Obstetric & Gynaecology Malaysia


What are the reasons for cesarean birth?

The following situations are some of the reasons why a cesarean birth is performed:

  • Failure of labor to progress or a very large baby
  • Concern for the baby, the umbilical cord compressed or fetal monitoring detect an abnormality
  • Breech presentation, multiple pregnancy, problems with the placenta
  • Maternal infections, such as human immunodeficiency virus, herpes or Covid 19
  • Maternal medical conditions, such as diabetes mellitus or high blood pressure

Can I request cesarean birth?

Some women may request a cesarean birth even if a vaginal delivery is an option. This decision should be weighed carefully and discussed with your doctor. As with any surgery, there are risks and complications to consider. Your hospital stay may be longer than with vaginal birth. Also, the more cesarean births a woman has, the greater her risk for some medical problems and problems with future pregnancies. This may not be a good option for women who want to have more children.

What are the preparations for cesarean birth?

You are discourage from taking aspirin or herbal preparation of roots or barks type prior surgery. You need to fast at least 6-8 hours prior surgery. When you are admitted to Lavender Ward on the day of your cesarean delivery at 6am, a nurse will prepare you for the operation. An intravenous line will be put in a vein in your arm or hand. This allows you to get fluids and medications during the surgery. Your baby heart will be checked with a hand held Doppler. Your pubic hair may be trimmed. You can request rectal enema to assist you to pass motion the night before. You will be given medication to prevent infection. You will be sent to OT receiving bay at 7am-reviewed by anesthetist.

A catheter (tube) is then placed in your urethra to drain your bladder in OT. Keeping the bladder empty decreases the chance of injuring it during surgery and help to rest the bladder and decrease mobilization.

What type of anesthesia will be used during the procedure?

You will be given either general anesthesia, an epidural block, or a spinal block. If general anesthesia is used, you will not be awake during the delivery. An epidural or spinal block numbs the lower half of the body. In spinal block, an injection is made into a space in your spine in your lower back and drug is injected directly into the spinal fluid.

How is the procedure performed?

A cut (incision) is made through your skin and the wall of the abdomen. The skin incision may be transverse or "bikini". The muscles in your abdomen are separated and may not need to be cut. Another incision will be made in the wall of the uterus. The incision in the wall of the uterus also will be transverse. The baby will be delivered through the incisions, the umbilical cord will be cut, and then the placenta will be removed. The uterus will be closed with stitches that will dissolve in the body. Dissolvable stitches are used to close your abdominal skin.


What are the complications?

Some complications occur in a small number of women and usually are easily treated:

-Infection eg pelvic abscess or wound infection, risk estimate is 1 in 250,

-Blood loss requiring blood transfusion, risk estimate is 1 in 250.

-Blood clots in the legs, pelvic organs, or lungs. TED (thromboembolic) stockings is used to prevent blood clot.

In government hospital, sc clexane daily injection for a week are used.

-Injury to the bowel, rare 1 in 2500, risk for stoma if large bowel involved

-Injury to bladder, risk 1in 150 or injury to ureter, risk 1in 1000.

-Risk of return to theatre, risk estimate is 1 in 350.

-Reaction to medications or to the anesthesia that is used

What should I expect after the procedure?

If you are awake for the surgery, you can probably hold your baby after checked by the pediatrician in Operating Theater (OT). You will be taken to OT recovery bay for an hour. Your blood pressure, pulse rate, breathing rate, amount of bleeding, and abdomen will be checked regularly. If you are planning on breastfeeding, be sure to let your Lavender ward nurses know. You should be able to begin breastfeeding right away if you are fine.

You may need to stay in bed for a while. You can call the nurse for IV Tramadol 50mg if pain every 2-8 hours. The first few times you get out of bed, a nurse or other adult should help you. The catheter is removed from the bladder once you mobilized. The abdominal incision will be sore for the first few days. Your doctor can prescribe pain medication for you to take after the anesthesia wears off. A heating pad may be helpful. There are many different ways to control pain-eg post op binder (bengkung moden). 

A hospital stay after a cesarean birth usually is 2–4 days. The length of your stay depends on the reason for the cesarean birth and on how long it takes for your body to recover. When you go home, you may need to take special care of yourself and limit your activities.

What should I expect during recovery?

While you recover, the following things may happen:

  • Mild cramping, especially if you are breastfeeding
  • Bleeding or discharge for about 4–6 weeks
  • Bleeding with clots and cramps
  • Pain in the incision

To prevent infection, for a few weeks after the cesarean birth you should not place anything in your vagina or have sex. Allow time to heal before doing any strenuous activity. Numbness, tingling or burning sensation (this is usually self-limiting but could take weeks or months to resolve. Frequency of micturition and urinary tract infection.

Call your ob-gyn if you have a fever, heavy bleeding, the pain gets worse or fluid leaks from your abdominal wound.