Several<unk> s Is: supra-umbilical incision Im: median incision IM: Maylard incision IP: Pfannenstiel incision Removal of the baby Illustration depicting<unk>  Antibiotic prophylaxis is used before an incision. The uterus is incised, and this incision is extended with blunt pressure along a cephalad-caudad axis. The infant is delivered, and the placenta is then removed. The surgeon then makes a decision about uterine exteriorization. Single-layer uterine closure is used when the mother does not want a future pregnancy. When subcutaneous tissue is 2 cm thick or more, surgical suture is used. Discouraged practices include manual cervical dilation, any subcutaneous drain, or supplemental oxygen therapy with intent to prevent infection.<unk>  can be performed with single or double layer suturing of the uterine incision. Single layer closure compared with double layer closure has been observed to result in reduced blood loss during the surgery. It is uncertain whether this is the direct effect of the suturing technique or if other factors such as the type and site of abdominal incision contribute to reduced blood loss. Standard procedure includes the closure of the peritoneum. Research questions whether this is needed, with some studies indicating peritoneal closure is associated with longer operative time and hospital stay. The Misgave Ladach method is a surgery technical that may have fewer secondary complications and faster healing, due to the insertion into the muscle. Anesthesia Both general and regional anaesthesia (spinal, epidural or combined spinal and epidural anaesthesia) are acceptable for use during<unk> . Evidence does not show a difference between regional anaesthesia and general anaesthesia with respect to major outcomes in the mother or baby. Regional anaesthesia may be preferred as it allows the mother to be awake and interact immediately with her baby. Compared to general anaesthesia, regional anaesthesia is better at preventing persistent postoperative pain 3 to 8 months after<unk> . Other advantages of regional anesthesia may 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 esophageal intubation. One trial found no difference in satisfaction when general anaesthesia was compared with either spinal anaesthesia. 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<unk> . Regional anaesthesia during<unk>  is different from 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. 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. Prevention of complications Postpartum infection is one of the main causes of maternal death and may account for 10% of maternal deaths globally. A<unk>  greatly increases the risk of infection and associated morbidity, estimated to be between 5 and 20 times as high, and routine use of antibiotic prophylaxis to prevent infections was found by a meta-analysis to substantially reduce the incidence of febrile morbidity. Infection can occur in around 8% of women who have<unk> s, largely endometritis, urinary tract infections and wound infections. The use of preventative antibiotics in women undergoing<unk>  decreased wound infection, endometritis, and serious infectious complications by about 65%. Side effects and effect on the baby is unclear. Women who have<unk> s can recognize the signs of fever that indicate the possibility of wound infection. Taking antibiotics before skin incision rather than after cord clamping reduces the risk for the mother, without increasing adverse effects for the baby. Moderate certainty evidence suggest that chlorhexidine gluconate as a skin preparation is slightly more effective in prevention surgical site infections than povodone iodine but further research is needed. Some doctors believe that during a<unk> , mechanical cervical dilation with a finger or forceps will prevent the obstruction of blood and lochia drainage, and thereby benefit the mother by reducing the risk of death. The evidence neither supported nor refuted this practice for reducing postoperative morbidity, pending further large studies. Hypotension (low blood pressure) is common in women who have spinal anaesthesia; intravenous fluids such as crystalloids, or compressing the legs with bandages, stockings, or inflatable devices may help to reduce the risk of hypotension but the evidence is still uncertain about their effectiveness. Skin-to-skin contact The WHO and UNICEF recommend that infants born by<unk>  should have skin-to-skin contact (SSC) as soon as the mother is alert and responsive. Immediate SSC following a spinal or epidural anesthetic is possible because the mother remains alert however, after a general anesthetic the father or other family member may provide SSC until the mother is able. It is known that during the hours of labor before a vaginal birth a woman's body begins to produce oxytocin which aids in the bonding process, and it is thought that SSC can trigger its production as well. Indeed, women have reported that they felt that SSC had helped them to feel close to and bond with their infant. A review of literature also found that immediate or early SSC increased the likelihood of successful breastfeeding and that newborns were found to cry less and relax quicker when they had SSC with their father as well.
Caesarean section
Labor induction
Natural childbirth
Forceps
Trial of labour
Cordotomy
Obstetrical forceps
Vaginal delivery