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Joining us today to discuss what Caesarian sections are all about and why they’re called Caesarian sections in the first place are two experts.  To my left, Dr. Adrianne Moore Assistant Professor of Obstetrics and Gynecology at the Weil Cornell Medical College in New York City.  Welcome Dr. Moore.  And her colleague, Dr. Steven Hockstein, Assistant Professor of Obstetrics and Gynecology also at the Weil Cornell Medical College in New York City.

MICHELLE LAMOTHE, MD:  How did this surgery get its name?  What is a Caesarian section?  What’s the history?  Dr. Hockstein?

STEVEN HOCKSTEIN, MD:  There are stories that Julius Caesar was delivered by Caesarian section.  And the current term comes from his last name.  It also may be that word “cesar” – to cut in Greek – may be the origin of the current term.

MICHELLE LAMOTHE, MD:  Why do women get C-sections or Caesarian sections?

STEVEN HOCKSTEIN, MD:  There’s a host of reasons a woman may end up delivering by Caesarian section.  One of the most common indications is the simple fact that she’s had a Caesarian section in the past, and she’s decided to have a Caesarian section again.  And this is something she should discuss with her physician.

Other reasons include what’s called arrest.  During the labor process at some point, the baby – or a dilation of the cervix, or descent of the baby just doesn’t occur despite good contractions.

MICHELLE LAMOTHE, MD:  Are those all called arrest?

STEVEN HOCKSTEIN, MD:  Well, there’s arrest of dilation, arrest of descent.

MICHELLE LAMOTHE, MD:  Well, they mean stopping of the ...

STEVEN HOCKSTEIN, MD:  Stopping of progress in labor.  And that occurs – maybe that the baby is too large for the mother’s pelvis.  But that does occur on occasion.  And that’s a reason.

Other reasons include malpresentation.  Perhaps the baby, instead of being head down in the vertex presentation, is breach – or coming down with the feet first.  And in most cases, or in almost all cases, that would be – it would be recommended that the baby deliver by Caesarian section.

MICHELLE LAMOTHE, MD:  Dr. Moore, can you talk to us a little bit about elective C-Sections?  What does that mean?

ADRIANNE MOORE, MD:  An Caesarian section is one that you would anticipate doing prior to the onset of labor.  So, for example, as Dr. Hockstein mentioned, the C-Sections done because a woman has had one in the past and is not willing to try to have a vaginal delivery after having a C-section in the past.

MICHELLE LAMOTHE, MD:  Is it common, though, that somebody might ask you to perform a C-section when they didn’t have a reason why they made need one?

ADRIANNE MOORE, MD:  That’s actually – it’s a very interesting question.  And, yes, it does come up sometimes.  Because there are risks inherent in Caesarian section, that’s the sort of thing that you would have to discuss and individualize with your physician.

MICHELLE LAMOTHE, MD:  Dr. Hockstein, can you talk to us a little bit about the risks of Caesarian section then?

STEVEN HOCKSTEIN, MD:  Caesarian sections are very, very safe.  Approximately one million Caesarian sections are done in this country every year.  And we do it all the time.  Everyday at the hospital, Caesarian sections are done.

Nevertheless, it is a major operation, and there is a blood loss of approximately one liter associated with the operation.  There are the complications of any surgery – risks of infection, risks of scar tissue, risks of damage to the bladder, other structures that are in the abdomen.  These things are rare, and complications rarely develop.  But it still is a major operation.

MICHELLE LAMOTHE, MD:  Well, tell me – it is a major operation.  And a woman would be mostly awake during this – could she be asleep?  What different kinds of anesthesia – Dr. Moore or Dr. Hockstein – would you prefer to – would you talk a little bit about the anesthesia types?

ADRIANNE MOORE, MD:  There are three types of anesthesia that are available for a Caesarian section, and combinations thereof.  If a woman has had an epidural during labor, then she may and requires a Caesarian section – she may then have a Caesarian section performed under an epidural anesthesia.

MICHELLE LAMOTHE, MD:  Could you tell us a little bit more – what is an epidural anesthesia?

ADRIANNE MOORE, MD:  Epidural anesthesia is an anesthesia applied around the spinal cord through a small catheter, and allows a woman to be awake from the waist up and not feeling the contractions as strongly from the waist down.

MICHELLE LAMOTHE, MD:  What other kinds of anesthesia would be available to a woman who is having a Caesarian section?

ADRIANNE MOORE, MD:  Spinal anesthesia can be performed, which is similar to the epidural anesthesia, but without having a catheter in place, so its action is much – is of a specific time – about an hour or two.  And she’s also awake.

MICHELLE LAMOTHE, MD:  And there is a third kind.

ADRIANNE MOORE, MD:  And the third kind would be general anesthesia where the woman is not awake at all, and has a breathing tube placed during the anesthesia.  This is most commonly used when the Caesarian section needs to be performed very rapidly for fetal distress or a nonreassuring fetal heart tracing.

MICHELLE LAMOTHE, MD:  When the baby is not doing as well as the doctor might hope.  Well, Dr. Hockstein, I’m going to challenge you to tell us actually about how a Caesarian section is performed.  You can tell us so that we really have an understanding of how this operation is done.

STEVEN HOCKSTEIN, MD:  Well, on average, the operation takes about 45 minutes.  So it’s not a very long operation.  After assuring that the woman is comfortable and her epidural and spinal anesthesia is providing her with adequate pain relief, generally a transverse skin incision is made – right, it’s about 10 or 11 centimeters long at the top of the hairline.  It would be hidden by a bikini – the “bikini incision” as it’s commonly called.

MICHELLE LAMOTHE, MD:  Okay.  And it’s a little incision – a little cut about how long?

STEVEN HOCKSTEIN, MD:  About 11, 12 centimeters – about that long.  And then you just go down through the layers of the abdominal wall to get to the uterus to where the baby is.  The muscles of the abdomen are separated, the uterus is entered, and the uterine incision is extended.  And then you literally reach in and elevate the baby up and out through the incision.  The cord is clamped and cut.  The baby is handed off to the nurse who is waiting.  And then the placenta is removed from the uterus, and then everything is put back.  The uterus is sewn shut.  The layers of the abdomen are sewn back together reapproximated.  And then the skin is then closed with stitches or with staples.

MICHELLE LAMOTHE, MD:  Dr. Moore, after this surgery, how long does it take for a woman to recover?  How long would a woman stay in the hospital, and how would she feel in the weeks that follow?

ADRIANNE MOORE, MD:  She would usually stay in the hospital three to five days, depending on how quickly her recovery course goes.  And because it’s major – major surgery, and you’ve just had a baby, the recovery is somewhat protracted.  And in about six weeks, you would be feeling much better.  And that’s the peripartum period.

MICHELLE LAMOTHE, MD:  And  so a woman would stay in the hospital for about how many days?

ADRIANNE MOORE, MD:  Three to five days.

MICHELLE LAMOTHE, MD:  And she could nurse her baby and would be beginning to get up and around, but she may sore for a while after that.