Cesarean Section Medications

Definition of Cesarean Section: A surgical procedure that involves the delivery of the
foetus through an abdominal incision. C-sections account for about 1/5 of all births in the us.
Indications include: failure to progress, foetal distress, cephalopelvic disproportion More...

Drugs associated with Cesarean Section

The following drugs and medications are in some way related to, or used in the treatment
of Cesarean Section. This service should be used as a supplement to, and NOT a
substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.

Drug Name  (View by: Brand | Generic) Reviews Ratings 

Marcaine (Pro, More...) 0 review(s)
Not rated
generic name: bupivacaine class: local injectable anesthetics Be the first

Claforan (Pro, More...) 0 review(s)
Not rated
generic name: cefotaxime class: third generation cephalosporins Be the first

Mefoxin (Pro, More...) 0 review(s)
Not rated
generic name: cefoxitin class: second generation cephalosporins Be the first

Cefotan (Pro, More...) 0 review(s)
Not rated
generic name: cefotetan class: second generation cephalosporins Be the first

Pipracil (More...) 0 review(s)
Not rated
generic name: piperacillin class: antipseudomonal penicillins Be the first

Naropin (Pro, More...) 0 review(s)
Not rated
generic name: ropivacaine class: local injectable anesthetics Be the first

Sensorcaine (Pro, More...) 0 review(s)
Not rated
generic name: bupivacaine class: local injectable anesthetics Be the first

Marcaine Spinal (More...) 0 review(s)

Not rated
generic name: bupivacaine class: local injectable anesthetics Be the first

Sensorcaine-MPF Spinal (More...) 0 review(s)

Not rated
generic name: bupivacaine class: local injectable anesthetics Be the first

Sensorcaine-MPF (More...) 0 review(s)
Not rated
generic name: bupivacaine class: local injectable anesthetics Be the first

Marcaine HCl (More...) 0 review(s)

Not rated
generic name: bupivacaine class: local injectable anesthetics Be the first
Naropin Polyamp (More...) 0 review(s)
Not rated
generic name: ropivacaine class: local injectable anesthetics Be the first

Naropin SDV (More...) 0 review(s)

Not rated
generic name: ropivacaine class: local injectable anesthetics Be the first

http://www.drugs.com/condition/cesarean-section.html

Cesarean section

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Definition

A cesarean section is a surgical procedure in which incisions are made through a

woman's abdomen and uterus to deliver her baby.

Purpose

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Cesarean sections, also called c-sections or cesarean deliveries, are performed

whenever abnormal conditions complicate labor and vaginal delivery,
threatening the life or health of the mother or the baby. Dystocia, or difficult
labor, is the other common cause of c-sections. The procedure is performed in the
United States on nearly one of every four babies delivered—more than 900,000
babies each year. The procedure is often used in cases where the mother has had
a previous c-section.

The most common reason that a cesarean section is performed (in 35% of all
cases, according to the United States Public Health Service) is the woman has had
a previous c-section. The "once a cesarean, always a cesarean" rule originated
when the uterine incision was made vertically (termed a "classical incision"); the
resulting scar was weak and had a risk of rupturing in subsequent deliveries.
Today, the incision is almost always made horizontally across the lower end of
the uterus (called a low transverse incision), resulting in reduced blood loss and a
decreased chance of rupture. This kind of incision allows many women to have a
vaginal birth after a cesarean (VBAC).

The second most common reason that a c-section is performed (in 30% of all
cases) is difficult childbirth due to non-progressive labor (dystocia). Difficult
labor is commonly caused by one of the three following conditions: abnormalities
in the mother's birth canal; abnormalities in the position of the fetus; or
abnormalities in the labor, including weak or infrequent contractions. The
mother's pelvic structure may not allow adequate passage for birth. When the
baby's head is too large to fit through the pelvis, the condition is called
cephalopelvic disproportion (CPD).

Another 12% of c-sections are performed to deliver a baby in a breech

presentation (buttocks or feet first). Breech presentation is found in about 3% of
all births.

In 9% of all cases, c-sections are performed in response to fetal distress, which

refers to any situation that threatens the baby such as the umbilical cord wrapped
around the baby's neck. This may appear on the fetal heart monitor as an
abnormal heart rate or rhythm. Fetal brain damage can result from oxygen
deprivation. Fetal distress is often related to abnormalities in the position of the
fetus or abnormalities in the birth canal, causing reduced blood flow through the
placenta.

