 30 percent of all children were born via Caesarean section in recent years.

The decision to have a caesarean is usually made today when the birth must be ended quickly and the conditions for a normal spontaneous birth are not met. A caesarean section can also be planned in advance by the doctor to avoid complications.

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Reasons for a section and types of caesarean section

One speaks of a planned primary caesarean section if the delivery is carried out before the onset of labor. Often, the course of pregnancy, the results of previous examinations and previous illnesses of the mother indicate that a caesarean section is planned instead of a normal birth.

Reasons for caesarean section

There are mostly medical reasons why doctors and the mother-to-be decide to have a caesarean section: twin pregnancies, birth arrest, problems with the umbilical cord or placenta or diseases of the mother are among them.

Indications for a planned caesarean section:

  • Twin or multiple pregnancies

  • Premature babies up to the 28th week of pregnancy

  • Serious illnesses or infections of the mother: for example HIV infection, gestational diabetes, HELLP syndrome, gestational gestosis, heart defects, previous stroke

  • a mother's pelvis too small for the expected size of the child

  • a placenta in front of the cervix (placenta praevia)

  • premature labor or premature blistering

  • an unfavorable position of the child for vaginal birth (breech position, breech end position)

Reasons for caesarean section

Medical reasons for a caesarean section

© Filimonova, Lifeline

Sometimes, however, things have to be done quickly: An unplanned, secondary caesarean section is used when the contractions have already started and the birth is in progress. The "emergency caesarean section" is performed when the life of the mother or child is in danger.

Indications for an unplanned caesarean section:

  • long labor and labor pains

  • complete exhaustion of the mother

  • Fever, sudden high blood pressure or seizures

  • The cervix does not open during childbirth

  • Weakness in the opening phase

  • Standstill of birth

  • premature replacement of the mother cake

  • uterine tear

  • falling heart sounds of the child

  • Undersupply of oxygen, for example, by the location of the umbilical cord

  • unfavorable child situation

Advantages of a planned caesarean section

The desired Caesarean section is also a planned section birth. Pregnant women are afraid of the pain during childbirth, negative consequences for the pelvic floor and bladder and hope for childbirth with less risk. In addition, the date of birth can largely be determined and the stay in the clinic can even be harmonized with the father's schedule.

There are also some advantages for hospitals through a planned caesarean section: the workflow is easier to plan because the interventions can be scheduled at times when there is enough staff on duty – and not on weekends, public holidays or at night. In addition, clinics can charge health insurance companies about twice the cost of a normal delivery for a caesarean section.

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Do you have to pay for your favorite Caesarean section yourself?

Although the costs of a medically unnecessary cesarean section are not covered by the health insurance companies, the expectant parents do not have to pay themselves. As a rule, the doctor attests an indication appropriate to the planned procedure.

However, a cesarean section on request would not be performed if the operation would pose a risk to the mother. This is the case if the mother is not allowed to undergo surgery for health reasons, such as severe cardiovascular disorders.

Preparation and procedure: This happens with a caesarean section

To prepare for the operation, the doctor must inform the patient about the upcoming procedure. The caesarean section usually lasts no longer than an hour. The operation is the only one in which relatives – very often the father – can be present.

Before the operation, the Pubic hair shaved and a bladder catheter placed. The urinary catheter is pushed into the bladder from the outside via the urethra and serves to empty the bladder during the operation and immediately afterwards. The body is covered with sterile surgical drapes. If the operation is carried out under partial anesthesia or relatives are present, a privacy screen is stretched over the surgical field.

In the case of a planned caesarean section, anesthesia is usually performed as a partial anesthetic. Anesthesia close to the spinal cord (epidural anesthesia, PDA) is used for this. The woman remains fully conscious and can witness the birth of her child. An unplanned Caesarean section or emergency Caesarean section, where every minute counts, is usually performed under general anesthesia.

This is how the baby is born

As soon as the anesthetic takes effect, the abdominal wall is opened. To do this, the doctor places a horizontal skin incision, about ten to 15 centimeters long, above the pubic bone in the bikini area, which is also called the panhandle incision. The length of the cut depends on the size of the child and the physical stature of the mother. Only in exceptional cases – for example in the case of premature births or under great time pressure – is the longitudinal cut made with the so-called T-cut from the navel to the pubic border.

The abdominal muscles are then separated. Since the uterus is behind the bladder, it has to be pushed down before the uterine wall can be opened with a small incision. Then the child is carefully lifted out, head first, possibly sucked off the nose and throat and the umbilical cord is cut.

When the baby is born – this is already the case after ten to 15 minutes – the placenta is removed. Medications that support the contractions of the uterus (after-effects) can also be administered. The uterine wall and abdominal wall are then closed again and the anesthesia is ended.

An operation based on the "Misgav-Ladach method" developed in Israel is gentler. With this procedure, the doctor does not cut the tissue layers hard with a knife, but only cuts them lightly. The tissue is then pulled apart and stretched. In this way, the surgeon spares nerves and blood vessels, and the healing process is faster.

Risks of Caesarean Section – Death Rate?

Until the beginning of the 20th century, the mother's risk of dying after a caesarean section was very high. In the meantime, anesthesia procedures, surgical techniques and medical monitoring have developed further, so that the caesarean section is now a standard procedure with a high level of safety.

