寶寶還沒出世之前，對孕媽媽來說，從陣痛開始到分娩結束的整個過程就是一個未知的世界。胎兒是怎樣通過產道的？在何種狀況時需要屏氣呢？通過這個圖表你就能充分了解整個分娩過程了，從而對你的分娩有幫助。

順產分娩圖：寶寶經過產道過程圖解


為了通過狹窄的產道，身體發生的不可思議的變化

整個頭部出來後，為了左右較寬的肩膀也能出來，身體會再度旋轉90度而朝向側面。如果是面朝媽媽後背的情況下想要露出身體，肩膀會掛在稱為坐骨棘的陰道中的突起上。

短促呼吸的技巧進入發露狀態後，助產醫師往往會要求停止屏氣用力，自此只是在陣痛的作用下繼續分娩。但如果媽媽仍繼續屏氣用力，產道變窄而會夾住胎兒。另外，為防止會陰斷裂，雙手要離開握棒，只用身體的力量，進行輕輕的淺淺的短促呼吸。

一次一個地露出肩膀即使面朝側面，兩肩也是無法一下子出來的，一般都是先一側後一側慢慢地露出來。兩肩出來後，腹部、雙腳也就能一下子順利地分娩出來了。此時我們能聽到寶寶健康的“產聲

胎兒整個身體分娩出來後，陣痛一下子就消失得無影無踪了。在切斷與胎盤連接的臍帶後，醫師會為寶寶擦洗身體、導出所吸入的羊水和粘液、檢查體溫、點眼藥水、稱體重等等。產後的處理之後要保持安靜胎盤排出後整個分娩即全部結束。之後，需要進行產後的護理，如縫合會陰斷裂的傷口等。此時產婦要靜養2個小時左右。由於此時容易發生出血和疼痛等問題，醫院往往會在分娩室或住院部繼續觀察產婦的身體狀況，諸如檢查血壓和心跳、有無出血、子宮的恢復情況等

分娩第三階段初產婦約5-30分鐘經產婦約5-15分鐘這是胎兒誕生後胎盤排出的階段。胎兒誕生後數分鐘，會再次發生輕微陣痛(後陣痛)，妊娠期間為胎兒運送氧氣和營養的胎盤會被排出體外。自此整個分娩過程結束。
子宮收縮胎盤脫落分娩數分鐘後，已張開到最大程度的子宮開始收縮，以便能恢復到原來的大小。這之前貼合緊密的子宮壁和胎盤

胎盤排出分娩結束脫落的胎盤，向下通過產道排出體外。由於在等待胎盤自然脫落的期間，失血量會增多，所以最近往往由助產士結合後陣痛的節奏拽出臍帶胎盤。

除了旋轉，還有這些變化呢!狹窄的產道，形狀也比較複雜，因此胎兒為了能快速通過，除了會旋轉，胎兒的身體以及產婦的身體也會發生各種各樣的變化。

腹膜外剖腹產術優缺大評比

回想起許多年前，在醫學中心當住院醫師的經驗。有一天，替一位第一胎剖腹產，第二胎也是剖腹產的媽媽開刀，下刀後五分鐘，主治醫師開始抱怨：「哇！沾黏的真是厲害」，好不容易30分鐘後小孩出生，縫好子宮，卻發現腹腔一個很大且類似惡性的腫瘤，

告訴家屬嚴重性後，切下來馬上做冷凍切片，20分鐘後報告回來，只有2個字～「紗布」。原來是上回剖腹產遺留在腹中沒拿出來，這時，大家才鬆了一口氣。主治醫師告訴家屬，腫瘤是「良性」的，而且絕對不會再復發……。

文／戴銘浚婦兒醫院院長戴銘浚；執行／林佩蓉；圖片提供／戴銘浚婦兒醫院

剖腹產是在不得已的情況下，基於照顧產婦和胎兒的生命安全考量，進行的外科干預手術。隨著醫學的進步，特別是麻醉設備日新月異，剖腹生產手術的方式，也不斷的推陳出新，目前主要有一般腹膜內剖腹產，以及腹膜外剖腹產兩種。
“>凱撒帝王切開術
一般腹膜內剖腹產又稱凱撒帝王切開術（Cesarean Section），傳說威震四方的羅馬皇帝凱撒就是以這種方式降臨人間因而得名。一般腹膜內剖腹產的方式，是在產婦肚臍下方，以直式或橫式切開術，打開肚子約15公分後進入腹腔，再推開腸子，進入子宮，接引嬰兒出生，手術時間約需30分鐘。這種打開腹膜的生產手術方式，優點是容易學也容易操作，手術視野較大，手術進行時如有臨時狀況，也可以方便迅速的處理。

