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A Cesarean section (C-section) is surgery to deliver a baby. The baby is taken out through the mother's abdomen.

In the United States, about one in four women have their babies this way. Most C-sections are done when unexpected problems happen during delivery. These include Health problems in the mother The position of the baby Not enough room for the baby to go through the vagina Signs of distress in the baby C-sections are also more common among women carrying more than one baby. The surgery is relatively safe for mother and baby. Still, it is major surgery and carries risks. It also takes longer to recover from a C-section than from vaginal birth. After healing, the incision may leave a weak spot in the wall of the uterus. This could cause problems with an attempted vaginal birth later. However, more than half of women who have a C-section can give vaginal birth later. What is a cesarean section? A cesarean section is an operation in which an obstetrician makes a cut through your belly and uterus (womb) so that your baby can be born. It's the most common major surgery that women have. What's the difference between an elective and an emergency cesarean? An elective cesarean is planned to take place before your labor begins. An emergency cesarean is not planned before labor begins and happens in a range of situations. Although many cesareans are unplanned, only about a small percent of these are genuine emergencies. Most unplanned cesareans give you, your partner, and the maternity staff enough time to be well prepared for the operation. The reasons for needing a cesarean section vary, because every pregnancy and birth is different. Read about reasons that may require a cesarean. Much may depend on whether this is your first baby, or whether you've already had one baby or more by cesarean. Your circumstances may mean that your doctor advises you to have a planned repeat cesarean. Occasionally, the operation may be carried out as an emergency. We've drawn up a birth plan to help you decide what to do if you have a cesarean section -- whether you are expecting to give birth that way or not. Simply print out our checklist.

Some hospitals will allow the baby's father to be with you during your cesarean. If so, he will have to change into thin cotton theater clothes, which include a mask for his nose and mouth, a cap and special footwear. During your cesarean you'll lie on an operating table, which is tilted or wedged to the left. It's tilted so the weight of your uterus doesn't reduce the blood supply to your lungs and make your blood pressure drop. Quite a lot of things will happen to prepare you for your cesarean:

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You'll have a blood sample taken to check your iron levels are high enough and that you haven't got anemia. A drip will be inserted into a vein in your arm to give you fluids and to make it easy to give you drugs later if you need them. You'll be given an anesthetic. This will usually be regional, which means it numbs your bottom half, via a spinal or epidural. If so, you'll be awake for your baby's birth and it's safer for you and your baby than a general anesthetic, which puts you to sleep. A thin tube, or catheter, will be inserted into your bladder via your urethra. This will make sure your bladder is empty. It can be put in after the anesthetic is working so that you don't feel it. The area where the cut will be made will be cleaned with antiseptic to help prevent infection. You'll be given either white stockings, extra fluid or blood-thinning injections to reduce the risk of a clot forming in one of your leg veins (deep vein thrombosis). You'll have a cuff put on your arm to monitor your blood pressure. Electrodes will be placed on your chest to monitor your heart rate and you may have a finger-pulse monitor attached, too. A sticky plastic plate will be attached to your leg. This is the earth for the electronic equipment used by your obstetrician to stop bleeding during the surgery don't worry, you won't feel this happening. You'll be offered: an injection of antibiotics to help prevent infection anti-sickness medicine to stop you from vomiting diamorphine for strong pain relief during and just after the cesarean pain relief for after the operation, which your doctor will have discussed with you beforehand y oxygen through a mask, if your baby is in distress You may be surprised how many people are needed to do a cesarean section. y y y y

y What will happen before my cesarean? Your doctor should talk you through the procedure. They will: y y y y y tell you what will happen during the cesarean section explain why they think you need the operation explain any possible risks it poses to you and your baby ask for your consent, which you have the right to refuse Before surgery, you will need to change into a hospital gown and to take off jewelery (apart from a wedding ring, which can be taped over). If you have a brace or false teeth, you'll need to remove these too for safety reasons. You will also need to take off make-up and nail varnish, so your skin tone can be monitored during the operation. You won't be able to wear contact lenses. If you wear glasses, give them to your partner or one of the nurses, so that you can put them on to see your baby.

