The mechanics of a Caesar - this had me clutching my previously sectioned tummy!!!

Okay, so one can be excused for thinking a caesarean section is a simple operation consisting of a nice quick little cut into our abdomen followed by a nice quick little cut into our uterus, the OB lifting out our freshly baked babe, a few stiches or staples and Bob's your uncle. . .:rolleyes:
Well thats what the brochures we get handed to read explaining our impending caesareans tell us right? :doh:

So, I've been doing some reading and I just had to share what's really going on down there whilst we lay nervously on the operating table. Sorry if it's TMI - if you are really squeemish, don't read on.

Okay, so bypassing the insertion of the IV, catheter and Spinal/epi. The surgeon uses a scalpel to create an incision along your pubic hair line. This exposes the sub-cutaneous tissue which is soon covered with blood from the tiny cut blood vessels. With the scalpel and tweezers the OB cuts further into the sub-cutaneous tissue til he/she reaches a thich layer of fibrous tissue, called the facia which is responsible for holding your muscles and internal organs in place. He cuts through this layer with the scalpel then scrapes and/or pushes your abdominal muscles out of the way. This makes the uterus visible which is covered by a thin layer of tissue called the peritoneum (which covers most of yor internal organs). The peritoneum is lifted off the uterus and an incision is made into it. This exposes the uterus and bladder. Your bladder is peeled away from your uterus so an incision can be made into the lower segment of your uterus. The Ob puts a small cut into the uterus and extends this cut by either putting 2 fingers inside and ripping the incision open or using blunt ended scissors. (lovely)
The Ob then punctures the amniotic sac with toothed forceps and OB proceeds to get baby out.
Once bub and placenta are delivered, the OB quite often sits the uterus outside of the abdominal cavity so it is easier to stitch up. Then bleeding blood vessels are sutured, and the abdominal cavity is cleared of blood and fluid before the uterus is placed back inside. The bladder is sewn back onto the surface of the uterus, the peritoneum is closed, muscles are pushed back into place and are sometimes stitched into place. The facia (the thick fibrous tissue that holds your organs in place) is the most important part to be stitched. This layer is closed using heavy thread and many individual stitches in order to ensure it stops your internal organs from spilling out everywhere.
Finally your skin is closed with sutures or staples.

I found this all very interresting to read. Much more involved than I realised. And is certainly does not sound like the easy way out does it :wall:

I don't know about you. But after reading this I am starting to think that the prospect of dealing with a perineal tear or episiotomy with my next babys birth, is starting to seem a little more apealling then having my abdomen all chopped up again. :)

What are your thoughts???

when it is explained in all that detail it sure sounds scary doesnt it!! lol
I have to say I was petrified before my energency c/s...But as I couldnt feel it, the thought of tearing my perineum sounds a hell of a lot more painful for some unknown reason!! That was the only thing about natural labour that I was ****ting myself about - tearing something! (and pooing on the midwife, but thats another thread) pmsl

I look back at my photos and videos from the op and it still freaks me out to know that all that blood and insides are actually mine.

thanks for posting, it's really interesting

I personally find it fascinating.. When I had my c.s I looked at the lights above to see if I could see anything but it was a patterned surface so I could only make out a red colour which was blood..

*shudder*

This is one of the many reasons why I'm having a VBAC!

The pamphlets we receive do make it sound so simple and quick and easy. After my C section 2 weeks ago, the midwife told me I may feel pulling to one side of my stomach because they cut one side then tear the side furtherest from the surgeon (depends which side the surgeons on to what side gets torn) and she said they do this cause it heals better having one side sliced and the other torn, and you may feel a dragging or burning feeling to one side more than the other side this is the side thats been torn. And it all made sense when she told me, cause I could feel them cutting me then I my whole body was shaking from one side to the other this must of been when they were tearing the rest cause its what it felt like.

I guess they dont tell us this because too many of us would freak out prior to the operation and they could do without a patient in thearte goiong into panic on the operating table. Same reason as I think they wount let support people in when your getting your spinal and epidural because of the length of the needle, may freak some people out, they try and hide it.

I also found it quiet fascinating too, but other people ive told so far think its horrendous, and i suppose it is in a way because its not natural for the human body to have to go through that much trauma, under anesthetic or not, no wonder we feel so much pain afterwards!

It is fascinating and amazing what medicine can do these days and it is fabulous that we have an option to have c/s if our life or bubs life is in danger. Glad I'm not pg 200 years ago! Having said that after my c/s for "failure to progress" (pffft)with a bub who wasn't in distress and came out with agpars of 9 and 10, bring on the VBAC!!!! Only 22 weeks to go! :cheer:

I find it fascinating too. Any surgery isn't going to be pretty and if they put all the gory details in a brochure it would freak people out. Tan, I agree, it's amazing that we have these options and I'm also glad I'm not pregnant even 100 years ago!

One thing I found interesting though was

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The bladder is sewn back onto the surface of the uterus

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I didn't think the bladder was actually attached to the uterus so why would they need to sew it back? I thought they just pushed it aside out of the way?

gimme a tear anyday. this might sound silly, but i cant handle needles - and the thougt of this happening to my body petrifies me.

i think a vaginal delivery actually sounds like the easy way out!

