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A cesarean section, or C-section, is a surgical procedure in which the obstetrician makes an incision in the abdominal region, under spinal anesthesia administered by an anesthesiologist, to allow the baby to be born.

This type of delivery can be scheduled by the obstetrician in advance, if desired by the woman or if vaginal delivery presents a risk to the woman or the baby, such as in cases of placenta previa. It can also be performed in emergency situations such as uterine rupture or umbilical cord prolapse, or during labor, for example.

Generally, a cesarean section is performed following these steps:

1. Spinal anesthesia is administered to the pregnant woman, who must be sitting or lying down for the administration of the anesthesia;

2. Then, a catheter is inserted to contain urine;

3. After the anesthesia takes effect, the doctor will make an incision near the "bikini line," and will cut through 6 more layers of tissue until reaching the baby.
4. After the incisions, the baby is removed along with the placenta and amniotic membrane;
5. The final part of the surgery is the closure of the incision. At this point, the doctor will stitch all the layers of tissue cut for delivery, which can take an average of 30 minutes.

When the baby is removed from the womb, the neonatologist will assess whether the baby is breathing correctly, and then the nurse can place the baby in the mother's arms, with the help of the companion, while the doctor also removes the placenta.

Absolute indication:
The absolute indications for performing a cesarean section refer to situations in which a cesarean section is fully recommended, and include:

• Uterine rupture, as it can endanger the life of the woman and the fetus, requiring immediate delivery;

• Infection of the placenta and possibly the fetus, requiring immediate delivery;

• Non-reassuring heart rate outside the expulsive phase of labor;

• Abnormalities in fetal position;

• Small maternal pelvis, making vaginal delivery impossible. However, this diagnosis is only possible after complete dilation of the woman;

• Active infection with the herpes simplex virus;

• Maternal infection with the HIV virus, without antiretroviral treatment and/or unknown viral load or greater than 1000.

• Umbilical cord prolapse without complete dilation;

• Complete placenta previa or placenta accreta.

Only in cases of placenta previa and placenta accreta is it necessary to schedule surgery, as spontaneous labor may represent a life-threatening risk for the woman and the baby. In other situations, the need for surgery can only be determined after the onset of labor.

Relative Indications:
Relative indications for performing a cesarean section refer to situations in which the doctor may or may not recommend a cesarean section, and include:

• Having performed two or more cesarean sections previously;

• Gestational diabetes, in cases where the estimated fetal weight on ultrasound is greater than 4.5 kg;

• Eclampsia or pre-eclampsia;

• Restricted fetal growth if there is an abnormal Doppler ultrasound;

• Failure of normal labor to progress, being stalled, prolonged, and without complete dilation.

Possible Risks:
Cesarean section is considered a safe procedure; however, due to the use of anesthesia and the fact that it is an invasive procedure, there is a greater risk of complications, especially when compared to normal delivery, the main ones being:

• Development of infection;

• Hemorrhages;

• Thrombosis;

• Injury to the baby during surgery; • Poor wound healing or difficulty in wound healing, especially in overweight women;

• Keloid formation;

• Increased risk of uterine rupture in future pregnancies;

• Difficulty breastfeeding;

• Placenta accreta, which is when the placenta remains attached to the uterus after delivery;

• Placenta previa;

• Endometriosis.

These complications are more frequent in women who have had 2 or more cesarean sections, as repeating the procedure increases the chances of complications during childbirth and fertility problems.

Complete healing can take from 6 to 12 months. However, according to doctors' guidelines, the postpartum period should be 40 days. This is the time necessary for minimal regeneration to occur before the mother returns to her routine.

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