What happens during a cesarean? If it's your first cesarean, your baby will be with you very soon. Once everything is set up it can take just five or 10 minutes for your baby to be born. You're likely to be in theatre for an hour or so because it takes longer to close you up afterwards. Closing you up takes longer if you have had one or more cesareans. It largely depends on how much scar tissue or adhesions (bands of scar tissue) you have from previous operations. A screen is put up over your chest so that you can't see the operation, but you can ask for this to be lowered as your baby is born. Your anesthesiologist will check that your painkiller is working properly.

Once you're completely numb, your doctor will make a straight cut into the skin of your belly. You may want to ask for a bikini cut -- two fingers width above your pubic bone, at the top of your pubic hair. This sort of cut is less painful after the operation and looks better as it heals than a cut down the middle of your tummy. Further openings are made through layers of tissue and muscle before reaching your uterus. Your tummy muscles are parted, rather than cut, and your bladder will be moved down to expose the lower part of your uterus. The cut to your uterus is usually small, but your doctor makes the opening bigger using scissors or fingers, so that it is torn rather than cut. This causes less bleeding than a sharp incision. The opening to your uterus is usually in the lower part, which is why the operation is sometimes called a lower segment cesarean section (LSCS). If you have a lot of fluid, you may be able to hear it whoosh out through the opening. Your obstetrician will lift out your baby. You may feel the assistant pressing on your belly to help your baby be born. If your baby is breech, he will be born bottom first. If you're having twins the lower twin is born first, just as if you'd given birth vaginally. Occasionally, forceps are used during a cesarean to deliver your baby's head carefully. They are usually only needed when your baby is in a breech position or ispremature. Surgeons may occasionally make a larger, vertical cut in your uterus if your baby is very premature, or is lying across your uterus or if you have a condition such as alow-lying placenta or growths, known as fibroids. What will happen after my baby is born? Your baby may be placed on your chest straight away for you to cuddle, or he may need to be checked by a midwife or pediatrician. Your partner can usually hold your baby if you are unable to. If you're having twins, you may be cuddling one baby each sooner than you expected! Babies born by cesarean tend to be a little colder than babies born vaginally, so they need wrapping up well. Your baby will be given an Apgar score one minute and five minutes after he's born. The score measures your babys wellbeing. If there has been concern about your baby's health or you're under a general anesthetic, a pediatrician will do these checks and give your baby oxygen if he needs it. Some babies need to go to special care (SCBU) for a while. You'll be given the hormone oxytocin via a drip to help your uterus contract and to reduce blood loss. Your doctor will pull gently on the umbilical cord to remove the placenta. This will be checked to make sure it is complete before you're stitched up. Your doctor will probably use a double layer of stitches to repair your uterus, and the cut in your belly will be closed in layers. Finally, your skin wound will be closed with stitches or staples. When you're ready, you'll be moved into the recovery room where you, your partner and, if all is well, your baby or babies can be together. You may start shivering after your cesarean, because your core body temperature drops during the operation. The anesthetic hinders your body's ability to regulate your temperature, and the effect may be worsened if the theatre is cool. It can be unnerving, but is usually harmless and only lasts 20 or 30 minutes. The midwife or nurse looking after you will warm you up with blankets and fluids. If you want to breastfeed, it's a good idea to try while you're still in the recovery room

