VIDEO TRANSCRIPT: THIS TRANSCRIPT WAS GENERATED USING AN AUTOMATED SERVICE SO WE APOLOGIZE FOR ANY TYPOS AND SPELLING ERRORS.

Let's talk about c-sections!

Shieva Ghofrany: [00:00:00] Hi everyone. We're gonna be in the operating room. That's Princess. Hi Princess. Princess is here and to, she assists us. She's amazing scrub tech. We're gonna talk about C-sections today and what we see when we're in the operating room. So stay tuned. If you don't want to see anything in the or, swipe away, but we're gonna show you not gory details, no one's in here. 

I just wanna show you the operating room and some of the things that you. Okay, so typically if you have a planned C-section, you are gonna walk in, and this is our operating room. Different places are different, but you'll walk in from the main door. If it's a planned C-section, some hospitals will wheel you in with a wi with a wheelchair. 

Some will wheel you in on a stretcher. But our hospital, assuming it's planned and you're feeling okay, we actually walk you in with the nurse. You will typically walk in and your partner will stay in the room, meaning in your the room you started. Our hospital happens to be a labor room. Some hospitals will have a pre-op separate room. 

They'll stay in that room waiting for you until you are ready, and this is what [00:01:00] the operating room will look like when you come in. Again, different hospitals have different operating rooms. We happen to have very big cesarean section operating rooms. Some are much smaller, and that's okay. As long as you have the vital equipment, that's all you need. 

When you walk in, you'll typically go over to the bed and you will sit on the edge of the bed with your legs hanging over because you're gonna be ready for the. The spinal is when you lean over, you hunt your back. We say like an angry cat or like a shrimp. You want instead of your back being straight or curved backwards, you want it to be curved like a c cuz you want those spaces between the vertebra to open up so that the anesthesiologist can easily administer the spinal anesthesia. 

It is not a spinal tap. They're not removing fluid, they're just putting one shot of Novocaine. It's really something called lidocaine. But to numb your. And the slight, the deeper tissue. And then one needle goes in to just give you a shot of medicine. And then that medicine makes your feet tingle at your butt tingle. 

And you go numb. Okay, we're gonna show the anesthesia equipment. [00:02:00] Thank you Princess. She is reminding me to show you the anesthesia equipment. You're gonna be hooked up to equipment like this, which is gonna show your heart rate, your oxygen in your, from your finger, your pulse. So we kind of are watching the whole time. 

We know you may or may not have some oxygen on. Either a mask, which is rare to have a face mask of oxygen when you're awake cause you usually don't need it. Or nasal prongs meaning two little things up into your nostrils to give you anesthesia. Do you have to wear your mask during covid? It depends on you. 

The hospital, the anesthesiologist, we will sometimes allow patients to pull down their mask a little bit, especially if they are covid negative, if they're positive. Completely different setup because we'll all be wearing N 95 s as will the patients when we are in here. You get your anesthesia, you lie. 

The minute you lay down, this is where one of my partners says it's like the pit pit crew at nascar, the pit crew at nascar. The races, because we lay you down and then all of a sudden we have a lot of activity we have to do. You [00:03:00] are not strapped down. Your arms will not be strapped in the majority of hospitals, unless you are under general anesthesia where they were. 

Your arms will fall. So just know that you can certainly ask your doctor, but I've never heard of a hospital where the arms will be strapped down if you are awake. So you'll come over here, you'll be lying down, and then immediately what will happen is activity. Like we turn on, we listen to the baby's heart rate, either with one of the monitors like this or with the little doppler. 

And this is just a machine called the Boby. This is where when we are doing the surgery, we need the cautery to help stop bleeding. So these are some of the. And that's the suction where we make sure we quantify how much blood and how much fluid gets lost. And that's something that is very common and very safe to do. 

When we look at the, there's a whiteboard that I'm not gonna show you because there is a patient's name on there right now, but it will talk about all of the instruments that we use so that the nurses and the scrub tech can keep track of the instruments they count. And some hospitals like [00:04:00] ours will have a very fancy machine that actually. 

But there's nothing in there. It's almost like a metal detector. You'll also have a little sticky pad that you won't notice that gets stuck onto your thigh, typically, because that's attached to the cautery. And then the other things in the room. For example, the baby bassinet, that's where the pediatrician and the pediatric nurses, or if you have a nurse practitioner or a PA who will be in the room to receive the. 

Suction the baby. If the baby needs tell us that everything's okay with the baby, typically they'll weigh the baby, they'll bundle the baby up and then they'll bring the baby over to you and your partner. As long as you're feeling okay and the baby's okay, they keep the baby there. Now Princess, we're gonna look at some of the instruments. 

