i.

Procedure Skin prep

Preoperative skin preparation before cesarean section using a one-minute alcohol wash followed by application of an iodophor-impregnated adhesive film was evaluated in a prospective, randomized, controlled study of 79 patients. The iodophor film was as effective as the five-minute iodophor scrub followed by an iodophor wash, as determined by a reduction in skin bacterial counts. Clinical infectious morbidity was no different between the treatment and control groups, although the study was too small to draw statistically significant conclusions in this respect. This study demonstrated the antimicrobial effectiveness of a new, more rapid method of pre-operative skin preparation before cesarean section as compared to a longer, traditional method. This new, rapid method offers advantages for many patients undergoing abdominal delivery.

Draping
A surgical drape for use in cesarean section procedures is disclosed. The drape has a fluid collection bag secured to the lower surface of the drape to collect amniotic and other fluids released during the surgery. The fluid collection bag is maintained in an open position by a moldable strip at the opening of the bag. An adhesive at the opening of the bag seals the bag after use.
Surgical drapes are customarily used in an operating room to protect the site of the operation from possible contamination from bacteria which can be found on other portions of the patient's body and which may be airborne or conveyed to the surgical patient by the operating room staff. The patient is essentially isolated from the operating room environment and the operating room staff by the placement of surgical drapes which cover the patient's body other than that portion of the body which is the site of the surgical procedure. Surgical drapes are also used in a delivery room when a woman is giving birth to a child. In normal delivery, the surgical drapes cover the upper portion of the woman's body as well as the legs, which are usually placed in stirrups in an elevated position slightly above the patient's body. If the delivery of the child is by cesarean section, the drapes that are employed for normal deliveries are not appropriate. In a cesarean section delivery, the patient is in a flat position or rolled toward the left side and their legs are not elevated. Drapes that have previously been used for cesarean section procedures include the laparotomy drapes which are used for abdominal surgery. Although these drapes are adequate for protecting the patient from possible bacteria contamination, they do not provide for the handling of the significant amounts of amniotic fluid and other body fluids that are commonly released during the cesarean section procedure. Surgical drapes which provide some mechanism for the direction of body fluids have previously been known. For example, U.S. Pat. No. 3,791,382 discloses surgical drape constructions which provide a pocket on the outer surface of the drape to receive fluid runoff from the site of the surgical procedure. U.S. Pat. No. 4,076,017 and U.S. Pat. No. 4,105,019 disclose surgical drapes specifically directed to the problem of postpartum fluid control. These patents disclose a pocket formed on the outer surface of the surgical drape by folding an edge of a nonabsorbent sheet upon itself and sealing it together. U.S. Pat. No. 4,169,472 discloses a surgical drape which includes an impervious bag used for collecting liquids and other fluids which may be present during the operating procedure. This patent is particularly directed to surgical drapes which are used in surgical procedures involving a patient's head. The bag disclosed in this patent is on the outer surface of the drape, that is, that portion of the drape which is away from the patient's body during the surgical procedure. Although all of the above-mentioned drapes disclose some provision for the collection of body fluids, the construction of the drapes are inappropriate for a cesarean section surgical procedure. The normal use of the drapes disclosed in the prior art presumes that the fluid will flow away from the site of the surgical procedure, across the upper surface of the drape, to the pocket which is on the upper surface of the surgical drape but below the site of the surgical procedure. In the cesarean section procedure, the patient is substantially in a flat position or rolled toward the left side and, therefore, the surgical drapes with fluid direction means on the outer surface of the drape are not sufficient to collect fluids which are present during the cesarean section procedure. SUMMARY OF THE INVENTION