The remaining 14% of c-sections are indicated by other serious factors. One is
prolapse of the umbilical cord: the cord is pushed into the vagina ahead of the
baby and becomes compressed, cutting off blood flow to the baby. Another is
"placental abruption," whereby the placenta separates from the uterine wall
before the baby is born, cutting off blood flow to the baby. The risk of this is
especially high in multiple births (twins, triplets, or more). A third factor is
"placenta previa," in which the placenta covers the cervix partially or completely,
making vaginal delivery impossible. In some cases requiring c-section, the baby is
in a transverse position, lying horizontally across the pelvis, perhaps with a
shoulder in the birth canal.

The mother's health may make delivery by c-section the safer choice, especially in
cases of maternal diabetes, hypertension, genital herpes, malignancies of the
genital tract, and preeclampsia (high blood pressure related to pregnancy).

Choosing cesarean section

A 1997 survey of female obstetricians found that 31% would choose to have a c-
section without trial of labor if they had an uncomplicated pregnancy. This
finding mirrors a growing movement to allow women the right to choose c-
section over vaginal delivery, even when no indications for c-section exist.

There are a number of reasons why a woman might choose a c-section in the
absence of the usual indications. These include:

 Convenience. A scheduled c-section would allow a woman to choose the

time and date of delivery to avoid conflicting with work or family
obligations.
 Fear of childbirth. A woman might fear the pain of labor and delivery and
feel that a scheduled c-section would allow her to circumvent it.
 Avoiding risks of vaginal delivery. Certain risks inherent to vaginal
delivery (urinary or rectal incontinence, sexual dysfunction, dystocia) are
avoided in a c-section.

Demographics

Women of higher socioeconomic status are more likely to have a c-section,

22.9%, compared to 13.2% of women who live in low-income families. C-section
rates are highest among non-Hispanic white women (20.6%). Asian-American
women have a c-section rate of 19.2%; African-American women, a rate of 18.9%,
and Hispanic women, a rate of 13.9%.
Description

Regional anesthesia, either a spinal or epidural, is the preferred method of pain

relief during a c-section. The benefits of regional anesthesia include allowing the
mother to be awake during the surgery, avoiding the risks of general anesthesia,
and allowing early contact between mother and child. Spinal anesthesia involves
inserting a needle into a region between the vertebrae of the lower back and
injecting numbing medications. An epidural is similar to a spinal except that a
catheter is inserted so that numbing medications may be administered
continuously. Some women experience a drop in blood pressure when a regional
anesthetic is administered; this can be countered with fluids and/or medications.

In some instances, use of general anesthesia may be indicated. General

anesthesia can be more rapidly administered in the case of an emergency (e.g.,
severe fetal distress). If the mother has a coagulation disorder that would be
complicated by a drop in blood pressure (a risk with regional anesthesia), general
anesthesia is an alternative. A major drawback of general anesthesia is that the
procedure carries with it certain risks such as pulmonary aspiration and failed
intubation. The baby may also be affected by the anesthetics since they cross the
placenta; this effect is generally mild if delivery occurs within 10 minutes after
anesthesia is administered.

Once the patient has received anesthesia, the abdomen is washed with an
antibacterial solution and a portion of the pubic hair may be shaved. The first
incision opens the abdomen. Infrequently, it will be vertical from just below the
navel to the top of the pubic bone or, more commonly, it will be a horizontal
incision across and above the pubic bone (informally called a "bikini cut").

The second incision opens the uterus. In most cases, a transverse incision is
made. This is the favored type because it heals well and makes it possible for a
woman to attempt a vaginal delivery in the future. The classical incision is
vertical. Because it provides a larger opening
To remove a baby by cesarean section, an incision is made into the
abdomen, usually just above the pubic hairline (A). The uterus is
located and divided (B), allowing for delivery of the baby (C). After all
the contents of the uterus are removed, the uterus is repaired, and the
rest of the layers of the abdominal wall are closed (D). (
Illustration by GGS Inc.
)
than a low transverse incision, it is used in the most critical situations such as
placenta previa. However, the classic incision causes more bleeding, a greater risk
of abdominal infection, and a weaker scar.