before moving to the postnatal ward. A midwife will be there to help you find acomfortable position for breastfeeding and to take care of you immediately after the operation. The cesarean section surgery rate now tops nearly than 33% of all births in the United States of America. Here is a picture essay, step-by-step of a cesarean birth. y In this photo you will see that the mother has been draped with sterile drapes and is in the operating room as they make the initial incision into her abdomen. y There are multiple layers that your surgeon must go through before reaching the baby. All in all from the start of surgery, until the birth of your baby is about 5-10 minutes. y The doctor will use a combination of sharp instruments and blunt dissection as s/he goes through each layer. You may also hear whirring noises as a machine is used to caterize or burn small blood vessels to prevent bleeding. y When the doctor reaches the uterus, you will also hear suctioning. After cutting through the uterus, the amniotic fluid will be suctioned away to make a bit more room in the uterus for the doctor's hands or instruments such as forceps or a vacuum extractor. y Your baby is usually engaged in the pelvis, usually head down, but perhaps rear first or breech. Whatever part has entered the pelvis will be lifted out by the doctors. You may feel pressure at this point and some women report feeling nauseated during this intense, but brief moment. y The baby's head is born! y Once the head is out, your doctor will suction the baby's nose and mouth for fluids. In a vaginal birth these are normally squeezed out by labor and birth. In a cesarean birth, the baby needs some extra help getting rid of these fluids. If meconium is present there may be extra suctioning required. y Once your baby has been well suctioned, the doctor will start to help the rest of the body be born. S/he will check of umbilical cord entaglement or other complications as the body is born. You may also have the assistant surgeon pressing on the upper part of your abdomen of fundus to assist in the birth. y The moment you've been waiting for - your baby's birth! It's been about 5-10 minutes since your surgery started. Your baby will briefly be held over the drape to show you the baby and the taken away by a nursery nurse or neonatologist to a nearby warmer. y Usually the warmer is in the same room as the surgery. Here your baby will be suctioned again to ensure that they have help clearing the amniotic fluid. y The repair of the uterus and the layers that were cut during the surgery need to be repaired. During this portion of the surgery the placenta will also be removed and examined by your doctor. This is the longest part of the cesarean section, which total takes about 45-60 minutes to complete. During this time you can usually have your baby with you to breastfeed or hold. It can also be possible for your support person to hold the baby close to your face if you are unable to hold your baby.

Definition: O.R.I.F. is an abbreviation for Open ReductionInternal Fixation. Open reduction internal fixation is a method of surgically repairing a fractured bone. Generally, this involves either the use of plates and screws or an intramedullary (IM) rod to stabilize the bone.

If you are having a broken bone treated by ORIF, you will be taken to the operating room, given anesthesia so that you will not feel the surgery, and have your bones repaired by an orthopedic surgeon. Also Known As: Open Reduction Internal Fixation, Operative Treatment, Open Treatment A definition of ORIF (Open Reduction Internal Fixation) In some cases, when a patient has a severe fracture, an open reduction internal fixation surgery is necessary, where plates, pins and screws will be placed in the bone. After surgery, when a patient has been cleared for passive range of motion, a dynamic splint will help them strengthen and extend the affected joint to regain range of motion. A Dynasplint System provides a low-load, prolonged-duration stretch of the soft tissue. If you have had an open reduction internal fixation, you may want to consider wearing aorthopedic rehabilitation device like a Dynasplint System to aid in your recovery process. A hand fracture occurs when one of the small bones of the hand is broken. There are several small bones that together make up the supporting framework of the hand.

Pins Small metal pins may be inserted through this skin in order to hold the bones in a better position. This procedure is usually done with the patient under general anesthesia, but may also be done with a local anesthesia block. The metal pins remain in place for several weeks while the fracture heals, and then the pins can usually be removed in the office.

Metal Plates & Screws In some unusual types of hand fractures further treatment may be necessary. In knees cases, metal screws with either a plate or an external fixator can be used to help maintain proper alignment of the bones.

What problems may I encounter if I sustain a hand fracture? Most hand fractures will heal uneventfully. The two most common problems patients who sustain a hand fracture will face are stiffness of the fingers any noticeable bump. The bump is usually a result of extra bone the body forms as part of the healing process. While the bump does diminish in size over time it may never completely go away. Finger stiffness is prevented by beginning motion as soon as possible. It is sometimes necessary to work with a specialized hand therapist in order to help regain finger motion.

Having a Cast:

How does a hand fracture occur? Most hand fractures occur as a result of direct trauma to the hand. Commonly an object either falls on the hand or the hand strikes an object. When he hand fracture occurs common symptoms include:

Having a cast for treatment of a broken bone can elicit different emotions. While some are excited to have a cast, this often quickly turns into annoyance with the realization that you may have to learn to do simple activities in a new way. Fortunately, you are not the first person to have a cast, and those before you have figured out tips and tricks to make having a cast not as difficult an experience.