The present invention relates to a surgical drape which is disposable and which is particularly suited for use in a cesarean section procedure. The disposable drape of the present invention is constructed so that it may be used to collect fluids even when the patient is in a generally flat or horizontal position. The present drape includes a fluid direction system which will direct amniotic fluids from the surface of the drape, through an opening in the drape, to a collection bag which is disposed on the under or lower surface of the drape. The collection bag may be readily placed between the patient's legs when the patient is in a flat or rolled position. The drape also includes a mechanism to maintain the opening to the fluid collection bag in an open position during the surgical procedure, and it also provides a sealing system to seal the bag containing such body fluids after the surgical procedure has been completed. Other details of the present invention will be readily apparent to one skilled in the art from the description of the invention which follows. BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a top plan view of the surgical drape of the present invention. FIG. 2 is a fragmentary top plan view of the fenestration area of the drape. FIG. 3 is a fragmentary bottom plan view of the area of the drape shown in FIG. 2. FIG. 4 is a cross-sectional view of the drape taken along lines 4--4 of FIG. 2. FIG. 5 is an exploded fragmentary view of the drape. FIG. 6 is a detailed cross-sectional view of the opening to the collection bag in the drape. Detailed Description of the Invention The surgical drape of the present invention is generally shown in FIG. 1. The drape 10 has a top edge 30, a bottom edge 31 and two side edges 32. FIG. 1 shows the upper surface of the drape, which is that surface which is away from the patient's body. The lower surface of the drape is in contact with the patient's body. The surgical drape shown in FIG. 1 has an upper portion 11 which may be transverse to the length of the drape and which forms a cross or T-portion of the drape. When the drape is in use, the upper portion is placed toward the head of the patient. At the bottom edge of the upper portion of the drape there may be flaps 12 which function to cover an arm board, if an arm board is used in the surgical procedure. The surgical drape of the present invention may also be fabricated as a large rectangular sheet with a constant width rather than a T-shaped sheet.

The lower portion of the drape 13 is that portion of the drape which is placed toward the feet of the patient. The upper portion 11 and the attached lower section 13 of the drape will hereinafter be referred to as the main sheet of the drape. On the upper surface of the drape, there is a first reinforcement panel 14 which extends from the upper portion 11 of the drape to the lower portion of the drape. This reinforcement panel is generally made with an impervious film covered with anabsorbent material. The impervious film is in contact with the upper surface of the main portion of the surgical drape, and the absorbent surface overlies the film and is the upper surface of the drape. There is an opening 15 in the drape, which inFIG. 2 is shown to be rectangular in shape. There is an adhesively-coated plastic film 16 over the opening and a triangular fenestration 33 in the film. It should be understood that the fenestration may be any desirable configuration, the triangularconfiguration being particularly useful in cesarean section procedures. The adhesive coating on the film faces the patient and is covered before use with a releasable paper. The nonadhesive surface of the film is also covered with a removable paperinsert 27 to maintain the sterility of the film during the placement of the drape on the patient. The first reinforcement panel 14 is secured to the main surface of the drape by lines of adhesive which are spaced inwardly from the side edges of the reinforcement panel. This provides a flap of unsecured reinforcement material which can befolded to provide fluid direction flaps, as indicated at 17 in FIG. 1. The top portion of the flap may also be used to secure surgicalinstruments, tubing and wires to the upper surface of the drape by means of clamps. There is a second reinforcement panel 18 spaced below, that is, toward the bottom edge of the drape, from the first reinforcement panel. The second reinforcement panel is also constructed of a fluid-impervious plastic film with an absorbentupper surface. The second reinforcement panel is adhesively secured to the upper surface of the lower portion 13 of the drape. Between the first reinforcement panel and the second reinforcement panel, there is an opening through the main sheet of thedrape. There is a fluid collection bag 19 on the lower surface of the drape. The opening in the bag is secured to the edges of the opening in the drape into which the flaps 17 are directed. The fluid collection bag is secured to the surface of thedrape only at its open end, as is shown in FIGS. 4 and 6. The lower or closed end of the fluid collection bag is free of the drape and may readily be placed between the patient's legs so that

