It is often said that the name comes from the Roman Emperor Caesar (born 100 and murdered on March 15, 44 BC) but the truth is that in the first century BC this procedure was fatal (if it was ever done) and it is known that Caesar’s mother lived long after his birth. The first written evidences about cesarean arise during the Middle Ages (14th century), the word that was used at that time came from the Latin caedere, caesura (cut) and it is possible that it is the real origin of the word “Caesarean” today. The later reports show a very high mortality due to hemorrhage and infection during the next 400 years. The truth is that there was some experience in the cesareans of dying women or immediately after death to save the baby

In 1888 someone had the idea of suturing the uterus (before there were no sutures and the wounds were left open) and the mortality decreased from 90-100% to 50% -a record for the time-. There was no anesthesia, no antibiotics, and the surgeons did not wash their hands, did not wear gloves (in 1890 Halsted, Surgeon, began to use gloves in surgeries) and the materials were not sterile. If the baby could not be born, it was expected to die and it was extracted in parts. The mother usually died in hours or days due to the hemorrhage and / or infection.

In the last 60-70 years everything changed: antibiotics were discovered and better anesthetics, suture materials, surgical instruments, sterilization methods and medical equipment were invented and Obstetricians acquired better training and knowledge about the reproductive process of the human being. In the literature, we begin to see cesarean as the Alternative Method of Birth

Our procedure has been modified to obtain the best possible results with respect to safety, infecto-hemorrhagic complications, costs, postoperative pain and early discharge, we have named it the Gómez-Gil Cesarean Section  and we are getting amazing results.

How can I know if my baby will be born by birth or cesarean?

There are three basic ways to know where your baby will be born:

• Previous birth: those mothers who have delivered full-term babies (more than 37 weeks) will surely give birth without problems. Having delivered a premature baby does not guarantee a delivery of a mature baby (matter of fetal size)
• Radiopelvimetry (RxP): the radiological study done at the end of pregnancy helps compare the dimensions of the fetal head with the maternal pelvis. This study may reveal “Pelvic Sufficiency” (can give birth) or “Pelvic Insufficiency” (can not give birth). The RxP is not very sensitive and there are cases of “Pelvis Insufficient” deliveries and Caesarean cases after a failed labor in “Sufficient Pelvis”. Its use has decreased considerably
• Labor test: “every woman without contraindications can give birth until proven otherwise” and the only way to try to prove it is waiting for the birth and follow its evolution: if the delivery develops normally because we will have a vaginal delivery normal in 75-84% of cases. If the delivery deviates from normality for maternal or fetal reasons, a Cesarean section is performed. This is the most common way

How is the cesarean section?

Once the patient is anesthetized and prepared, we approach the abdominal cavity through a low transverse incision (under the bikini line) that is called Joel-Cohen and has excellent aesthetic results, in addition to bleeding, pain and less infection. Never, even in emergencies, we make a vertical incision (except the patient already has one), since we consider it to be unattractive and without any particular benefit for the patient. Once we reach the uterus we make a transverse incision and we reach the baby through the muscular wall and the water bag and, holding it by the head or hips (if it is sitting), we extract it from the womb, we cut the cord and then We remove the placenta to repair with sutures the uterus and the rest of the tissues that we incise until we reach the skin. Usually, we get the baby in the first 1 to 2 minutes and finish the procedure in about 18.20 minutes or less. In our team we use a technique based on the best available medical evidence, a modification of the Misgav-Ladach technique that we have published as Cesárea Gómez-Gil

Births by elective cesarean (non-medical indications) will be carried out from week 38.0 to avoid a slight percentage of Newborn respiratory difficulty that occurs between weeks 37.0-38.0

Some recent publications have suggested not interrupting pregnancy before week 39 (delivery or caesarean section) due to some respiratory complications of the newborn. Later work suggests that the potential complications are similar, so the recommendation should not be so strict. In our practice, complications are so low that our interruption behavior remains the same, by week 38, and usually before the 40th. We do not use lung maturation with cesareans or deliveries before week 38.6 (we discuss their indication if the baby will be born before 37 weeks)

Preparation

Days and night before the cesarean section : The pubic region should be shaved at least 3 days before the intervention; If you do so within 48 hours before the intervention, you may increase the risk of infection of the operative wound. If you wish you can have a Fleet enema in the afternoon, especially if you have a tendency to constipation. You can eat what you want before going to bed, as long as it is reasonable, do not agree very heavy meals or that produce a lot of gas or acidity. Try to rest, go to bed early. Do not use color nail polish, transparent brightness is adequate and allows the monitoring of your vital signs on your fingers (oxygen pulsimeter)

In the morning, before the Caesarean : if the intervention is at 1 pm, you will be allowed to have breakfast until 6 am This breakfast should be very light and could consist of cereal with milk and a non-citrus juice. Soda crackers, Social Club accompanied with a Gatorade or a natural juice has been an option for many patients. After 6 am you will not be able to eat anything or water. If your cesarean is in the morning, usually at 7:30 a.m., you should not take anything since midnight. If your cesarean section is Emergency our anesthesiologists are prepared for airway management with full stomach

Fasting : should be 8 hours, this type of fasting involves not taking anything by mouth, or water.

Admission must enter the clinic 2 hours before the suggested time for your surgery. The patient enters directly to the Delivery Room, 3rd floor of the Medical Center of Caracas , where she will be received by the nursing staff. In the Trinity Teacher, the patient enters the 2nd floor, Obstetric Triage, in the hospitalization building, where she will be received by the Resident Obstetrician on duty. In both cases the relative in charge will be in the Ground Floor, Admission, to finalize the administrative details of the entrance.

