Summer Elizabeth Seastrand, MSN, CNM

C-section incisions can be up-and-down (vertical), from belly button to lower abdomen or side-to-side (horizontal), across the lower abdomen. Side-to-side incisions are more frequently used. After the exterior incisions are made, the doctor then cuts into the uterus and amniotic sac and delivers the infant and cuts the baby's umbilical cord. The mother receives medicine to expel the placenta and the doctor helps to safely remove it. Finally, the doctor uses sutures to seal the uterus and tissue incisions. The initial C-section skin incision is also closed with sutures or staples.

C-sections are typically performed with regional anesthesia, which inhibits pain in the lower half of the body, but allows mothers to be awake. However, some mothers may receive general anesthesia, where they are put to sleep during the surgical procedure.

C-sections may be planned or unplanned, depending on the circumstances of the birth.

Pre-existing conditions like heart disease, high blood pressure, herpes, and HIV may prompt a doctor to prescribe a C-section. Other situations for C-section include:

• A large baby or birth to multiple children
• Pelvic fracture or limited birth canal
• Baby in the "breech position," where a baby is positioned feet or bottom first in the uterus
• Baby with a developmental disorder
• Irregular fetal heartbeat
• Mother with a history of previous C-sections

Other mothers may require a C-section due to complications arising during delivery. These unplanned, emergency C-sections allow for a healthy birth even when complex complications are present. Problems during labor which may necessitate a C-section include:

• Labor not progressing
• Fetus switching position during labor
• Distressed infant
• Blockage of the cervical opening by the placenta
• Prolapsed umbilical cord

Mothers should expect about a six-week recovery period following a C-section, including an initial hospital stay of two to three days. While in the hospital, mothers may spend time with their baby and begin breastfeeding. After returning home, mothers should limit strenuous activities such as lifting, reaching, and exercise, and should make sure to get plenty of rest.

The choice of treatment for pelvic organ prolapse depends on the severity of the condition. Mild to moderate prolapse may be managed by doing pelvic floor strengthening exercises, taking hormone replacement therapy, or using pessaries. Pessaries are small devices inserted into the vagina to help support the pelvic organs. Pessary fitting is a quick procedure done in a doctor's office. For severe prolapse, surgical treatment may be necessary. Pelvic organ prolapse surgery repairs the following:

• Cystocele or bladder prolapse, where the bladder sags into the vagina. The surgeon repairs a cystocele by strengthening the front wall of the vagina using stitches so that the bladder will no longer sag.
• Enterocele or small bowel prolapse, which occurs when the small bowel descends towards the vagina. To correct an enterocele, the tissues between the small bowel and the vagina are sewn together, allowing them to provide more support.
• Rectocele or posterior prolapse, which is the bulging of the front wall of the rectum into the back wall of the vagina. Surgery to repair a rectocele removes the excess stretched tissue between the rectum and vagina.
• Uterine prolapse, which occurs when the uterus slips down to the vagina. To treat a uterine prolapse, the surgeon may secure the neck of the uterus (called cervix) to a ligament in the pelvis using stitches. Another option for this type of prolapse is a vaginal hysterectomy, which is the removal of the uterus.

Each of these procedures is performed through a vaginal incision, but an enterocele repair may use the abdominal approach as an alternative. If two or more pelvic organs have prolapsed, a combination of any of these procedures may be performed during the same surgical session.

For women who no longer wish to have intercourse, an operation called colpocleisis

may be a surgical option as well. By closing the vaginal canal, colpocleisis treats pelvic organ prolapse and eliminates any risk of its recurrence.

In most instances, pelvic organ prolapse surgery only requires a hospital stay of one day. Patients may experience vaginal bleeding for the first few weeks following surgery. If this happens, patients should use sanitary pads rather than tampons, as a higher risk of infection is associated with the use of tampons. To further help with recovery, patients should begin doing gentle pelvic floor strengthening exercises a few days after surgery. Doing these exercises at least three times a day as a routine tightens the pelvic floor muscles and prevents the recurrence of prolapse.

Despite the name, not everyone with polycystic ovarian syndrome develops cysts on their ovaries. It is also possible to have ovarian cysts without having PCOS. The symptoms of polycystic ovarian syndrome are actually related to insulin resistance, a condition where the insulin made by the body is not effectively recognized by the cells. This causes the pancreas to release higher levels of insulin in order to keep blood sugar levels stable, and the excess insulin interferes with hormone production in the pituitary and ovaries, causing the PCOS symptoms.

The symptoms of PCOS include:

• Weight gain
• Acne
• Facial or body hair
• Thinning head hair
• Missing or irregular periods
• Infertility

PCOS is a syndrome, which means that if patients have PCOS, they might not have each and every symptom. Even a few of them might be enough to have physicians check for polycystic ovarian syndrome. A doctor might perform an exam and order blood tests to measure hormone levels.

Treatment for PCOS may include:

• Insulin sensitizers, which help the body use insulin more effectively, lowering hormone levels. The most commonly used insulin sensitizer is metformin.
• Weight loss. Being overweight does not cause PCOS, and PCOS can make losing weight difficult. Still, weight loss can improve symptoms for many women.
• Birth control pills to regulate menstruation and sometimes reduce symptoms such as acne.
• Fertility medications, especially medications to stimulate ovulation such as clomiphene.
• Anti-androgen medications, which work to treat symptoms such as acne and facial hair.
• Low-carb diets, which work similarly to insulin sensitizers to lower hormone levels and help reduce weight.
• Ovarian drilling or resectioning, surgical procedures sometimes performed if infertility is a persistent problem. These procedures open up the wall of the ovary to temporarily make ovulation more likely.

Polycystic ovarian syndrome is one of the most common endocrine disorders affecting women. Left untreated, it can increase the risk of diabetes, heart disease, and certain cancers. Fortunately there are many good treatment options available.