the fluid collected during the surgical procedure will becollected away from the upper surface of the drape and will not interfere with the surgical procedure. The opening 21 may be formed by cutting or slitting the lower portion 13 of the main sheet of may be formed by the selected glueing of drape fabrics as shown in FIG. 5. In FIG. 5, the top portion 11 of the main sheet extends to the bottom of thefirst reinforcement panel 14. The lower surface of the fluid collection bag 19 is glued to the upper surface of sheet 11. The lower portion 13 of the drape is then glued to the top portion of the sheet 11 and to the upper surface of the bag 19 at theopening of the bag. The reinforcement panel is then glued to the sheet 11 and the flaps 17 inserted into the opening 21 of the bag 19. The second reinforcement panel 18 is then glued to the drape. The top edge of the second reinforcement panel 18extends onto the bottom edge 34 of the top portion 11 of the main sheet. There may be a drainage tube 35 in the lower, closed end of the bag 19 to drain excess fluid from the bag 19. The upper, top edge of the fluid collection bag which is on the upper surface of the drape forms a flap 22 and has an adhesive, preferably a double-faced adhesive tape 23 on its surface. There is a release sheet 24 over the outer surface of thetape. This flap 22 is folded away from the opening 21. The purpose of the adhesive surface is to allow the collection bag to be sealed after the completion of the surgical procedure so that the fluid will not escape from the bag as the drape is beingremoved from the patient. There is a thin, moldable metal or plastic strip 25 in the drape at the opening or mouth of the bag as shown in FIGS. 2, 4 and 6. The purpose of the strip, which is moldable and is capable of being bent and being maintained in a fixedconfiguration, is to provide better direction of the fluid into the bag during the surgical procedure and to prevent the bag from being inadvertently closed during the surgical procedure. The edges of the reinforcement panels 14 and 18 may also contain tubing or cord holders 20 which are useful to secure suction tubing or cautery wires to the upper surface of the drape during the procedure. The drape is folded into a compact size to allow the drape to be aseptically placed in position on the patient. The drape is preferably folded so that the incise film 16 is on the outer surface of the folded drape. When placing the drape on thepatient, the release sheet 26 is removed from the adhesive surface of the film 16, and the film is secured to the skin of the patient over the operative site. The drape is then unfolded and spread over the patient's body. After the drape is unfolded,the paper insert 27, covering the upper surface of the film 16, is removed and discarded. The initial surgical incision is made through the fenestration 33 in the film. The metal strip 25 is then bent in an appropriate shape to insure the opening 21 ismaintained in communication with the fluid collection bag 19. The bag 19 may be conveniently placed between the patient's legs, out of the way of the surgical staff. Any fluid from the site of the incision is directed by the flaps 17 through theopening 21 in the drape and into the fluid collection bag 19. When the surgical incision is to be closed, the release sheet 24 on the flap 22 of the bag is removed, and the flap 22 is secured to the upper surface of the drape, sealing the fluidcollection bag.

How is a C-section done? Before a C-section, a needle called an IV is put in one of the mother's veins to give fluids and medicine (if needed) during the surgery. She will then get medicine (eitherepidural or spinal anesthesia) to numb her belly and legs. Fast-acting general anesthesia, which makes the mother sleep during the surgery, is only used in an emergency. Once the anesthesia is working, the doctor makes the incision. Usually it is made low across the belly, just above the pubic hair line. This may be called a "bikini cut." Sometimes the incision is made from the navel down to the pubic area. See a picture of C-section incisions . After lifting the baby out, the doctor removes the placenta and closes the incision with stitches. How long does it take to recover from a C-section? Most women go home 3 to 5 days after a C-section, but it may take 4 weeks or longer to fully recover. By contrast, women who deliver vaginally usually go home in a day or two and are back to their normal activities in 1 to 2 weeks. Before you go home, a nurse will tell you how to care for the incision, what to expect during recovery, and when to call the doctor. In general, if you have a C-section:

You will need to take it easy while the incision heals. Avoid heavy lifting, intenseexercise, and sit-ups. Ask family members or friends for help with housework, cooking, and shopping. You will have pain in your lower belly and may need pain medicine for 1 to 2 weeks. You can expect some vaginal bleeding for several weeks. (Use sanitary pads, not tampons.) Call your doctor if you have any problems or signs of infection, such as a fever or red streaks or pus from your incision.

Position

The Trendelenburg position increases the spread and accelerates the onset of epidural anesthesia for Cesarean section.
Setayesh AR, Kholdebarin AR, Moghadam MS, Setayesh HR.

Source
Department of Anesthesiology, School of Medicine, Iran University of Medical Sciences and Health, Tehran, Iran. Setayesh@iums.ac.ir

Abstract
PURPOSE: The effect of position on the spread and the onset time of epidural anesthesia has not been well documented. This study was undertaken to assess the effect of modified Trendelenburg position on the spread of epidural anesthesia for Cesarean section. METHODS: Seven hundred thirty-nine parturients underwent epidural anesthesia for elective or emergent Cesarean section. Patients were divided into two groups in a randomized-controlled study. All patients received 20 mL of 2% lidocaine injected through a 19G epidural needle, a standard technique in our institution. During induction of epidural anesthesia, the first group was placed in 15 Trendelenburg with 10 head-up position and the second in the horizontal position. The onset time and the level of anesthesia, patients' vital signs, and Apgar score were recorded in both groups. RESULTS: There were no significant differences in vital signs, oxygen saturation and Apgar score between the two groups. The results show significant differences in the time of onset (on average four minutes faster in the modified Trendelenburg position group) (P <0.001), and in achieving T5 level sensory blockade (97.5% vs 42.8%) between the modified Trendelenburg and horizontally positioned pregnant women. CONCLUSION: This study demonstrates that the modified Trendelenburg position has a significant effect on the spread and the onset time of single shot epidural anesthesia, and can be used safely in term parturients for emergency or elective Cesarean section.