Do they sleep me completely?

We use Peridural/Rachidian Regional Anesthesia that anesthetizes the maternal pelvis (from the umbilicus downwards) without affecting the baby. Only in cases of extreme emergency is general anesthesia administered

Post-cesarean analgesia

We have several schemes of intravenous analgesia, oral, mixed (intravenous, oral, rectal) and analgesia per epidural infusion pump

The Obstetric Pain Units can manage post-operative pain by using digital pumps that manage, continually and / or at the patient’s request, small quantities of analgesics that efficiently control pain and allow a faster and more comfortable recovery. It is used for approximately 2 days.

Complications

In our times Cesarean section has become a very safe procedure with minimal complications and rapid recovery, the most frequent complications are hematoma and wound infection, postpartum hemorrhage, venous thrombosis, among others. With the adoption of better techniques we have taken the complications to almost non-existent levels

The risk of dying from a Cesarean is one (1) death for every 18,000 Cesarean sections performed. In the world in general, it is much easier to die in a traffic accident than to die as a result of a Cesarean

Is it better to give birth than to have the baby through a cesarean section?

If there is no contraindication for vaginal delivery and it develops properly, there is no need to perform a Cesarean section. In these conditions vaginal delivery is better, there are no abdominal injuries, recovery is much faster and the surgical risks of a Major Surgery are avoided

So, is a cesarean “bad”?

In our times it is not, if it is possible to give birth it is convenient to give birth. Before, a Cesarean was to condemn the patient to death; Now, Caesarean is a very safe method invented by man to correct the imperfections of Nature. The current Caesarean section suggests Medical Advance and has avoided and will prevent many cases of fetal and maternal death and disease. In countries such as Brazil the cesarean rate reaches 80% and in Venezuela it could be similar, in the USA it stands at 31%.

Delivery after a cesarean section

If the cause of the first Caesarean section does not recur it could have a Vaginal Birth but we must bear in mind the risk of uterine rupture (~ 1%) that could have catastrophic results for mom and baby. I do not do it

My recovery after a Cesarean

It takes more time than a Vaginal Birth (this is debatable, it depends on the technique). There are more wounds to heal (see Wound Care) and more pain to tolerate for 2-3 days. It takes about 6 to 8 hours to walk again and about 5-7 days to feel recovered and restart certain domestic tasks

Keep in mind the following limitations:

1. Avoid, as much as possible, going up and down stairs
2. Do not lift weights greater than your baby’s weight during the first two weeks after cesarean
3. Do not do domestic tasks that require stooping, bending or carrying heavy weights (vacuuming, sweeping, picking up things from the floor, washing clothes, flirting) during the first two weeks; start work progressively and seek help if necessary
4. Do not drive vehicles for two weeks
5. Do not bathe in a bathtub during the first two weeks, use the shower

Video: Removal of subcuticular suture

My right to request a cesarean section

The availability of information for the patient (Internet, publications) has changed the way current medicine is exercised: the patient has the right to receive and verify the information that the doctor gives him, in this way the patient makes use of his right to participate in the decision of the treatment to which it will be submitted. At the end of the day it is your body and you have the right to choose in an informed manner the way in which you will be invaded by medical treatment. In many parts of the world there have been movements based on the right of women to choose the pathway through which their baby will be born: if I can choose between various treatments for cancer, uterine fibroids, obesity, high blood pressure, etc. Why can not I choose my baby’s birth path?

• Pro-Caesarean section: if you panic to give birth or you simply do not want to give birth and feel in control of the way and when your baby will be born, I believe that you have the right to choose and your doctor should perform a Caesarean if you agree with you ( your doctor may not agree to practice a Cesarean section a priori and refer you to another doctor, for example)
• Pro-Labor : At least 80% of women could give birth without risks for her or her baby. Well-controlled labor and delivery should not make us panic, in fact, a modern management of labor should not be an extremely painful act thanks to modern methods of pain management (spinal analgesia) or extremely dangerous thanks to electronic fetal surveillance methods (intrapartum fetal monitoring). In general terms: a properly managed delivery that evolves satisfactorily is better than a Cesarean section in many aspects

Cesarean sections of short hospitalization

In selected patients, hospital discharge can be decided within 24 hours in order to significantly reduce the costs of the intervention. We have greatly increased the number of early discharges because our technique has given excellent results with respect to recovery.

My particular position: “Vaginal childbirth is the most natural non-perfect way for the birth of a baby but every woman has the right to give birth or at least to try it knowing that if it is not safe she will have an alternative and secondary method that will try to guarantee the well-being of her baby and herself. “

Caesarean indications

There are several indications, some absolute and others debatable

• Fetus-Pelvic Disproportion
• Previous placenta
• Multiple pregnancy
• Fetal suffering
• Previous Cesarean section
• Podálica Presentation
• Preeclampsia
• Placental abnormalities
• Maternal desire

Video: Cesarean section

Note: this is the CS of my daughter back in the day when our current procedure was not developed. We do not use several instruments and steps that were used then.

The cesarean section: changed the natural history of human birth?

This is an inescapable fact, it has been made safer than some types of vaginal delivery. Your frequency will continue to rise

Am I less a mother for having a cesarean section?

No, nobody can judge you for it; in fact you are no less a mother for having had your children by caesarean section or giving them breast if there were not the necessary conditions.

I ignore certain stupidities, my children were born by caesarean section and were fed formula and are as much or more loved and healthy than the average child born around the world.