Once the uterus is opened, the amniotic sac is ruptured and the baby is delivered.
The time from the initial incision to birth is typically five minutes. The umbilical
cord is clamped and cut, and the newborn is evaluated. The placenta is removed
from the mother, and her uterus and abdomen are stitched closed (surgical
staples may be used instead in closing the outermost layer of the abdominal
incision). From birth through suturing may take 30–40 minutes; the entire
surgical procedure may be performed in less than one hour.

Diagnosis/Preparation

There are several ways that obstetricians and other doctors diagnose conditions
that may make a c-section necessary. Ultrasound testing reveals the positions of
the baby and the placenta and may be used to estimate the baby's size and
gestational age. Fetal heart monitors, in use since the 1970s, transmit any signals
of fetal distress. Oxygen deprivation may be determined by checking the amniotic
fluid for meconium (feces); a lack of oxygen may cause an unborn baby to
defecate. Oxygen deprivation may also be determined by testing the pH of a blood
sample taken from the baby's scalp; a pH of 7.25 or higher is normal, between 7.2
and 7.25 is suspicious, and below 7.2 is a sign of trouble.

When a c-section becomes necessary, the mother is prepped for surgery. A

catheter is inserted into her bladder and an intravenous (IV) line is inserted into
her arm. Leads for monitoring the mother's heart rate, rhythm, and blood
pressure are attached. In the operating room , the mother is given anesthesia,
usually a regional anesthetic (epidural or spinal), making her numb from below
her breasts to her toes. In some cases, a general anesthetic will be administered.
Surgical drapes are placed over the body, except the head; these drapes block the
direct view of the procedure.

Aftercare

A woman who undergoes a c-section requires both the care given to any new
mother and the care given to any patient recovering from major surgery. She
should be offered pain medication that does not interfere with breastfeeding. She
should be encouraged to get out of bed and walk around eight to 24 hours after
surgery to stimulate circulation (thus avoiding the formation of blood clots) and
bowel movement. She should limit climbing stairs to once a day, and avoid lifting
anything heavier than the baby. She should nap as often as the baby sleeps, and
arrange for help with the housework, meals, and care of other children. She may
resume driving after two weeks, although some doctors recommend waiting for
six weeks, the typical recovery period from major surgery.

Risks

Because a c-section is a surgical procedure, it carries more risk to both the

mother and the baby. The maternal death rate is less than 0.02%, but that is four
times the maternal death rate associated with vaginal delivery. Complications
occur in less than 10% of cases.

The mother is at risk for increased bleeding (a c-section may result in twice the
blood loss of a vaginal delivery) from the two incisions, the placental attachment
site, and possible damage to a uterine artery. The mother may develop infection
of the incision, the urinary tract, or the tissue lining the uterus (endometritis);
infections occur in approximately 7% of women after having a c-section. Less
commonly, she may receive injury to the surrounding organs such as the bladder
and bowel. When a general anesthesia is used, she may experience complications
from the anesthesia. Very rarely, she may develop a wound hematoma at the site
of either incision or other blood clots leading to pelvic thrombophlebitis
(inflammation of the major vein running from the pelvis into the leg) or a
pulmonary embolus (a blood clot lodging in the lung).

Undergoing a c-section may also inflict psychological distress on the mother,

beyond hormonal mood swings and postpartum depression ("baby blues"). The
woman may feel disappointment and a sense of failure for not experiencing a
vaginal delivery. She may feel isolated if the father or birthing coach is not with
her in the operating room, or if an unfamiliar doctor treats her rather than her
own doctor or midwife. She may feel helpless from a loss of control over labor
and delivery with no opportunity to actively participate. To overcome these
feelings, the woman must understand why the c-section was necessary. She must
accept that she could not control the unforeseen events that made the c-section
the optimum means of delivery, and recognize that preserving the health and
safety of both her and her child was more important than her delivering
vaginally. Women who undergo a c-section should be encouraged to share their
feelings with others. Hospitals can often recommend support groups for such
mothers. Women should also be encouraged to seek professional help if negative
emotions persist.