Anesthesia used technique

Anesthesia for Cesarean

All surgery requires anesthesia since it numbs the pain. In cesarean birth, anesthesia is very important since the fetus can by affected by the anesthesia. Three types of anesthesia used in a cesarean section: Spinal anesthesia numbs your body from the chest down so you can be awake during surgery. You feel very little or no pain and very little if any medicine reaches your baby. Epidural anesthesia numbs your body from the chest down so you can be awake during surgery. You feel very little or no pain and very little if any medicine reaches your baby. General anesthesia makes you unconscious or asleep. General anesthesia is usually used in very serious or emergency cesarean births. Its also used for mothers who dont want spinal or epidural anesthesia There is very little difference between spinal and epidural anesthesia. Both are administered locallyto a specific areathat numbs part of the body without putting you to sleep. Spinal anesthesia was prevalent before the popularity of lumbar epidural anesthesia that is now used for most cesareans. The mother usually decides on the type of anesthesia after talking with her OB/GYN andanesthesiologist. Most doctors recommend local anesthesiaspinal or lumbar epiduralfor an uncomplicated cesarean birth.

Elective Caesarean sections

Main article: Elective caesarean section
This section may stray from the topic of the article into the topic of another article, Elective_caesarean_section. Please help improve this section or discuss this issue on the talk page. (January 2011)

Caesarean sections are in some cases performed for reasons other than medical necessity. These can vary, with a key distinction being between hospital- or doctor-centric reasons and mothercentric reasons. Critics of doctor-ordered Caesareans worry that Caesareans are in some cases performed because they are profitable for the hospital, because a quick Caesarean is more convenient for an obstetrician than a lengthy vaginal birth, or because it is easier to perform surgery at a scheduled time than to respond to nature's schedule and deliver a baby at an hour that is not predetermined.[66] Another reason for doctors to recommend C-sections is money. In China, doctors are compensated based on the monetary value of medical treatments offered. As a result, they have an incentive to persuade mothers to choosing the more expensive C-section. Non-medically indicated (elective) childbirth before 39 weeks gestation "carry significant risks for the baby with no known benefit to the mother." Hospitals should institute strict monitoring of

births to comply with full term (more than 39 weeks gestation) elective C-section guidelines. In review, three hospitals following policy guidelines brought elective early deliveries down 64%, 57%, and 80%.[7] The researchers found many benefits but no adverse effects in the health of the mothers and babies at those hospitals.[42][7] In this context, it is worth remembering many studies have shown operations performed out-ofhours tend to have more complications (both surgical and anaesthetic).[67] For this reason, if a Caesarean is anticipated to be likely to be needed for a woman, it may be preferable to perform this electively (or pre-emptively) during daylight operating hours, rather than wait for it to become an emergency with the increased risk of surgical and anaesthetic complications that can follow from emergency surgery. Another contributing factor for doctor-ordered procedures may be fear of medical malpractice lawsuits. Italian gynaecologyst Enrico Zupi, whose clinic in Rome, Mater Dei, was under media attention for carrying a record of Caesarian sections (90% over total birth), explained: We shouldn't be blamed. Our approach must be understood. We doctors are often sued for events and complications that cannot be classified as malpractice. So we turn to defensive medicine. We will keep acting this way as long as medical mistakes are not depenalized. We are not martyrs. So if a pregnant woman is facing an even minimum risk, we suggest she gets a C-section "[52] Studies of United States women have indicated married white women giving birth in private hospitals are more likely to have a Caesarean section than poorer women, although they are less likely to have complications that may lead to a Caesarean section being required. The women in these studies have indicated their preference for Caesarean section is more likely to be partly due to considerations of pain and vaginal tone.[68] In contrast, a recent study in the British Medical Journal retrospectively analysed a large number of Caesarean sections in England and stratified them by social class. Their finding was Caesarean sections are not more likely in women of higher social class than in women in other classes.[69] Some have suggested, due to the comparative risks of Caesarean section with an uncomplicated vaginal delivery, patients should be discouraged or forbidden from choosing it.[70] Some 42% of obstetricians believe the media and women are responsible for the rising Caesarean section rates.[71] Some studies, however, conclude that relatively few women wish to be delivered by Caesarean section.[72]

