An anonymous commenter left a comment about something that she was shocked and quite bothered by during her c-section. Here is the portion of the comment that I'd like to share:
After my husband and baby left the room and they took down the sheet, I looked
down and saw that my legs were in "frog" position and people were pushing on my
stomach and looking between my legs. I was so upset that no one told me what
they doing or gave me more privacy (the room was still full of people and I had
made it really clear I have vulnerability issues.) Is this normal practice? Do
you often see medical people doing things to c-section patients' bodies without
telling them? It seems like they should treat you the same as they do when they
do an exam or vaginal delivery.
To answer your question: yes, this is normal practice. How it was done in regards to not informing you, no that isn't normal. At least where I work. And this got me thinking about sharing with everyone what happens when you have a c-section. Seeing that 1 out of every 3 pregnant women end up with one in our country, I think it's important to have an idea of what to expect.
The following is how I've seen c-section preparation done in places where I've worked. Also, if the c-section is emergent things are just happening quickly by numerous nurses and doctors with no particular order with little explanation to what prep is going on. So just use this as a general guide and keep in mind that different hospitals do things differently and emergencies tend to blow some of the normalcy of the preparation out the window.
It usually takes two hours to "prep" someone for a c-section when it's a scheduled event. It doesn't need to because in an urgent situation (not emergent but we need to move quickly) it takes all of 20 minutes if that. But, whatever. I think the two hour prep time is to give the obstetrician and the anesthesiologist some wiggle room to run a little behind. It also makes things easier on the nurse most of the time if all she is doing is admitting you and doing all the prep stuff.
So first thing done putting the baby on the fetal monitor and getting an NST. But most nurses will just leave the woman on the monitor until you head over to the OR. An IV is started, and fluid is begun. Anesthesia likes to have lots of fluid run in before heading into surgery, so at least one liter is run in at a minimum. Paper work crap is done, like the nursing assessment, advance directives, consents, etc. A "clip" is done of the pubic area (it's better to have the nurse do than do it yourself; home razors are full of bacteria and cause microscopic nicks in the skin....a perfect set up for post-op infections, especially for the big girls who have a pannus hanging over the area to be cut.). A foley catheter is put into the bladder to make sure the bladder stays small to reduce the risk of nicking it during surgery. It also is needed after having a spinal because you'll not be able to pee for up to 18 hours post-surgery. Some places are kind and have the nurses put the catheter in after the spinal. I much prefer this because it's kinder to the woman and it's what I'd want if I was the one getting a section. But some places or doctors don't "allow" this because they are afraid that after the spinal is placed that the woman's blood pressure will plummet or the baby will nose dive and they don't want some nurse futzing around with a foley when they want to start cutting. And frankly, some nurses prefer to do it prior to going into the OR because it's one less thing they have to do once they get into the OR; the role of that nurse during the first 10 minutes in the OR are numerous because she's the one setting everything up, being asked (or told) to do 10 things at once. This is anxiety provoking to some.
There are also a lot of medications given to reduce the acid in the stomach. There is also an antibiotic given prior to going into the OR.
Once all this is done, then off to the OR. The OR is cold and warming blankets are given if needed. The woman sits on the OR table for the spinal, which usually doesn't take very long and sets in quite quickly. The nurse listens to the fetal heart rate once you are laying down, the foley catheter is placed if not done earlier, legs are strapped to the table, and then the nurse begins the surgical scrub of the belly.
At this point, the doctors will drape the belly and get into position to start the surgery. They do a test of the skin to ensure the spinal is in fact working. Typically they do this without actually telling you to really make sure you aren't thinking you feel something due to anxiety. If they get no response (and if you have any feeling left at this point you will feel it...they pinch really hard with a surgical instrument) then they get started. The support person is brought in at this point, and sits next to the woman's head. There is a big blue drape that comes up so you are shielded from what the surgeons are doing.
It doesn't take very long to get to the uterus and pull out the baby. Unless, of course, there is a lot of scar tissue from previous c-sections or abdominal surgery they have to work through. The baby is handed off to an awaiting nurse and/or pediatrician. They dry the baby, suction the airway, and hand the baby over to the support person or snuggled up to the woman if it's possible. Some places will then bring the baby to the nursery or leave the baby with the mom.
Now, during the surgery, most women fell tugging and pressure. But there should not be any pain. Some woman find the pressure very uncomfortable, especially during the expulsion of the baby because the assistant to the surgeon does a lot of pushing and leaning on the belly. And some will have an uncomfortable sensation or even nausea during the closing process when they exteriorize the uterus. This is when they literally take the uterus, tubes, and ovaries out of the pelvis while they suture the uterine incision back together. Some surgeons don't do this. Most surgeons close the uterus in two layers, which may seem like a stupid thing to mention, but if the woman hopes to have a VBAC for the next baby it's important to know this. This is detailed in the operative note, not something that anyone would mention. The risk of uterine rupture is lower with two layer closure than one layer, which is why this would be important to know in the future.
Once the abdomen is closed up, which is done in layers, the drape comes off and then the abdominal dressing is put on. This is the point when the doctor pushes on the abdomen really hard while having the woman frog legged to fish out any large blood clots in the vagina. However, unlike the anonymous commenter's experience, I've always seen the woman being told this is going to happen. There are people that are in the room but they are all busy doing whatever they need to do before they leave the OR so they really aren't paying attention to the manual expression of blood clots from the vagina.
And finally, the woman is moved over onto a stretcher or bed and wheeled to the PACU/recovery area and monitored closely for several hours. During the recovery time, breastfeeding can be initiated.
So there you have it. C-section crash course.