types of lscs?

Caesarean section
By SickKids staff
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Important information regarding Caesarean sections: why it may be required, how it is done, what the complications are, and potential effects.
Key points

Caesarean section is major abdominal surgery where the incision is made through the skin, the underlying fat, and into the abdomen and uterus.
Complications of caesarean section include hemorrhaging, pain, infection, blood clots or damage to the uterus.
Caesarean section is generally a safe procedure for the baby however they are at a slightly higher risk for breathing problems, and trauma due to surgical cuts.

Caesarean section, sometimes referred to as C-section, is the surgical delivery of a baby through incisions in the abdomen and uterus. Sometimes caesarean section is done after a long labour that has not progressed properly. Caesarean section may also be performed in emergency situations where the mother or baby’s life is in jeopardy. Other times, a caesarean section may be planned because the mother had a previous caesarean section or has a condition that makes labour dangerous.

Caesarean section, sometimes referred to as C-section, is the surgical delivery of a baby through incisions in the abdomen and uterus. Sometimes caesarean section is done after a long labour that has not progressed properly. Caesarean section may also be performed in emergency situations where the mother or baby’s life is in jeopardy. Other times, a caesarean section may be planned because the mother had a previous caesarean section or has a condition that makes labour dangerous.

Caesarean section is used for the following reasons:

if the mother has a condition that makes labour hazardous to the baby, such as placenta previa or a problem with the umbilical cord called vasa previa
if the mother has a previous "classic" uterine incision or uterine reconstruction, which can make uterine contractions dangerous for the mother
if the baby needs to be delivered due to a health problem in the mother or baby, but attempts to induce labour are not possible or have failed
if the contractions of the uterus are not effective and labour is not progressing properly
if the baby’s head is too large to pass through the mother’s pelvis
if the baby’s position in the womb – a breech position, for example – makes it difficult to deliver naturally
if the baby’s heart rate, measured by a fetal monitor, shows that the baby is not tolerating labour well
if there is an emergency condition, such as severe placental abruption, where a vaginal delivery would be life-threatening
if the mother has active genital herpes, which is a disease that can be passed to the baby during a vaginal delivery

Anaesthesia during caesarean section

Caesarean section is done under either a regional or general anaesthesia. Regional anaesthetics, such as epidurals and spinal blocks, numb the area from the waist down, and allow the woman to remain awake during the surgery. In an epidural, a fine tube is inserted into the woman’s back, into a space between the spinal cord and its outer membrane. The anaesthesia medication moves through the tube into the woman’s back, and the flow of medication can be controlled. In a spinal block, the anaesthesia medication is injected in one single dose into a part of the woman’s spinal column. The pain-relieving effects of a spinal block are almost instant, and they last for about one to two hours after the injection. General anaesthesia, which puts the woman to sleep, is frequently used for emergency caesarean sections.
What happens during surgery?

Caesarean section is major abdominal surgery where the incision is made through the skin, the underlying fat, and into the abdomen and uterus. The bladder may have to be moved out of the way before the surgeon can cut into the uterus. The cut is just a bit longer than the size of the baby’s head. After the cut is made, an assistant pushes on the top of the woman’s uterus, and the baby is carefully delivered through the incision. After the baby is born and the placenta removed, the surgeon stitches up the uterus and the different tissue layers.

There are two types of caesarean section, which differ according to the direction of the incision on the abdomen. These are the classical cut and the bikini cut. The bikini cut is more popular because it heals and looks better, and causes less pain after surgery. In the bikini cut caesarean section, the doctor makes an incision from one side of the abdomen to the other, just above the pubic hair line. The scar is at the woman’s bikini line, and therefore does not show if she wants to wear a two-piece bathing suit. In the classical caesarean section, the incision is made vertically from just below the belly button to the top of the bikini line.
Caesarean Section Cuts
Bikini cut with curved line across lower abdomen, and classical cut with straight line between belly button and bikini line
In the bikini cut caesarean section, the doctor makes an incision from one side of the abdomen to the other, just above the pubic hair line. In the classical caesarean section, the incision is made vertically from just below the belly button to the top of the bikini line.

There are also two types of incisions that can be made on the uterus itself. If the bikini cut was used on the abdomen, the surgeon may make a side-to-side cut on the uterus, called a low transverse uterine incision or lower segment caesarean section (LSCS). If the classic cut was used on the abdomen, the doctor may make a bikini cut on the uterus or more rarely will make a cut on the uterus that goes vertically, called a classic uterine incision. Side-to-side incisions of the uterus are generally safer and have a smaller chance of breaking open in a subsequent pregnancy. Women who have an LSCS are likely to be able to attempt a vaginal birth after caesarean section (VBAC). Women who have classical caesarean section should not attempt a VBAC because of the higher risk of uterine rupture during childbirth.
Planned caesarean section

Planned caesarean sections are often done after a woman has already had a caesarean section in a previous pregnancy. Planned caesarean sections have some clear benefits, in that the pregnancy is guaranteed not to go post-term and the risk of post-term pregnancy problems is eliminated. Also, planned caesarean section may be required when the mother or baby has a condition that makes going through labour dangerous.

However, some women are interested in planning a caesarean section for the sake of convenience or to avoid the rigours of labour. If this is how you feel, it is important to note that, while caesarean section is considered safe, it is associated with a higher risk of complications for both mother and baby compared with vaginal birth. Caesarean section is not the easy way out by any means.
Complications of caesarean sections

One possible complication during caesarean section is heavy bleeding, called hemorrhaging. The uterus is a large, muscular organ with many blood vessels. Therefore, when an incision is made in the uterus, it can lead to hemorrhaging. Sometimes a blood transfusion is needed to replace the blood that is lost during the caesarean section. Very rarely the bleeding cannot be stopped and a surgical removal of the uterus, called a hysterectomy, must be performed.

Pain is a common complication after caesarean section. Women sometimes do not realize that they will feel a considerable amount of pain, lasting several weeks after the surgery. The pain after caesarean section is more severe than that after a vaginal birth. In fact, a recent study showed that 100% of women who underwent planned and unplanned caesarean section required narcotic pain medication afterwards, compared with 11% of women who had a vaginal birth.

There are a number of other complications that can occur during or after a caesarean section. These include:

fever
infection at the incision site
urinary tract infection
infection of the uterus or lungs
blood clots in the uterus, leg veins, or lungs
damage to the uterus, which can make future childbirth dangerous

Effects on the baby

Caesarean section is generally a safe procedure for the baby. An added bonus is that babies born by caesarean section often have nicely shaped, rounded heads if there has been no labour. This is because their skull bones do not become compressed by the pelvis, as they would during a vaginal birth. However, the heads of babies born vaginally can’t be distinguished from those born by caesarean section after 24 hours.

Babies born by caesarean section are, however, slightly at risk for breathing problems, because there may be retention of the fluid that is produced in the lungs before birth. Other risks include asthma and certain allergies.

Caesarean section babies are also at higher risk of trauma due to surgical cuts, especially during emergency surgery. These cuts are usually minor.
Last updated: September 11th 2009