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Pain Swelling A palpable deformity Difficulty moving the fingers What tests are needed to diagnose a hand fracture? If a hand fracture is suspected, your doctor will obtain x-ray studies to determine if the bone is broken. If a fracture is seen in one of the bones of the hand a decision will be made to determine appropriate treatment for the injury.

What Are Casts Made Of?:

Casts are usually made from either plaster or fiberglass. Each of these materials has advantages and disadvantages. The plaster is usually used in the early stages of treatment because it can be molded more precisely. Fiberglass is more durable and therefore applied once the broken bone has started healing. Types of Casts Question: What is used to make a cast for the treatment of a broken bone?

What treatments are used for hand fractures? Possible treatments of hand fractures include: Cast & Splints If the fracture is not displaced (meaning it is in proper position) a cast or splint will likely be sufficient for treatment of the fracture. Furthermore, there are some types of hand fractures that do not necessarily need to be in perfect position in order to heal properly. These fractures may also be casted or splinted and allowed to heal.

After a bone is broken it needs rest and support to heal properly. Orthopedic doctors use casts to support and protect injured bones. While casts can be uncomfortable and cumbersome, they are an effective and efficient method to treat fractures. Answer: Casts come in many shapes and sizes, but the two most common types of cast material used are plaster and fiberglass. A cast is a supportive bandage that is solid, and wraps all the way around the extremity.

Plaster While fiberglass material is newer, many casts used today are still made from plaster.

Plaster casts are most often used when a fracture reduction (repositioning of the bone) is performed. The reason plaster is used after repositioning the bone is that plaster can be well molded to the patient, and therefore it can support the bone more precisely. When a bone was out of position, and is manipulated back into position, plaster may be used to help hold the bone in the proper position.

How to Keep Odor Away:

The problem with plaster is that it is heavy and must remain dry. Plaster casts are a burden for the patient because of their bulky and heavy material. Furthermore, water will distort the cast shape and can cause problems for healing should the cast get wet.

Cast smells are usually due to moisture under the cast. It is important to keep moisture away by not letting water get on the cast, and not sweating excessively under the cast. For ideas on how to solve cast smells: Solve a Smelly Cast Question: What can I do about a smelly cast? The use of a cast is a common treatment in orthopedics. Often used for treatment of a broken bone, a cast can also be useful after surgery and for other conditions that require immobilization. Unfortunately, a cast can start to stink. Often the smell can become quite bad. Cast odor tends to be most problematic in young children and athletes. Little kids have a hard time keeping the cast dry. Athletes may not give up their exercise causing sweat to accumulate under the cast. What can you do if you have a stinky cast? Answer: Once a cast starts to smell bad, it is unlikely that it will start to smell good. I hope to give you a few ideas to help with the stench of a stinky cast, but the best advice is to care for your cast early on to keep it from getting smelly!

Fiberglass Fiberglass casts are usually fitted when the bone is not out of position, or if the healing process has already started. Fiberglass casts are lighter weight, longer wearing, and more breathable than plaster. The fiberglass casts are sturdier than the plaster and require less maintenance. Both plaster and fiberglass casts are wrapped over a few layers of cotton that serve to protect the skin. Keeping this cotton clean and dry will be of utmost importance for your comfort. There is a special type of padding material that can be used under fiberglass casts to allow the cast to get wet. Ask your doctor if you are interested in a "waterproof" cast.

How to Keep a Cast Dry:

Keeping one's cast dry is probably the most important thing you can do to keep happy while wearing a cast. Wet casts itch, smell, and are annoying. Keeping a cast dry is possible, even while keeping you clean. Here are some ideas for you to keep your cast dry in the shower or tub: Keep a Cast Dry If you have a broken bone, it is quite likely that you have a cast -- and that you face the big challenge of trying to bathe or shower while keeping your cast dry. Here, some ideas for keeping your cast dry so you can and still keep yourself clean.