Normal results

The after-effects of a c-section vary, depending on the woman's age, physical

fitness, and overall health. Following this procedure, a woman commonly
experiences gas pains, incision pain, and uterine contractions (also common in
vaginal delivery). Her hospital stay may be two to four days. Breastfeeding the
baby is encouraged, taking care that it is in a position that keeps the baby from
resting on the mother's incision. As the woman heals, she may gradually increase
appropriate exercises to regain abdominal tone. Full recovery may be achieved in
four to six weeks.

The prognosis for a successful vaginal birth after a cesarean (VBAC) may be at
least 75%, especially when the c-section involved a low transverse incision in the
uterus and there were no complications during or after delivery.

Morbidity and mortality rates

Surgical injuries to the ureter or bowel occur in approximately 0.1% of c-sections.

The risk of infection to the incision ranges from 2.5% to 15%. Urinary tract
infections occur in 2–16% of patients post-c-section. The risk for developing a
deep-vein thrombosis is three to five times higher in patients undergoing c-
section than vaginal delivery.

Of the hundreds of thousands of women in the United States who undergo a c-

section each year, about 500 die from serious infections, hemorrhaging, or other
complications. The overall maternal mortality rate is estimated to be between six
and 22 deaths per 100,000 births; approximately one-third of maternal deaths
that occur after c-section can be attributed to the procedure. These deaths may be
related to the health conditions that made the operation necessary, and not
simply to the operation itself.

Alternatives

When a c-section is being considered because labor is not progressing, the

mother should first be encouraged to walk around to stimulate labor. Labor may
also be stimulated with the drug oxytocin. A woman should receive regular
prenatal care and be able to alert her doctor to the first signs of trouble. Once
labor begins, she should be encouraged to move around and to urinate. The
doctor should be conservative in diagnosing dystocia and fetal distress, taking a
position of "watchful waiting" before deciding to operate.

Approximately 3–4% of babies present at term in the breech position. Before

opting to perform an elective c-section, the doctor may first attempt to reposition
the baby; this is called external cephalic version. The doctor may also try a
vaginal breech delivery, depending on the size of the mother's pelvis, the size of
the baby, and the type of breech position the baby is in. However, a c-section is
safer than a vaginal delivery when the baby is 8 lb (3.6 kg) or larger, in a breech
position with the feet crossed, or in a breech position with the head
hyperextended.

A vaginal birth after cesarean (VBAC) is an option for women who have had
previous c-sections and are interested in a trial of labor (TOL). TOL is a
purposeful attempt to deliver vaginally. The success rate for VBAC in patients
who have had a prior low transverse uterine incision is approximately 70%. The
most severe risk associated with TOL is uterine rupture: 0.2–1.5% of attempted
VBACs among women with a low transverse uterine scar will end in uterine
rupture, compared to 12% of women with a classic uterine incision. To minimize
this risk, the American College of Obstetricians and Gynecologists (ACOG)
recommends that VBAC be limited to women with full-term pregnancies (37–40
weeks) who have only had one previous low transverse c-section.

http://www.surgeryencyclopedia.com/Ce-Fi/Cesarean-Section.html

The Cesarean Section FAQ

It seems that everyone is aware that the cesarean section is the number one
surgery these days. More babies are born abdominally than people lose gall
bladders and tonsils. We are very grateful for the medical technology that has
enabled us to save the lives of babies and mothers who would not have made it
otherwise. However, as the cesarean rates rise to close to 25% nationally, and
even higher in some places, we have to ask ourselves if all of the cesareans are
necessary. The answer to that question is no.

This FAQ will deal partially with preventing the unnecessary cesarean, but
mainly on the procedures, routines, not-so-routine, support, recovery and other
aspects of cesareans, with a short section on Vaginal Birth After Cesarean
(VBAC).

Feel free to write me and tell me what you like and don't like about this FAQ. I
could use some more stories from people who have been there.

This FAQ contains the following topics:

 Preventing the Unnecessary Cesarean

 Indications for a Cesarean
 Medications for Pain Relief During and After
 Procedures for Cesarean
 Partners and Cesareans
 Emergency Cesareans
  Recovery from the Cesarean
 Breastfeeding After a Cesarean
 Vaginal Birth After Cesarean Information
 Books and Resources
 Emotions and Feelings

Preventing the Unnecessary Cesarean

Why would I want to avoid a cesarean?

