Dr. Saju Joy, MD

C-section incisions can be up-and-down (vertical), from belly button to lower abdomen or side-to-side (horizontal), across the lower abdomen. Side-to-side incisions are more frequently used. After the exterior incisions are made, the doctor then cuts into the uterus and amniotic sac and delivers the infant and cuts the baby's umbilical cord. The mother receives medicine to expel the placenta and the doctor helps to safely remove it. Finally, the doctor uses sutures to seal the uterus and tissue incisions. The initial C-section skin incision is also closed with sutures or staples.

C-sections are typically performed with regional anesthesia, which inhibits pain in the lower half of the body, but allows mothers to be awake. However, some mothers may receive general anesthesia, where they are put to sleep during the surgical procedure.

C-sections may be planned or unplanned, depending on the circumstances of the birth.

Pre-existing conditions like heart disease, high blood pressure, herpes, and HIV may prompt a doctor to prescribe a C-section. Other situations for C-section include:

• A large baby or birth to multiple children
• Pelvic fracture or limited birth canal
• Baby in the "breech position," where a baby is positioned feet or bottom first in the uterus
• Baby with a developmental disorder
• Irregular fetal heartbeat
• Mother with a history of previous C-sections

Other mothers may require a C-section due to complications arising during delivery. These unplanned, emergency C-sections allow for a healthy birth even when complex complications are present. Problems during labor which may necessitate a C-section include:

• Labor not progressing
• Fetus switching position during labor
• Distressed infant
• Blockage of the cervical opening by the placenta
• Prolapsed umbilical cord

Mothers should expect about a six-week recovery period following a C-section, including an initial hospital stay of two to three days. While in the hospital, mothers may spend time with their baby and begin breastfeeding. After returning home, mothers should limit strenuous activities such as lifting, reaching, and exercise, and should make sure to get plenty of rest.

Hydrocephalus is most often treated with an implanted device called a shunt. A shunt is a long, thin tube that is used to drain excess fluid. One end is placed within the brain. The tube runs under the skin, along the neck behind the ear, and to another part of the body where the fluid can be reabsorbed. Most often this is the abdomen, but the chest or other areas can also be used. Shunts have a valve that allows doctors to monitor and control the pressure within the brain. Insertion of a shunt is a surgical procedure that takes one to two hours. Incisions are made in the head and the abdomen, and the shunt is threaded into place before the openings are stitched closed.

In cases where hydrocephalus is caused by a blockage, a procedure called endoscopic third ventriculostomy, or ETV, may be performed. During this procedure, a surgeon makes a dime-sized hole in the skull and uses a thin tube with a camera on the end (called an endoscope) to see inside the brain. The surgeon punctures a hole in the floor of the third ventricle, a fluid-filled space within the brain. The hole provides an opening for cerebrospinal fluid to flow around the blockage, normalizing pressure. The entire procedure usually takes less than an hour and patients can often go home the following day. ETV can provide a permanent and safe alternative to a shunt, but it is only useful for patients whose hydrocephalus is caused by a blockage.