The key to an odor-free cast is moisture. If you can keep your cast dry, you will likely not have odor problems. This means keeping water out of the cast and keeping sweat from under the cast. Some suggestions for keep a cast dry include:

Cover Your Cast There are a number of ways to keep your cast dryand keep you clean. You can either be creative with products from around the house, or buy devices specifically made to keep your cast dry. Don't Play Sports This may not be acceptable to everyone who has a cast, but if you exercise you will likely sweat under the cast. This moisture promotes bacterial and fungal growth that is the cause of bad odors.

One tip not to try? Don't try to shower by holding the cast out of the way. Water will inevitably drip down your arm or leg, soaking the cast's padding. Even if you plan on holding your cast out of the path of the water, find something to cover it.

Get a New Cast

1. Plastic Bag A newspaper bag is often the perfect size plastic bag to cover your cast. Other good options are bread bags or small trash bags. These can be sealed at the top either with some tape or a rubber band. A rubber band allows the bag to be reused, and it is also much gentler on your skin. Be sure to check the bag for holes, and do not try to submerge the cast.

If the odor becomes a problem, call your doctor and let him or her know that you think you should have the cast looked at. Sometimes a cast cannot be removed because it is holding the bone in an important position. However, often a cast can be replaced. Furthermore, there are conditions where a cast should be removed. Odors can be a sign of a more severe skin infection under the cast, and if this is suspected, the skin should be evaluated by your doctor.

Odor Solving Ideas

another type of support. How to Use Crutches Crutches are often used for the treatment of injured legs. Using crutches requires good upperbody strength and flexibility. Using crutches also requires the injury to be isolated to a single leg; patients with an injured arm or two injured legs will usually require another type of support. Read these tips to properly use your crutches. Difficulty: Average Time Required: 10 minutes Here's How: 1. Size the Crutches: The crutches should be properly sized so they are used appropriately and do not cause problems. Crutches should:

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Baking Soda A little baking soda can help to dry up some moisture and cover some of the smell of a stinky cast. Gently powder the cast with a small amount of baking soda. Perfume Simply covering up the bad smell with a stronger, less annoying odor can help to cover up the problem smell. Obviously, dabbing a little perfume on the cast will do nothing to rid the smell under the cast, but it may help you and those around you cope with the problem. Fabric Softener Taking a sheet of fabric softener and rubbing it on the cast can help in the same way perfume can cover up some of the odor. Fabric softener tends not to be as strong as perfume, so it may be more appropriate for those who don't like the scent of perfume. CastComfort Spray CastComfort is a product that is made specifically for cast smells. There is nothing fancy about this product, just a talc-based spray. However, it is easy to apply to your cast, and not too expensive. Vacuum Suction There is a product called a CastCooler. This product wraps around your cast and connects to a standard vacuum. The product helps to cool the skin and remove moisture under the cast. This is a safe product that seems to help with some of the common symptoms of cast annoyance.

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Be about one to two inches below the armpit when you are standing straight;

What Not to Do!

Have handles at hip height, so that your elbows are slightly bent when grasping. Crutches that are not sized appropriately cannot be used properly, and may cause problems. Check the Padding and Grips: Check the crutches to ensure they have ample cushion on the armpit, grips, and especially on the base that contacts the floor. These parts of crutches can be replaced by a medical supply store if they become worn.

These solutions may not solve your problem, and if that is the case, see your doctor about possibly getting a new cast. Do not, under any circumstances:

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Wash a cast you were told to keep dry. There are waterproof casts, but make sure that's what you have before getting your cast wet.

Getting Up From A Chair: Place both crutches in the hand on the affected side (i.e., if you injured your right leg, grasp both crutches by the handle with your right hand). Grasp the handrest of your chair with one hand, and the crutch handles in your other hand. Place your weight on your uninjured leg and push up with your arms.

Push anything under the cast to scratch an itch. Don't stick hangars, sticks, pencils, forks or other objects under the cast. Not only can these do skin damage, but they can also pull the padding out from under the cast. It never hurts to call your doctor to discuss the problem, and the only solution may be to have the cast replaced. You may also consider a waterproof cast. While there is a cost sometimes associated with the materials for a waterproof cast, it may be worthwhile to help you keep it from smelling too bad.