Don't be scared. It's a lot of instruments and we don't even use the majority of them, but Princess is here meticulously, right? Hi Princess. She counts all the instruments ahead of time to make sure that we have the right. She counts them during, she counts them afterwards. We always have these extra, the white, what we call laparotomy [00:05:00] pads. 

Mm-hmm. , those are what we use to keep everything as dry as possible. She makes sure those are counted. So this is all of the equipment that we're gonna be using. All right. Right. Princess? Yes. That was great. That's right. And the drape. Okay. More to common effect. So this is the hallway in our hospital that you come walking down, you go into the room. 

Like I said, you sit down on the edge of the. You get your spinal anesthesia. Sometimes it can take two to three minutes. Sometimes it takes longer. If you happen to have a lot of swelling in your lower back, if you happen to have a higher BMI where there's a little bit more subcutaneous tissue, a k a bad, um, I'm taking off my mask cuz now I'm alone in the hallway. 

Then we will make sure that everything is done meticulously with the spinal, but sometimes it takes them a little bit longer to actually place the spinal. So you have to be patient. Your doctor is doing the best job that she can, but the anesthesiologist doctor, when she's doing it has to make sure she's doing it safely and she's getting the medicine in the right space. 

Is there a chance of, God [00:06:00] forbid, things like paralysis? It's so rare. So as I always joke, don't ask your your anesthesiologist if that's possible, cuz many ask what's possible. Doctors have to back. And again, the likelihood of that is so incredibly small. Now you've gotten your anesthesia, you're lying down. 

We're putting the baby monitor on. We're putting a catheter in your bladder to empty your bladder. Something called a fully catheter. It's little tube. And we're cleaning off your belly to make sure that it's been completely cleaned as much as we can from all the bacteria. And. We put the drapes on your belly so that you don't see what's going on and that we're sterile. 

And then once the surgeon has made sure that you're only feeling touch and pressure, but no pain, then one of the nurses will grab your birth partner to come into the room. Now, what's very common at that minute that you lay down, once you've had your anesthesia, and again, it feels very overwhelming. Like the pit crew at nascar, you get laid down and all of a sudden we're cleaning your belly, we're putting in the catheter, we're listening to the baby's. 

Not in that order. It's actually [00:07:00] heartbeat. Clean your belly, putting your catheter, um, while the anesthesiologist is monitoring all of your vital signs. So we know that you are safe. We know that your blood pressure's okay, that your pulse is okay, and that your oxygen levels are okay. You might feel quite the opposite. 

So it's very common to all of a sudden feel dizzy, to sometimes feel nauseated to sometimes. A headache and to feel a little bit like you can't take a deep breath because your muscles that are in your chest can sometimes be a little bit numb as well. So while you are oxygenating and you are breathing and we know you're okay, you might feel overwhelmed. 

And I try to remind patients that it's very common and I don't wanna preemptively, um, make anyone anxious that they're gonna feel that way. But I'd rather you know that if you're laying down and you're feeling all those feelings a little bit shortness of breath, a little bit of anxiety, a little bit of nausea, Maybe a little bit of a headache, feeling like pressure in your chest. 

These are all normal, normal things. After the spinal, they're partially due to anxiety and partially due to the physiological changes that happen from the spinal, and your [00:08:00] anesthesiologist is watching you the whole time, so you're okay. Then we get started with the C-section where you feel touching and pressure, but no pain, and then your doctor has to get through a couple of layers your. 

your subcutaneous layer, aka your fat, your fascia, which is the tough white layer of tissue that stops you from getting a hernia and keeps everything inside your peritoneum, which is a filmy tissuey layer that doesn't keep everything inside, but is kind of necessary to keep everything, um, as closed up in your pelvis as possible. 

And then we get to the pe. Actually the, the pelvis itself, the pelvic, um, inlet. So we look at the inside of the pelvis and we look at your uterus. Once we're looking at your uterus, and we have various retractors that we use to be able to see everything. And we have our assistants there with us. It's typically the surgeon. 

She may have a second surgeon with her who's one of her partners. She may have an a resident who's one of her who's gonna assist her. She may have a PA or a nurse practitioner who does surgery, and sometimes even medical students. So there's probably a couple people in the room once [00:09:00] we look at your. 

Then we do varying things. We make an incision sometimes on the very top layer of your uterus before we get to the muscle. Different surgeons will do this differently, but just so you know, from the skin to getting the baby out will take anywhere from three to 10 minutes because it might be quick and easy, an average one without the patient having too much subcutaneous tissue, and we can get the baby out quickly, or it might. 

