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Caesarian section

Information on surgical delivery

More and more children are being born by caesarian section. In Germany, around 30 % of women give birth this way.
Why is that?

Reasons for having a caesarean section

One reason is that women today tend to have their first child later in life and this increases the risk of complications during birth. At the same time, hospitals can plan surgical births more easily, and they are more interesting in economic terms.

Another reason is that obstetricians intervene earlier and more often in the birth procedure (inducing contractions with medicine, rupturing the membranes) for fear of liability cases. However, this also increases the probability of needing to have a caesarean section in the end.

Some women opt to have a caesarean birth from the outset, even if there are no concrete medical reasons for doing so. Either they fear the pain of childbirth or the risk of a permanently weakened pelvic floor (incontinence).
Some choose to have a caesarean because they believe it to be the safer alternative.

Medical reasons for having a caesarean section

  • irregular position of the child
  • if natural childbirth holds health risks for mother or child
  • pre-existing medical conditions of the mother or child
  • the size of the baby is disproportionate to the size of the mother’s pelvis
  • multiple births
  • Rh incompatibility
  • premature rupture of membranes
  • previous operations to the womb
  • the mother is infected with HIV
  • the placenta is lying in front of the cervix
  • obstructed labour
  • complete exhaustion or inadequate cooperation of the mother
  • complications during childbirth (e.g. a tear in the womb (uterus rupture), premature placental abruption, the mother develops fever)
  • the baby’s heart rate decreases constantly
  • umbilical cord prolapse → danger of oxygen deficiency in the child
  • severe pregnancy-related disorders suffered by the mother, e.g. eclampsia, manifested HELLP syndrome

Types of caesarian section

There are two types of caesarian section: The planned or primary caesarian (including caesarean delivery on maternal request) and the unplanned secondary caesarean, which is carried out spontaneously during birth.

By the way, the expression “emergency caesarian section” relates to how urgently surgical delivery needs to be carried out or how high the risk is to mother and / or child during spontaneous vaginal delivery. An emergency caesarean section can thus also be a planned one.

Caesarian procedure

Irrespective of whether surgical delivery is a medical necessity or if it is carried out on maternal request, the procedure is always the same.

Mostly, anaesthesia is local using a spinal or epidural block. A general anaesthetic is only used in exceptional cases. Following this, a urinary catheter is inserted into the urethra. Due to the local anaesthetic, you are awake and alert for the birth of your baby. And, so that you do not see more than you wish to, a screen will be raised above your waist. To offer you support, your partner can be with you at the head of the operating table.

Once the anaesthesia has taken effect, a horizontal incision will be made in the bikini zone (so that the scar will barely be noticeable later) and the abdominal wall will be opened gradually. Finally, an incision is carefully made into the uterus and the baby is delivered. Congratulations! You have become parents!

After the umbilical cord has been cut, the baby is wrapped in warm towels and placed in Dad’s arms. Time for the first vis-à-vis and for marvelling the miracle you have created together – whose nose has the baby got and whose chin?

While the obstetrician sews the incision, the father can accompany the baby to the first examination.

Normally, your condition is monitored in the delivery room for around two hours. The time will fly past – you will put your baby to your breast for the first time and give him/her the important first milk or colostrum.

After that, you will be moved from the delivery room to the maternity ward. Depending on how fit you feel, you can usually leave the hospital after four to eight days.

The Misgav Ladach method

An operation technique which is often used today is the Misgav Ladach method. It was developed in 1994 in Jerusalem and is referred to as the “gentle” caesarean section.

The main difference to other techniques is that an incision is made into the upper layer of skin only and the deeper layers of the abdominal wall are carefully pulled apart with the fingers. The aim is to protect the tissue and to minimize blood loss.

Furthermore, fewer stitches are used to close the wound, as the peritoneum generally grows back together on its own.