Walking: Move both crutches together a short distance in front of you (about 18 inches). While supporting yourself with your hands, allow your body to swing forward as if you were going to step on the injured leg, but instead of placing weight on the injured leg, rest your weight on the crutch handles. Do not allow the crutch top to touch your armpit - keep your body supported with your hands.

How to Walk With Crutches:

Crutches are often used for the treatment of injured legs. Using crutches requires good upperbody strength and flexibility. Using crutches also requires the injury to be isolated to a single leg; patients with an injured arm or two injured legs will usually require

Going Up Stairs (option 1): Stand close to the step, and place the crutches on ground level. With your weight on the crutches, pick the uninjured foot up to the step. Then bring the crutches up to the step level. Repeat this for each step.

Going Up Stairs (option 2): An alternative, if there is a handrail, is to hold both crutches in one hand and hold the handrail with the other. Again, lead with the uninjured leg.

Tips: 1. 2. 3. Take short steps. Don't let your armpits rest on the crutches, even when resting. When going up and down stairs, go one step at a time, and rest at each step.

How to Prepare for Orthopedic Surgery


Knowing what will happen on the day of an expected surgery can help you be prepared. Find out what to bring to the hospital, how to prepare, and when to show up. Call your doctor if you have questions specific to your surgery. Time Required: 1 hour

How to Have Fun With Your Cast: Here's How: Maybe having a cast is not your idea of fun, but why not at least have some fun with the hand you're dealt. You've got to have this cast all the time, so you might as well enjoy what you are looking at. Here are some idea to brighten up your cast appearance: Look Cool in Your Cast

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Arrive Early Hospital operating rooms are on a tight schedule, and the use of operating rooms is very expensive. Being late to the hospital could mean having to reschedule the procedure, and wasting of time and resources. There may be some waiting time before the procedure, so it's a good idea to bring a book or magazine to read.

When to Ask fro Help: 2. As a general rule of thumb, if you are unsure, call your doctor. Most cast problems are minor, but there are a few warning signs to be aware of when you have a cast. If you think there is a problem under your cast, you should have this seen by your doctor. Casts are an excellent treatment for broken bones. However, problems can arise and you should know how to assess the integrity your cast. Difficulty: Average Time Required: 10 minutes Here's How: Call your doctor if you experience any of the following symtpoms: 3. Your doctor may ask you to take your regular medications with a sip of water in the morning. Check with your doctor about whether or not you should take these medications. Do Not Eat or Drink The length of time to not eat or drink will vary depending on the procedure. The reason for not eating is primarily due to the anesthesia that can cause nausea and vomiting if the stomach is not empty.

If the surgery will involve the abdomen, there will also be a need to have an empty bowel. Your doctor will provide specific instructions for your preoperative diet-pay close attention to these instructions.

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Pain or swelling that is not adequately controlled with medication prescribed by your doctor. Numbness or tingling in the extremity (hand or foot). Inability to move your fingers or toes beyond the cast. Circulation problems in your hand or foot. (Check by pressing down on a fingernail or toenail--the skin beneath should blanche, but quickly turn pink again when pressure is released). Loosening, splitting or breaking of the cast. Unusual odors, sensations, or wounds beneath the cast. If you develop a fever or gerneralized illness.

Pack Light Your belongings should be limited--it is best to start with less and have someone bring more later. A bag of toiletries and some loose comfortable clothes is a good start. Leave all valuables at home, including cell phones (not allowed in most hospitals), laptops, cash (a few dollars, but no more), and jewelry. Bring any hospital documents and current medications Come to the hospital with your insurance information and any documents your doctor has given to you. Also, have your current medications, in their original containers, with you. Do not copy the medication information separately as it is best for the doctor to have all the information printed from the pharmacist.

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5. Do not remove the cast. Call your doctor or go to the emergency room if you suspect a problem with the cast.

What To Expect Exactly what will happen in your case will vary depending on the procedure being performed. However, the general schedule of your day will be somewhat consistent. To get an idea of what happens during surgery, I have organized a sample schedulefor one common operation, a knee replacement surgery. This will give you an idea of what will happen, who you will see, and what to expect.

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