10, 15, 20 minutes, especially if there is scar tissue or a thicker layer of fat, which as you can imagine, takes us a little bit longer to get through. If there is scar tissue, meaning from your previous C-section of previous surgeries, you have had your uterus kind of stuck to the back wall of your muscle or your uterus stuck to your bladder, or your stuck to your bowels, then sometimes we need to make sure, here's Marie, one of our residents. 

Then we need to make sure that the scar tissue, which. Layers that are stuck together, that we get through the scar tissue. People will often say, well, did you remove the scar tissue? Scar tissue is not like a thing. It's things stuck [00:10:00] together. It's like saying when you're trying to remove, I know this is gross, but the chicken skin from the underlying layer of the chicken breast, you feel that filly stuff that's stuck there. 

You don't remove it and throw it away necessarily. You just detach those connections. Can you remove scard tissue? Meaning can. Um, detach the connections in the hopes that it won't recur. Yes, you can. Sometimes it doesn't recur. Sometimes it does. People tend to make scar tissue or they don't. We have yet to figure out exactly how to prevent it. 

We have varying levels of, um, barriers that we use. There's a liquid, there's a couple of different filmy pieces of, again, they look like tissue or like saran wrap that we sometimes put during the C-section. Try to prevent future adhesions they're called or scar. Nobody really knows if it works. This data is a little bit all over the map. 

Okay? Once the incision is made on the uterus, then we're counting down the clock. We're gonna get that baby out within the next like one to two minutes because we make the incision on the uterus. And you guys might think, oh, you make the incision, the baby pops out, right? No, the answer is [00:11:00] make the incision. 

Then you have to get your hand in there, and then depending on the baby's position, you have to get the head out of an incision that is now starting to contract. Because the minute we have made that incision into the uterus, the uterus wants to contract. You'd think it would push the baby out of the incision, but that doesn't seem to happen. 

So we have to sometimes, and I say to patients, you might hear grunting and groaning and feel pulling and tugging as we're getting the baby out. And sometimes you even need to use a vacuum. To actually help the baby's head come out of the uterine incision or out of the subcutaneous layer in skin, which again is the fat and the skin. 

Sometimes it's super easy. Sometimes you have to actually wrestle with the baby to get the baby out a little bit. The minute the baby's out, assuming the baby is either crying or has good muscle tone, then most hospitals now will do delayed cord clamping, meaning even at the C-section, we delay the cord clamp. 

We clamp the cord anywhere from 45 seconds to a minute or so on. We hand the baby to the pediatrician or the pediatric team. They make sure the baby is doing the things we want, not too much fluid. They suction the baby a little bit. They don't clean the baby off. They may or may not put in the [00:12:00] eye ointment at this point. 

They likely will wave the baby, measure the baby's inches, and then bundle the baby up and hand the baby. To you and your birth partner. At which point, if the nurses have the opportunity to assist you with this, then you can try to do skin to skin. And if not, you can just snuggle that baby up against your shoulder. 

Your birth partner can unsnap your gown. So again, this can be as emotionally attached as any other delivery, sometimes more because you haven't gone through a long labor necessarily. Once that is done, then we have to close up our layers. We typically will close after the placenta has come out, so we remove the place. 

and then we close the uterus. Some people close one layer, some people close two. I'm not gonna talk about that this time because it's outside of the scope of our discussion. We then close after the uterus, some people close something called the bladder flap, which is just an extra thin layer where we kind of, um, close up that thin layer right above the uterus, which is right about a centimeter to above the bladder. 

I don't actually tend to do that one, but some people still do. Some people close the peritoneal. again, most of us don't, but [00:13:00] I'm mentioning cuz some people do. Some people close the muscle and then all of us close the fascia, which is this tough layer that keeps everything in. And then depending on how thick your subcutaneous layer in is one or two layers in the subcutaneous layer. 

I always put a layer in even when patients are thin, because it can help decrease that puckering people get. And then the skin and the skin can be closed with staples or sutures. I'll do another video about the pros and cons and ver varieties of what people. . And then after you're all closed up, you go into the recovery room, you stay there for a couple of hours to be watched to make sure that your uterus is contracting and that your blood pressure is stable and that everything about your vital signs is okay. 

And then you go to the maternity ward quick and easy. Right. Okay. I hope that helps for you guys to know what happens during the C-section. Um, I'm gonna also add what I think patients should do preoperatively about eating.