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C-Section - before, during, and after

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Transcript

Hello, everyone, welcome back to parently. Today we're going to talk about the broad subject of Syrian section. One third of all women in the United States have a certain section. So this discussion today applies to many, many patients. As we move forward. I think this information is very, very helpful.

Now, so certain sections are divided basically into two categories. One is elective repeat or simply repeats a certain section. This is the women that have had a certain section in the past, and they're not a candidate for attempted fashion delivery, or they simply decline at the attempted fashion delivery. There's also the group of women that have a certain section because of failed labor. So these women are women that were in labor either electively or they were in labor due to natural reasons, and they failed the process of labor. They could not Deliver badly and they move forward with a certain section.

So for the group of women that have to have a certain section, either electively or because of failed induction labor, you will do you will be delivered by somebody that is a surgeon, most obstetrician gynecologist in the United States performs a certain sections. There's also a group of family doctors that usually are fellowship trained. And those doctors also can perform certain sections. There's a small group, also of general surgeons in smaller communities in the United States that all also can perform certain sections, or we're going to basically identify most women, the United States are delivered by a obstetrician gynecologist. So what's the process of certain section? What's the mechanics of it?

Well, you come to the operating room, and when you come to the operating room, a plan has already been made by your anesthesia. ologists or your nurse anesthetist of how you're going to be managed during a certain section, there's only two options you're either going to go to sleep that's called general anesthesia, or you're going to have regional anesthesia. regional anesthesia means you're going to have an epidural, or you're going to have a spinal, so you're numb basically from right below your breast down to your feet. Most of them and obviously, like the regional aspect because they're awake. Your spouse can be with you or your family member, and you see the birth of your baby you can hear the birth of your baby. As providers as surgeons, we also like you to have regional anesthesia, because we don't have to hurry to get the baby out when you have general anesthesia.

Just like that general anesthetic drug is going into your body. It's also going into your baby's body. So if it takes a little bit of time to get the baby delivered out of the uterus, then The baby goes up to the Nick you bed. And sometimes the babies are very sleepy because of the general anesthesia and they have to take a drug called Narcan to help reverse that. So regional anesthesia is the safest for both you and your baby. Now after you have been brought to the operating room, and we're going to assume that you're going to have regional anesthesia, well, you'll sit on the side of the bed and a nurse anesthetist or anesthesiologist will put a little needle in your back and they will either give a drug right through the needle and this is done in the lower part of your back or they will put a catheter just like a IV and through that IV catheter, they will give you a drug.

Now when you we just inject the drug that's called a spinal when we had the catheter, that's called an epidural. The spinal tends to set up very quickly and that means you will become number very quick and so much anesthesia providers prefer the spinal over the epidural for the surgeon section. However, if you were in labor for a long time and had a epidural placed earlier in the labor, the anesthetist anesthesiologist will continue to use the epidural catheter and your sister intrasexual will be done under the epidural anesthesia. Also the epidural if you have that in place, can be used for drug pain relief. After the surgeon section is over. The spinal tends to wear off in four to eight hours so you don't get the effect that the epidural can perform for pain relief after your certain section.

Years a certain section lasts anywhere from 20 minutes to two hours. Every surgeon works at a different pace. And after the certain section is complete, you're going to go to the recovery room. In the recovery room, you're going to be there why to three hours depending on if you have risks for bleeding if your blood pressure's an issue, that is a variable length of time, but most women are in the recovery room, less than two hours after your recovery room, you're going to go to your postpartum room. Some unit, you stay on the labor and delivery unit, but some women go to the postpartum floor. At that point, you will have a nurse that takes care of you that simply does postpartum post operative care.

Plan on being there anywhere from two days to five days, with the average of three days. Now what do I mean by that? So let's assume that you get to your postpartum room on Monday at noon, I plan on going home sometime Thursday afternoon. That's the average. Now, your healthcare provider may send you home on Wednesday, or they may feel more comfortable sending you home on Friday, but the average for most women is about three days. During that three day period of time, your anesthesia from your either your spinal or your at the girl will wear off.

At that point, the nurse will want to get you out of bed. You will have had a Foley catheter in place that was draining your urine, that Foley catheter will be removed some time, usually the next day. So back to our example of you got there on Monday at noon. We would take that Foley catheter out later that night, Monday night, or first thing Tuesday morning. Now, with the significant opioid crisis going on in the United States, the opioid opioid drugs that we've used in the past, we're minimizing those because we know that a woman that's called a virgin from the narcotic standpoint, in other words, she's never had narcotics or opioids. So she's a virgin in that respect.

That woman, potentially if we give her narcotics for multiple days, can become addicted even one hospital ization for multiple days can cause a woman to become addicted. And obviously from a healthcare standpoint, we don't want that to happen. So we're going to use a combination of drugs for you and your post operative period, we're going to use a non steroidal anti inflammatory drug. And the most common one, we use the United States as ibuprofen or Advil, and you will take about 800 milligrams of that and use it orally every eight hours. Some centers also use a drug called toradol. I like toradol.

It's an anti inflammatory, I think it works better than ibuprofen. And that's given either in the form of an IV or intramuscular. And then it can be transferred to an oral toradol. That works extremely well for me. After you've been on the narcotic, two or three days, most centers in the country now want to have you off narcotics, and if you're still on narcotics only give you several more days. So when your healthcare provider talks about you going home on a prescription, usually it's going to be a prescription of an anti inflammatory or over the counter ibuprofen.

And they may only give you one to three days more of a narcotic to take at home. Now, also, during that hospitalization, your nurses going to be talking to you about other things that are normal in the post operative postpartum period. They're going to be getting blood on a daily basis, at least for the first day or two and make sure you don't have any infection. Make sure your blood count is okay. They're going to be checking you to make sure that you're rebel immune, and if you're not, then they would give you a or offer you a MMR vaccine. Also, if you're RH negative and your baby is Rh positive, you may be a candidate for rhogam injection so you would get that as well.

Lastly, they're going to talk to you about incision care and how to Keep your incision clean. So insertion care actually is pretty easy. Most people are very concerned about how do I take care of my incision, but it's really usually quite simple with the technique of soap and water and leaving your skin exposed. For the first several days, you're going to have a dressing that will be removed by your nurse, usually on the first post operative day or the second post operative day, sometimes they're going to replace that. I prefer for my patients that that be left exposed, and then it's easy to take care of. At that point, they're going to start talking to you about concerns over potential infection of the insertion, what to look for, as you go home.

Your follow up visit with your healthcare provider usually will be made within the week. So if you go home on a Thursday, you will typically be seen within five to seven days after you're discharged. At that point they will talk to you about it any risk for infection such as incisional, redness, incidence, incisional, drainage, fever or feelings of flu. But typically most women don't have any problems with having an infection. Remember, one out of three patients in the United States has a Syrian section. So this is a very common surgery.

Definitely there are problems with certain sections as far as infection and bleeding, etc. But most women do extremely well. The main thing for you to understand as a patient is that one out of three patients will have a cesarean section. Our goal with this video is to educate you. This will help decrease your anxiety on how the process works, and how do I take care of myself after my second section is over. Have a great day.

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