[edit]Anaesthesia

Both general and regional anaesthesia (spinal, epidural or combined spinal and epidural anaesthesia) are acceptable for use during Caesarean section. Regional anaesthesia is preferred as it allows the mother to be awake and interact immediately with her baby.[73] Other advantages of regional anesthesia include the absence of typical risks of general anesthesia: pulmonary aspiration(which has a relatively high incidence in patients undergoing anesthesia in late pregnancy) of gastric contents and Oesophageal intubation.[74] Regional anaesthesia is used in 95% of deliveries, with spinal and combined spinal and epidural anaesthesia being the most commonly used regional techniques in scheduled Caesarean section.[75] Regional anaesthesia during Caesarean section is different to the analgesia (pain relief) used in labor and vaginal delivery. The pain that is experienced because of surgery is greater than that of labor and therefore requires a more intense nerve block. The dermatomal level of anesthesia required for Caesarean delivery is also higher than that required for labor analgesia.[74] General anesthesia may be necessary because of specific risks to mother or child. Patients with heavy, uncontrolled bleeding may not tolerate the hemodynamic effects of regional anesthesia. General anesthesia is also preferred in very urgent cases, such as severe fetal distress, when there is no time to perform a regional anesthesia.
[edit] At the hospital. Before your C-section, a member of your health care team will cleanse your abdomen. A tube (catheter) will likely be placed into your bladder to collect urine. Intravenous (IV) lines will be placed in a vein in your hand or arm to provide fluid and medication. A member of your health care team might also give you an antacid to reduce the risk of an upset stomach during the procedure. Anesthesia. Most C-sections are done under regional anesthesia, which numbs only the lower part of your body allowing you to remain awake during the procedure. A common choice is a spinal block, in which pain medication is injected directly into the sac surrounding your spinal cord. Another option might be epidural anesthesia, in which pain medication is injected into your lower back just outside the sac that surrounds your spinal cord. In an emergency, general anesthesia is sometimes needed. With general anesthesia, you won't be able to see, feel or hear anything during the birth. Abdominal incision. The doctor will make an incision through your abdominal wall. It's usually done horizontally near the pubic hairline (bikini incision). If a large incision is needed or your baby must be delivered very quickly, the doctor might make a vertical incision from just below the navel to just above the pubic bone.

Uterine incision. After the abdominal incision, the doctor will make an incision in your uterus. The uterine incision is usually horizontal across the lower part of the uterus (low transverse incision). Other types of uterine incisions might be used depending on the baby's position within your uterus and whether you have complications, such as placenta previa when the placenta partially or completely blocks the uterus.

Delivery. If you have epidural or spinal anesthesia, you'll likely feel some movement as the doctor gently removes the baby from your uterus but you shouldn't feel pain. The doctor will clear your baby's mouth and nose of fluids, then clamp and cut the umbilical cord. The placenta will be removed from your uterus, and the incisions will be closed with sutures. If you have regional anesthesia, you'll be able to hear and see the baby right after delivery. After the procedure After a C-section, most mothers and babies stay in the hospital for about three days. To control pain as the anesthesia wears off, you might use a pump that allows you to adjust the dose of intravenous (IV) pain medication. Soon after your C-section, you'll be encouraged to get up and walk. Moving around can speed your recovery and help prevent constipation and potentially dangerous blood clots. While you're in the hospital, your health care team will monitor your incision for signs of infection. They'll also monitor your movement, how much fluid you're drinking, and bladder and bowel function. Discomfort near the C-section incision can make breast-feeding somewhat awkward. With help, however, you'll be able to start breast-feeding soon after the C-section. Ask your nurse or the hospital's lactation consultant to teach you how to position yourself and support your baby so that you're comfortable. Remember that trying to breast-feed when you're in pain might make the process more difficult. Your health care team will select medications for your post-surgical pain with breast-feeding in mind. Continuing to take the medication shouldn't interfere with breast-feeding. Before you leave the hospital, talk with your health care provider about any preventive care you might need, including vaccinations. Making sure your vaccinations are current can help protect your health and your baby's healt

Incision site

incision that is first made on the skin, then the underlying abdominal muscle wall and finally the uterus itself.

Types of Uterine Wall Incisions

There are three types of incisions made in the uterine wall for the delivery of the baby. The type of incision chosen depends on the presentation of the baby and the speed at which the procedure can be done. the low vertical incisionan up-and-down incision is made in the lower, thinner part of the uterus. This incision is usually made when the baby is presenting breechrump first or feet first. the high vertical (classical) incisionan up-and-down incision is made in the upper part of the uterus. This incision is made when the baby is presenting sideways or the placenta is abnormally placed. the low transverse incisionalso called a bikini cut, is a side-to-side incision is made in the lower, thinner part of the uterus that contracts minimally during labor. This incision is made when the baby is presenting head first.