Risks during the procedure for the mother

The anesthetic can cause breathing problems and poor circulation during anesthesia. Nausea and vomiting are among the relatively common, very unpleasant side effects. Severe blood loss, a drop in blood pressure or, in very rare cases, pulmonary embolism may also occur during the operation. Injury to the bladder or intestine is also not excluded.

Problems in the child

A relatively common complication is child's breathing problems. With a natural, vaginal delivery, the amniotic fluid is pressed out of the lungs by the pressure in the birth canal. The release of stress hormones also supports the development of the child's lungs. This natural process does not apply to cesarean sections.

The liquid can be aspirated after the operation. However, the baby can still suffer from breathing disorders that require intensive medical care. With a planned caesarean section without previous contractions, adjustment problems in the child are more common than with a problem-free spontaneous delivery.

Post-Caesarean complications

The caesarean section is a major abdominal operation. The healing takes weeks and is not always without complications. An expectant mother can avoid birth pains by giving birth. To do this, she has to adjust to a slow healing process after the operation.

The following complaints can occur:

  • painful wound healing

  • Urination problems

  • Pain at the injection site of the anesthetic

  • Pain and difficulty walking

  • Circulation problems

  • Anemia

  • severe menstrual and scar pain

  • cosmetically disruptive scars after healing

  • The scar bursts open

  • Problems with uterine regression, adhesions

  • back pain

  • persistent numbness in the abdomen

  • psychological problems of the woman after emergency surgery

Since some caesarean sections lead to significant blood loss, some women subsequently suffer from anemia and iron deficiency. However, these are easy to treat and usually heal after some time.

After the operation, the uterine regression is slower, irregularities and more painful menstrual periods may occur. Adhesions within the uterus can cause problems in later pregnancies and births.

If the caesarean section was performed unplanned in an emergency situation, some mothers subsequently suffer from the feeling that they have failed as a woman. This is especially the case if the operation had to be performed under general anesthesia. Women who experience childbirth are relieved on the one hand about the pain-free birth, but on the other hand mourn having missed the first experience together with their child.

After the Caesarean section: the most important questions

A woman who has given birth vaginally is usually fit very quickly. After a caesarean section, this naturally takes some time longer. On average, the mother stays in the hospital with her newborn for between four and eight days. The urinary catheter is removed one to two days after the procedure.

In some cases, the scar has to be treated surgically again. In addition, metabolism and circulation are checked and any signs of infection are observed. In the hospital, the midwife helps the woman with breastfeeding and takes care of the baby.

What else is important after the caesarean? The most important questions and answers

When does the scar heal after a caesarean section?

Threads or staples are removed before leaving the clinic at the latest. At first, the caesarean section scar still looks very rough, is swollen, red and sensitive. Every little movement – getting up, coughing, laughing – strains the abdominal muscles and causes pain at first.

On the other hand, the woman receives pain relievers that are also suitable for breastfeeding women. If the healing proceeds without complications, the belly can be fully loaded again after about four to six weeks. However, the scar area can remain sensitive for a long time, become completely numb or itch from time to time.

Weekly flow after cesarean section?

As a rule, the weekly flow after a caesarean section is less pronounced than after a vaginal birth. When the caesarean section scar has healed externally, is no longer open or is wet, you can bathe again – this is the case after about two weeks. Contrary to popular belief, the weekly flow is not "highly infectious", but especially the nipples should be showered after bathing.

Regression after a caesarean section?

The regression takes a little longer after a caesarean section. The pelvic floor was not stressed as much as in a normal birth, but the previous months of pregnancy also left traces in a caesarean mother. That is why post-exercise gymnastics is important for them too. However, the appropriate exercises may only be started when the surgical scar has healed well. This is usually the case after four to six weeks and should be discussed with the doctor.

When can you do sports again after the caesarean section?

The mother should take some time to exercise and carry heavy objects – after four to six weeks the abdominal muscles can be fully stressed again.

When can I breastfeed after a caesarean?

The earlier the newborn is allowed to suck, the sooner the milk flow gets going – even after a caesarean section. In addition, early breastfeeding promotes uterine regression and attachment to the child. If the operation is performed under local anesthesia, the baby can be put on for the first time in the operating room, otherwise after waking up from general anesthesia. Administered pain relievers and medication are safe for the baby. Initially, you should get help with breastfeeding. For many women, breastfeeding while lying down is the least stressful in the first few weeks.

When can I have sex again and get pregnant?

New parents are usually allowed to have sex if the woman feels comfortable and the healing process went smoothly. When the weekly flow ceases, it is a sign that the uterus has receded. Then the risk of infection is only low.

Regardless of whether you have a caesarean section or not: In order for the mother's body to recover, doctors recommend that you have at least one year after the birth of your next pregnancy. After a caesarean section, this time is also necessary so that the scar tissue can regenerate and strengthen.

Is a normal birth possible after a caesarean section?

If a woman becomes pregnant again, she can of course give birth to the child despite a Caesarean section. It is not uncommon for both the woman and the maternity clinic to shy away from the slightly higher risk of complications that can occur after a caesarean section, such as a ruptured uterus (uterine rupture) or plazena problems.

The intervention can easily be carried out several times. The incision is then made so that the old surgical scar is cut out. However, it should be borne in mind that with every caesarean section, the risks for the mother and child during the operation increase and the strength of the abdominal tissue and the condition of the uterus suffer. This can affect pregnancy as well as the immediate birth process.

Therefore, every pregnancy after a caesarean section is classified as a high-risk pregnancy. Their course and delivery are under special medical care.