Probably the first piece of the whole puzzle, no matter how fast it has to occur or how slow it has to occur, is educating the patient and having the patient be a participant in the process, so they have to be informed of why you are doing what you are doing, what’s going to happen next, aware of the risks before you can even start the process.
The second piece is probably assuring patient comfort and that starts in the very beginning with the education so that they know what to expect next, and it also involves the next step in the process of anesthesia, whether that’s going to be a regional block where people are basically awake but numb, or a general anesthetic where people actually sleep through the procedure.
Once those two things are taken care of then it’s a matter of mobilizing a team of people. So, it’s an ORT and that includes OR staff circulating nurses and scrub tacks, an obstetrician, an assistant for the obstetrician, an assistant surgeon, an anesthesiologist or an anesthetist and then a nursery team to take care of the baby once the baby is delivered.
Once that team is mobilized, and a lot of these things are happening simultaneously in the background, the patient is not aware of. The patient is then in route to the operating room. There’s some blood work that’s drawn before that, an IV started to allow IV fluids to go in so that people have access to get their anesthetic, antibiotics that they might need before the incision is made on the abdomen or after the baby is delivered in pain medication.
The patient is taken to the operating room in a non-emergent situation and an epidural is placed or spinal is placed. That’s a process of either putting a needle or catheter into the paraspinous space inside the spinal cord but outside to where the nerves are, and that allows either for a long case with an epidural in place so that anesthetic can be delivered over a long period of time or an injection that gives you a two-hour period of time to be able to complete your procedure, but your anesthesiologist could tell you more about that piece.
Then after the patient is in the operating room with the whole team mobilized we go through the same initial steps again, making sure patient understands what’s going on, that they are comfortable in the process, while the abdomen is being prepped with the sterile solution, drapes are placed over the abdomen, that protects the field, but still allows the physician, the obstetrician to be able to talk to the patient over the top of the drape so they are awake and a participant in the process the whole time, and if the patient is awake they usually can have a partner there. So there will be a second person in the room. That’s not so much for the partner, but it’s for the patient.
We test the abdomen to make sure that the patient is numb before we start and then an incision is made on the abdomen. The large muscles in the abdominal wall are spread rather than cut the vast majority of time. The uterus is exposed and an incision is made in the uterine wall, the amniotic membranes are ruptured so it lets out the amniotic fluid, and then the baby’s head is guided down into that incision and the infant is delivered with the aid of maternal, pressure on the maternal abdomen, so someone pushing on the tummy. So frequently patients will kind of feel that pressure though it shouldn’t be pain.
The baby comes out and we suction of the amniotic fluid that’s inside the nose and the mouth to help the baby kind of transition into a world of air and then the umbilical cord is cut and the baby is handed off to the pediatric team that’s there waiting to do their evaluation.
It’s kind of in that little window that the mom and her partner get the first chance to see the baby. The placenta is then delivered, medicine is given to help the uterus firm up and contract down and the uterus is closed, the abdomen is closed and then the skin is closed with either surgical staples or small suture under the skin and with a bioclusive glue on the incision after. At that point in time, the mom moves off to the recovery room to be with her partner and her baby.
The fastest part of the process is from the incision on the tummy to the time the baby is out and that usually occurs in somewhere around one to two minutes at the most. After the baby is safely delivered and in the hands of the pediatric team, then the whole process slows down and it becomes a very meticulous process of evaluating the abdomen and the uterus, meticulously closing each layer. That process usually takes between 20 and 40 minutes barring prior surgeries or other unexpected findings.