Cesarean birth happens through an incision in the abdominal wall and uterus rather than through the vagina. There has been a gradual increase in cesarean births over the past 30 years. The health care provider will make an incision in the abdomen wall first. In an emergency cesarean this will most likely be a vertical incision (from the navel to the pubic area) which will allow the health care provider to deliver the baby faster. The most common incision is made horizontally (often called a bikini cut), just above the pubic bone. The muscles in your stomach will not be cut. They will be pulled apart so that the health care provider can gain access to the uterus. An incision will then be made into the uterus, horizontally or vertically. The same type of incision does not have to be made in both the abdomen and uterus. The classical incision made vertically, is usually reserved for complicated situations such as placenta previa, emergencies, or for babies with abnormalities. A vaginal birth after cesarean (VBAC) is not recommended for women with the classical incision. Another type of incision that is rarely used is the lower segment vertical incision. This would only be used in cases where problems with the uterus would not allow another type of incision to be made. The most common incision is the low transverse incision. This incision has fewer risks and complications than the others and allows most women to attempt a VBAC in their next pregnancy with little risk of uterine rupture. The health care provider will then suction out the amniotic fluid and then deliver the baby. The baby's head will be delivered first so that the mouth and nose can be cleaned out to allow it to breathe. Once the whole body is delivered, the health care provider will lift up and show you your baby. Most health care providers will then pass the baby on to the nurse for evaluation. Finally, your placenta will be delivered (you may feel some tugging) after which the surgical team will begin the close up process.

Discussion of the procedure

esarean Surgery

Delivery through low transverse incision

The nurses will get you ready for surgery by placing an IV in your hand or arm to give you fluids and medicines. You may also have blood drawn for blood tests. Youll have monitors attached for watching your blood pressure, heart beat, and how much oxygen youre getting during surgery. Youll also have a urinary catheter inserted to drain urine from your bladder so your bladder is not in the way. Once you get to the operating room, you may have added oxygen through a mask. If you havent already had the epidural or spinal block, that will be done, too. If you are having an emergency cesarean you will likely have general anesthesia. If you have general anesthesia, all preparations will be done before you are given anesthesia to keep your baby from getting too much anesthetic, making it harder for him to wake up at birth. Your arms will likely be secured onto padded boards. Your abdomen will be scrubbed and drape put up below your chin to help keep the surgical area sterile. If youre awake, you wont be able to see what is happening. Your doctor, the anesthesiologist or a nurse will let you what is happening and answer your questions. Once everything is ready, about a 6 inch incision will be made in the skin of your abdomen. Whether the incision is up-and-down (vertical) or side-to-side (transverse), will depend on several thingsif you had a previous cesarean birth, if this cesarean is an emergency, the position of your baby or the placenta, and the size of your baby. A bikini incision is used most often for cosmetic reasons as well as it heals well and presents fewer problems in later births. If your baby needs to be born quickly, an incision just below your belly button to just above your public bone is made. This allows your doctor to get to your baby more quickly. Once inside your abdomen, your bladder is moved to one side and a smaller incision is made in the uterus. Again, the incision in the uterus can be transverse or verticalthe type of incision made on your skin does not affect the type of incision made in the uterus. The low transverse it the most common and

used in about 90% of cesareanssee illustration above. The low transverse causes fewer problems in later pregnancies because it makes a stronger scar reducing the chances of uterine rupture. In fact, you may be able to try a vaginal birth in later pregnancies.

Your doctor presses on the top of your uterus and pulls your baby out through the incision. You wont feel any pain but may feel some pressure or pulling because the incision is kept as small as possible. Once your baby is out, the umbilical cord will be cutif your partner is there, they may allowed to cut the cord. Your baby will be given to the nurses to clean the airways and body. The placenta will be removed, the uterus closed with absorbable stitches, you will be closed up layer by layer. The incision on your abdomen will be closed with staples or clips. The doctor will press on your uterus to force blood and blood clots out through the vagina. Youll be given medicine to shrink your uterus and reduce bleeding. You may also be given antibiotics to help prevent infection. If your baby is OK you may be able to hold her and even nurse her, depending on the rules at your hospital. If your baby is not OK, then she will be taken to the nursery quickly for special care. The nurses with you will talk with the nursery and let you know how your baby is doing.

