Christina X. Marea, 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.

It is important to note that having any of these conditions does not necessarily mean that a hysterectomy is necessary. There are other available treatment options in most cases.

Although the uterus is responsible for a period, it is the ovaries that control the hormonal changes that women go through every month. So if a woman has a hysterectomy but keeps her ovaries, she might still experience hormonal swings every month even if she no longer has a period. Alternately, if a younger woman has a hysterectomy where her ovaries as removed, she will essentially be in immediate menopause.

A hysterectomy can be performed traditionally through one large cut in the abdomen, laparoscopically using tiny incisions and small tools, or through the vagina. Full recovery may take four to six weeks. After a hysterectomy, patients might experience sexual changes such as vaginal dryness or a change in libido. It is common to experience strong emotions after a hysterectomy, including both grief and relief. If a patient's ovaries were removed, they may be at higher risk for certain diseases, such as heart disease and osteoporosis. Taking hormonal birth control might reduce this risk.

The device should be kept clean to avoid issues like vaginal odor, discharge, or irritation. To clean a pessary, it must be taken out and washed with soap and water. Healthcare providers will instruct patients on how to remove and reinsert the device. If patients are unable to do this on their own, they will need to get it done at the doctor's office at least once every two months.