Hi Guys,

it is quite facinating really isn't it. It's just when you think about the fact that this has been done to you it makes you feel a bit icky.

LOL, Limeslice. Tearing was always my greatest fear too. I even bought one of those EpiNo's but it ended up not being an issue anyway because I had a CS. My friend has told me though that when she tore she didn't even feel it and everything healed well so the prospect of tearing doesn't seem quite so bad now.

Danielle, I had a pulling stinging pain on one side of my tummy too. Now I know the reason for it :)

Laranna, before they peel the bladder out of the way I think your bladder is kind of fused against the uterus so when they put back in place sometimes they stitch it back to endure it stays in the right spot.

PS: Tanstar Good luck for your VBAC - You go girl!

I think it is actually quiet "cool" actually. I'm not intimidated, concerned, or grossed out by any of that... but then I've seen much worse surgeries ;) There are a LOT of proceedures where they simply dump your internal organs onto your outer body so they can get to the bit they want or achieve what they need to achieve. When they put it all back in, they often just push it in - amzingly the body is able to realign the organs to where they need to be (of course, there is some order in what goes back first!). For me, the worst part of ANY surgery is the diathermy. The best way I can describe it is to say it is like a welding iron but it is used to zap small bleeding blood vessels. To me, it smells like Pork and it is DISGUSTING. I can't stand it!

Great article!

Bumpity :bump:

this is interresting . . .

Great to read about... after the fact, but just reaffirming my VBAC plans for July! I'm thinking a small tear is nothing compared to the great ruddy scar on my tummy!

That was a great read!! I had two c/s, first under GA and the second with a spinal and really ... after reading it, I would have thought there was more involved :lol: But then again ... after the baby was out I stopped trying to constentrate to feel what they were doing and lost track of time ...

The thing that got to me ... were the spinal! NEEDLES!!! But that also was not as bad as I thought it would be

Wow. Wish I had seen this when I posted my intervention thread.

That just doesn't sound pleasant at all!

Awesome information!!!
I had a natural birth (thank god now I just read this thread)

But I was always open to the fact that they may need to do an emergancy cs...thank goodness that wasn't the case and I won't be so blasae about it next time round.......

My 2nd degree tear seems like nothing now compared to having a cs!!!

ok this has me positively terrified!!!! If I haven't gone into labour by next friday they are talking about induction which could possibly lead to intervention:wall: which could mean c/s, I know it's only a possibility but it just terrifies me!!! I would rather tear than have my insides messed around with.

I found the article interesting, but i worked in an anatomy lab one Summer as a student preparing cadavers (bodies or body parts) for the next years classes. I was fortunate to have a female cadaver to prepare and had to expose all the reproductive organs so i could visualise all the layers talked about in the article.

It was so interesting seeing what we look like on the inside. To see how close the bladder is to the uterus (realise why pregnant woman go wee all the time), to see how small the uterus is when it doesn't hold a baby, to see the ovaries and how they connect in. The body is amazing at how it can recover from all the 'damage' that we inflict on it.

I would prefer that (when performing a CS) they cut layer by layer (as the article says). Better than just diving in and hope they don't cut the baby or major organs/vessels of Mum.

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The Ob puts a small cut into the uterus and extends this cut by either putting 2 fingers inside and ripping the incision open or using blunt ended scissors. (lovely)

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I wonder if this is to make sure they don't cut the baby? Easier to be able to feel where baby is if you are using your fingers.

When I had my e-c/s 16 months ago for DS the surgeron explained all this to me tho I didn't take it all in and then once out of surgery when she came to do her rounds she sat down with us and explained it all again.

hey Brianna, my intention wasn't to terrify people. Best of luck with your birth. You'll be fine sweetie.

kate07 - Yup that's exactly why they use their hands or blunt ended scissors. Although there has still been many many cases of bubs being cut :(

I had a friend with a transverse baby (due to a uterus that was heart-shaped, can't remember the correct term) who needed a c/s and she had an extreme reaction to all of the amniotic fluid leaking into her abdominal cavity. She ended up with a massive infection and serious abdominal adhesions. The infection led to her being in intensive care with a collapsed lung. Three years and several operations later she's finally at a point where she's able to ride her horses again and not have to take strong painkillers every day.

It was a rare and extreme situation (and she didn't have a choice wrt the c/s), but it's interesting that amniotic fluid is not really supposed to end up in your abdomen and there's no way to avoid this with a c/s.

I also bless my dr with being careful and thorough. I've seen women after c/s in a lot more pain than I (I didn't need painkillers at all after a few hours) and I have to wonder how much of it is due to rough handling while on the table.

(Now you need to explain how an epidural/spinal is performed in detail - because that was my major issue, I had a spinal fluid leak and do just about anything to avoid an epidural again!).

Jennifer, Oh your poor friend. That must have been such a rare occurance. Oh and I think it might be called a bicornate uterus or something like that???
Yes my recovery was virtually painless too and I also credit my Ob for that. Apparently if your Ob is one of the ones who actually takes your uterus out of the abdominal cavity to suture it you're much more likely to be in more discomfort afterwards - makes sense.

Hmmm, you really want me to research and explain the details of administering a spinal block or epi or even a GA as well???