After surgery youll be taken to the recovery room and monitored for a an hour or two. If you feel up to it, you may be able to try breastfeeding while in the

recovery room. If everything is fine in the recovery room, you will be taken to your room and monitored to make sure you are OK and your uterus is shrinking. A typical stay after cesarean birth is 3 days. Most patients are encouraged to get up and move around the day after surgery. You should be able to return to normal activities in about 4-6 weeks. Learn more about Self Care After Cesarean Birth.

Psychological Effects of Having a Cesarean Birth

When having a cesarean birth, one must consider the psychological effects. Afterward, a cesarean can be much more painful than a vaginal birth. This most often causes psychological effects on the mother and sometimes the father. Research shows that there is no effect on the newborn. Some hospitals offer Family Centered Cesarean Births and allow the father to be present in the operating room during the cesarean birth. They also offer closer contact between the mother and her newborn after surgery and you may be able to hold your baby right after birth. If youre having a planned cesarean, talk with your hospital about having the options they offer such as allowing your partner to cut the cord and carrying the baby to the warmer, breastfeeding in the recovery room, and allowing you to touch or hold your baby in the operating room. All of these can help you begin bonding with your newborn. If you are have an emergency cesarean, your family wont be able to be with you.

Before Surgery
Cesarean delivery takes about 45 to 60 minutes. It takes place in an operating room. So if you were in a labor and delivery room, you will be moved to an operating room. Often, the mood of the operating room is unhurried and relaxed. A doctor will give you medicine through an epidural or spinal block, which will block the feeling of pain in part of your body but allow you to stay awake and alert. The spinal block works right away and completely numbs your body from the chest down. The epidural takes away pain, but you might be aware of some tugging or pushing. See Medical Methods of Pain Relief for more information. Medicine that makes you fall asleep and lose all awareness is usually only used in emergency situations. Your abdomen will be cleaned and prepped. You will have an IV for fluids and medicines. A nurse will insert a catheter to drain urine from your bladder. This is to protect the bladder from harm during surgery. Your heart rate, blood pressure, and breathing also will be monitored. Questions to ask:

Can I have a support person with me during the operation? What are my options for blocking pain? Can I have music played during the surgery? Will I be able to watch the surgery if I want?

During Surgery

The doctor will make two incisions. The first is about 6 inches long and goes through the skin, fat, and muscle. Most incisions are made side to side and low on the abdomen, called a bikini incision. Next, the doctor will make an incision to open the uterus. The opening is made just wide enough for the baby to fit through. One doctor will use a hand to support the baby while another doctor pushes the uterus to help push that baby out. Fluid will be suctioned out of your baby's mouth and nose. The doctor will hold up your baby for you to see. Once your baby is delivered, the umbilical cord is cut, and the placenta is removed. Then, the doctor cleans and stitches up the uterus and abdomen. The repair takes up most of the surgery time. Questions to ask:

Can my partner cut the umbilical cord? What happens to my baby right after delivery? Can I hold and touch my baby during the surgery repair? When is it okay for me to try to breastfeed? When can my partner take pictures or video?

After Surgery
You will be moved to a recovery room and monitored for a few hours. You might feel shaky, nauseated, and very sleepy. Later, you will be brought to a hospital room. When you and your baby are ready, you can hold, snuggle, and nurse your baby. Many people will be excited to see you. But don't accept too many visitors. Use your time in the hospital, usually about four days, to rest and bond with your baby. C-section is major surgery, and recovery takes about six weeks (not counting the fatigue of new motherhood). In the weeks ahead, you will need to focus on healing, getting as much rest as possible, and bonding with your baby nothing else. Be careful about taking on too much and accept help as needed. Questions to ask:

Can my baby be brought to me in the recovery room? What are the best positions for me to breastfeed?

ii. instrument used

Types

Cesarean section instruments can be grouped by type: retractors, clamps, forceps, scalpels, scissors and staplers. Of the retractors, a Richardson retractor and bladder blade are needed. Clamps such as the needle drive, kocher clamps and hemostat are used. Adson, Russian and pick-up forceps with teeth are the forceps used. The general scalpel, scissors and staplers are used for the cesarean section.

Function

Retractors hold organs and tissues out of the surgical field. They also open up incisions. Clamps grasp tissue or hold an incised blood vessel closed. They also hold the umbilical cord closed after it is cut. Forceps grasp and hold tissues and materials. Scalpels and scissors are for cutting and staplers are used to close the cesarean incision after the birth.