Cesarean section increase many of the risks to mothers and babies. When this
risk is weighed against other circumstances, it can be the better choice,
however,sometimes it is a choice of convenience, or a matter of lack of
information.

Here are some places to check out for help with avoiding an UNNECESSARY
cesarean:

 Avoiding unnecessary Cesareans

Indications for a Cesarean

What are some reasons that would mean I would need a cesarean?

Prolapsed cord (where the cord comes down before the baby), placenta abruptio
(where the placenta separates before the birth), placenta previa (where the
placenta partially or completely covers the cervix), fetal malpresentation
(transverse lie, breech (breech can sometimes be managed by External Version,
exercises or a vaginal breech birth), or asynclitic position), cephalopelvic
disproportion (CPD, meaning that the head is too large to fit through the pelvis.
This can also be over diagnosed, it can be caused by maternal positioning either
from restraint to bed, lack of mobility or anesthetics.), maternal medical
conditions (active herpes lesion, severe hypertension, diabetes, etc. (please note
that these conditions do not ALWAYS mean a cesarean.)), fetal distress (This
is a hot topic with the recent studies indicating that continuous electronic fetal
monitoring increases the cesarean rate and does not show a relative increase in
better outcomes. Discuss with your care provider how they define fetal distress
and what steps are used to remedy the situation before a cesarean.), maternal
exhaustion, and repeat cesarean, these are the main reasons for cesareans.

Pain Relief During and After the Cesarean

What type of pain relief is offered before and after a cesarean?

If you have not already had a epidural or spinal anesthesia for labor, or this is a
scheduled cesarean, and not an emergency cesarean, you will most likely be
given a regional anesthetic (epidural or spinal). If there is a reason that you
can't get regional anesthesia or it is an emergency you will be given a general
anesthetic. You may be offered or want to watch for someone giving you a pre-
operative sedative. If you are not particularly nervous about the cesarean, you
may want to forego this medication. It can reach the baby and make it harder to
start the baby breathing after a narcotic (usually), and it can make you groggy
an unaware during the birth. After the birth your regional anesthesia will help
you be pain free for a few hours, after which you will be prescribed some other
type of pain medication (narcotic or otherwise).

See also: Planning Your Cesarean FAQ for more discussion of options.

Note: Some people have noted that there are major discrepancies between
epidural and epidural. The feelings can range from total loss of sensation to
being able to feel parts of your body. However, with spinal anesthesia there is a
more uniform total loss of sensation. When you have already had the epidural,
generally a different medication will be added to the catheter and the dosage
increased.

Procedures for Cesarean

What is the procedure for a cesarean?

Some of these may go in a different order, and a few left out, but these are the
basics:

 A catheter inserted to collect urine

 An intravenous line inserted
 An antacid for your stomach acids
 Monitoring leads (heart monitor, blood pressure)
 Anesthesia
  Anti-bacterial wash of the abdomen, and partial shaving of the pubic hair
 Skin Incision (vertical or midline(most common))
 Uterine Incision
 Breaking the Bag of Waters
 Disengage the baby from the pelvis
 BIRTH!!!! (Accomplished by hand, forceps, or vacuum extractor)
 Cord Clamping and cutting
 Newborn Evaluation
 Placenta removed and the uterus repaired
 Skin Sutured (Usually the top layers will be stapled and removed within
2 weeks.)
 You will be moved to the Recovery Room (If the baby is able s/he can
go with you.)

How long will it be until my baby is born?

It is generally 5 minutes from the time that they make the initial incision until
the baby is born. The rest of the surgery will take between 30 and 40 minutes,
including repair.

Cesarean Primer for Partners

As her partner, how can I help her during a cesarean?

Most hospitals will allow you to go into the operating room with your partner,
or if you feel unable to, she may be accompanied by one other person (some
hospitals will allow two if one is the doula). Contrary to popular belief, most
people do not faint in the operating room. The mother will provided a drape to
block her view of the surgery, feel free to stay behind the curtain with her if
you are worried. Just being there for her and telling her what is going will help
her. Sometimes the doctor will allow you to cut the cord, carrying the baby to
the nursery, and take pictures. Make sure that you ask about these particular
things.

