At first it looks like a classic cesarean section : the operation takes place in the operating room under epidural or spinal anesthesia, and the obstetrician cuts the skin horizontally at the level of the pubis. But then, instead of incising the fascia (the sheath of the muscles) horizontally, the surgeon opens it on the left side vertically, so in the same direction as the muscle fibers. Then it bypasses the peritoneum (thin membrane that surrounds the viscera) instead of incising it and passes underneath to access the uterus. “It may seem like details, but it allows the mom to get up, walk and move painlessly a few hours after giving birth.” , specifies Dr Bénédicte Simon, surgeon, obstetrician-gynecologist, at the Franciscan clinic in Versailles.
Beyond the technical aspect, the extraperitoneal cesarean is a real plus for mothers. With a less strong analgesia (since the peritoneum is no longer incised), the risks of nausea and drop in blood pressure are reduced. And the woman actively participates at her childbirth. Indeed, once the obstetrician has cut the uterus and grabbed the baby’s head, he asks the mother to blow into a small mouthpiece. “Spinal anesthesia does not prevent the pushing force that comes from the rib cage” , explains the gynecologist. With each exhalation in this mouthpiece, the abdominals contract, which facilitates the progression of the baby and allows the woman to expel it on her own, as in a vaginal birth.
Simpler nappy suites
From birth, the dad can cut the cord if he wishes, and the mom keeps her baby skin to skin while the surgeon sews up the internal incisions and places invisible glue on the external scar. No stitches or staples that pull and that will then have to be removed. When the new mother returns to her room, her infusion has already been withdrawn in the recovery room, her bladder is not asleep, she has no catheter or bandage, her transit is normal, she is free to move around.
Four hours after the procedure, she can eat, get up, take a shower or take care of her baby. Usually 3 days later, instead of the usual 5, mom and baby can go home. “In 75% of cases, they could even go out the next day”, assures the surgeon. Thanks to this new technique, the mother can fully take charge of her baby, feed him, change him, bathe him, cuddle him without hindrance or pain, from the first day.
A method practiced by only 5 obstetricians
So how to explain that only 5 gynecologists-obstetricians perform extraperitoneal cesarean section in France and that it has not yet entered hospitals? Dr. Simon, who has already given birth to 600 women in this way, wonders and is surprised that this technique does not arouse more interest from his colleagues. Of course, this requires additional training from the obstetrician-surgeon and a different investment from the whole team, but everyone is a winner, both humanly and economically.
In practice
The extraperitoneal cesarean is only performed when the birth has been scheduled, and it lasts thirty to thirty-five minutes. The four clinics that offer it charge the same price as a traditional cesarean section, and health insurance and complementary health coverage is identical.
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