Read more: Surgical Instruments Used for a Cesarean Section | eHow.com http://www.ehow.com/about_5635742_surgical-instruments-used-cesareansection.html#ixzz27rGVNoiD

Hemostats (used for bleeders, blunt dissection) Kelley's Kocher's (used for faschia, and sometimes to clamp the umbilical cord. Long Kelley's (also used for umbilical cords) Allis Allis Adairs (some MD's use these to clamp uterine "bleeders") Babcocks (used for tubal ligations) Sponge sticks (also used on the uterus) Penningtons (uterus) Needle drivers Bandage scissors (to cut cord) Straight mayos (suture scissors) Curved Mayos (anatomy scissors) Metzenbaum scissors (used for the bladder flap and fine tissues) Pickups: Russians (uterus) Bonnies Adsons (skin) Smooth pick ups (bladder flap) Pick ups with teeth Retractors: Bladder blade Small and large richardson

balfor blade extra: bulb syringe a couple of cord clamps cord blood collection kit needle counter towels rayotec and laps ioban drape vacuum

Read more: http://wiki.answers.com/Q/What_are_the_instruments_in_cesarean_section _surgery#ixzz27rGd2zUpHere's a common list:

Hemostats (used for bleeders, blunt dissection) Kelley's Kocher's (used for faschia, and sometimes to clamp the umbilical cord) Long Kelley's (also used for umbilical cords) Allis Allis Adairs (some MD's use these to clamp uterine "bleeders") Babcocks (used for tubal ligations) Sponge sticks (also used on the uterus) Penningtons (uterus) Needle drivers Bandage scissors (to cut cord) Straight mayos (suture scissors) Curved Mayos (anatomy scissors) Metzenbaum scissors (used for the bladder flap and fine tissues) Pickups: Russians (uterus) Bonnies Adsons (skin)

Smooth pick ups (bladder flap) Pick ups with teeth Retractors: Bladder blade Small and large richardson Gule (spelling?) extra: bulb syringe a couple of cord clamps cord blood tube needle counter towels rayotec and laps

iii. suture used in each organ or layer involved

the uterus is closed in two layers using a large (such as 2-0 or 0) absorbable suture, something like a chromic gut, the fascia is closed using a heavy suture such as a 3-0 ethibond (nonabsorbable), plain gut can be used if any for subcutaneous closure, and an absorbable suture can be used on the subcuticular a smaller guage such as 4-0 vicryl, finally the skin can be closed with either staples (most common), tape (uncommon), or sutured with nylon suture (most eventually be removed). Read more: http://wiki.answers.com/Q/Which_sutures_are_used_for_a_cesarean_section #ixzz27rHe0kC4
The doctor sews the uterus shut with suture (surgical thread) that is absorbable and therefore does not need to be removed. Absorbable suture is very strong when it is first used and it retains its strength long enough to allow the tissues to heal. The body will gradually break down the suture s The next step in closing the wound is repair of the fascia (the thick fibrous layer of tissue that envelops the body beneath the skin). The fascia is usually closed with absorbable suture; however, a suture that retains its strength longer than that used to close the uterus is usually used because the fascia heals a bit slower. In cases where healing is likely to be slow, the surgeon may use a permanent suture to close the fascia. This suture is made of nylon or a similar substance that does not dissolve; it will remain in place for the rest of the patient's life. Fortunately, permanent sutures generally cause no problems and most patients are completely unaware of whether a permanent or absorbable suture has been used.

After the layer of fascia has been closed, the doctor makes sure there is no bleeding in the layers beneath the skin or in the fat. In most cases, it is not necessary to close the fat layer. Occasionally, when the layer of fat is very thick, the surgeon may sew it together with absorbable suture. There are two options for closing the skin. Today, most surgeons use staples; the staples are made of titanium that close the wound without much effort and generally yield a thin scar. The staples need to be removed three to five days after the operation. Both the staples and the special staple remover are designed for painless removal. The other option is for the surgeon to sew the skin shut with absorbablesubcuticular suture. This very thin suture is sewn just beneath the surface of the skin and dissolves automatically after a few weeks when the skin is healed. While the scar left by a skin suture is no better than that left by staples, the suture does not have to be removed later. Nevertheless, most doctors have found no advantage to suture and prefer to use skin staples. Suturing also prolongs the operation and can require the entire incision to be opened if an infection develops.

iv. ncp(pre, intra, post)