"...be prepared to see you wife/partner treated with an apparent lack of dignity.
I was taken away to be prepped and Dennis was left in the birthing center
labor room. When they ushered him into the operating room I was
spreadeagled on the table, buck naked, with betadine wash all over my belly. It
looked to him like I'd been crucified. Plus there were all these people there,
which generally would *not* be the case when I'm naked. To them it was just
business, but to him it was his wife and baby." -Penny H.

Emergency Cesarean

What is an emergency Cesarean?

Basically, an emergency cesarean would be one that meant a matter of minutes

was all that remained before the serious threat of loss of life or damage became
imminent. Generally, this would be a placenta abruptio, a prolapsed cord, etc.
General anesthesia is usually used, in combination with a vertical incision (for
the matter of time), and your partner is generally not allowed to accompany
you.

Recovery

What will my recovery be like?

Everyone's recovery will be different, depending on your age, body type, and
general health. However, some basics of recovery will be to remember that you
have just had major abdominal surgery as well as given birth to a new baby.
You may be plagued with gas pains from being opened, incisional pain, uterine
contractions (your uterus will still need to work to get back to it's original
shape). You may be extremely tired from medications, labor (if you had one),
or just in general. Your staples will usually be removed about 4-7 days
postpartum. Try to take everything easy. Do as little as possible, although
walking as soon as possible is very helpful in your recovery. The rule of thumb
is to not lift anything heavier than your baby. When you get home, take the
steps only once a day (if at all). Make a nest on the couch and nap there during
the day. Get as much help as you can with your cleaning, food preparations,
and other children.

You can start doing breathing exercises the first day in the hospital, someone
will show you how. Then each day you can gradually find small exercises to do
to get back into shape. Do not return to your previous exercise routine without
permission of your care provider. Overdoing it will only slow your recovery.
By the end of six weeks, some people say they are feeling pretty good, although
still dealing with some pain and sleeplessness. After this period you can usually
resume most activities (Some doctors will allow you to drive after about 2
weeks, others request that you wait the entire 6.).
Read: After a Cesarean

"Do get up as soon as they'll let you, even though it hurts like hell the first time
you get out of bed. Also, I found one of those big elastic belly supports really
helpful when I got home. I didn't use it for long, but for those first few days, it
really made laying on my side and rolling over in bed much less painful."
-France W.

Breastfeeding after a Cesarean

Can I still breastfeed if I had a cesarean?

Certainly you can. It may take some more effort on your part, but do not
hesitate to ask for help. Your hospital should have a lactation consultant on
hand to help you get started. Start breastfeeding as soon as possible, for some
this will be in the recovery room, for others you may have to pump for a sickly
baby or to encourage your milk supply. There are different positions that will
be helpful to you in breastfeeding after a cesarean, like the football hold, or any
other position that keeps the baby off of your incision.

For more help try:

 Breastfeeding After a Cesarean FAQ

"My son Aaron was born via emergency C-section. I was under general
anesthetic and was therefore unable to breastfeed "Immediately" after he was
born. After I was out of recovery and allowed to hold him (3 hours later), the
doctors told me to wait and not try to breastfeed him because of how tiring it
would be on me, and I needed my rest, etc., etc. They suggested waiting until
the next day to attempt the first feeding. I was so drugged up (morphine,
demerol) that I didn't protest. However when I was a little more aware a few
hours later, I insisted on having my baby and successfully breastfed him. So,
my advice would be to breastfeed when you feel up to it, not when you doctor
says you should or shouldn't. It's your baby and you choice." -Angie J.
 Vaginal Birth After a Cesarean

I had one cesarean (or more!), will I have to have another cesarean?

Recent studies have shown that there was an over 80% success rate for VBACs.
Finding a care provider who is supportive and being educated are still the keys
to preventing an unnecessary cesarean, even if it is a repeat cesarean.

One of the biggest fears of having a woman labor after having had a previous
cesarean was the fear that her scar would tear. That is very unlikely, especially
with the mid-line (bikini-cut) incisions that are the most popular today. Talk to
your care provider about any fears you have and read books, talk to others who
have experienced VBAC.

http://www.childbirth.org/section/CSFAQ.html