直式切開術
適用於有前置胎盤可能導致大出血，以及在生產過程中須同時進行腹部手術，例如切除子宮或卵巢腫瘤，和胎兒窘迫必須進行緊急剖腹產的情況下施行。
【缺點】
1.傷口容易形成被戲稱為有如拉鍊的疤痕，不太美觀。
2.會產生腹部疝氣。
橫式切開術
比較適合體型肥胖或須進行其他複雜腹部手術的產婦。
【優點】
1.比較不會出血。
2.不容易產生疤痕。
3.傷口有如微笑的標誌比較美觀。
4.不容易產生疝氣。

子宮的切法也有不同
腹膜內剖腹產，子宮的切法也分兩種。一種是子宮下部帝王切開術（Lower Segment Cesarean Section），一種是古典式子宮體部帝王切開術（Classic Cesarean Section）。

如今一般的腹膜內剖腹產，大多使用子宮下部切開。只有少部分因嚴重沾黏，嚴重的前置胎盤，或懷孕早、中期的剖腹產才使用古典式切開術，因後者常造成十分嚴重的沾黏，今已很少採用。
【共同的缺點】
不論是直式或橫式切開術，共同的缺點是：
1.血水、羊水和胎便會流入腹腔內，造成產婦容易出現腹痛。
2.會造成骨盆腔沾黏和腸子沾黏。
3.手術使用的止血紗布，也有可能遺留在腹腔內。
4.手術後須禁食多天等排氣才可進食。
5.併發症也多，容易產生脹氣且產婦感到疼痛。
6.中年後可能出現嚴重沾黏、腹痛和腸阻塞等症狀。
腹膜外剖腹產‧不受感染不沾黏
腹膜外剖腹產是在1909年Latzko醫師所正名，在當時主要是防止子宮腔內受感染，為了保護孕婦開刀後的預防，避免打開腹腔，以免感染源進入腹腔。後因抗生素的發達，已經可以克服感染，所以腹膜外剖腹產手術就被打入冷宮。到了近代，發現腹膜外剖腹產的其他好處，如不會造成沾黏、不用等排氣等好處，才又流行起來。（感染源進入腹腔，細菌可以用抗生素治療，但仍會造成沾黏。）

不須進入腹腔‧就可以生出寶寶
腹膜外剖腹產的開刀方式是：肚皮上是橫式切開，打開肚皮後，與一般剖腹產最大的區別是，沒有進入腹腔，而是將膀胱側撥，露出位於腹膜外的子宮下段，做子宮下部帝王切開術，而將嬰兒抱出。

【優點】
這種手術方式的優點正好彌補傳統剖腹產的缺點。
1.因為不打開腹膜，血水、羊水和胎便不會流入腹腔內。
2.不會造成沾黏。
3.不會發生因疏忽造成紗布遺留在腹腔內的糗事。
4.不會有骨盆腔和腸子沾黏等後遺症
5.更不需等排氣
6.手術清醒後2小時內可喝水，4小時可進食流質食物。
7.因為沒有打開腹膜，也不用縫合那兩層腹膜，所以手術時間比一般剖腹產節省5～7分鐘。8.手術時間越短自然對產婦組織的傷害性相對較小。
9.麻醉劑量因開刀時間短，不用下的重，比較不會影響術後腸蠕動，很快就能進食。
10.很快能下床走動，不用在床上躺兩天，曾有媽媽早上開刀，中午吃午餐，下午已經下床，拔除尿管，到嬰兒室看小孩，大家都很驚奇，還以為她是自然產的。
11.前一胎採一般剖腹產者，此胎依然可以採用腹膜外剖腹產，以免加重沾黏。

【缺點】
然而腹膜外剖腹產的缺點是，手術技巧性較高，若不熟練者來施作，易造成併發症，如膀胱破裂，大出血，輸尿管損傷等問題出現，所以要採用腹膜外剖腹產時，一定要找有經驗的醫師，才能輕鬆生產，愉快出院。

雖有爭議‧卻可降低併發症
一般腹膜內剖腹產，只要是婦產科醫師都會做，不會有爭議。但對於腹膜外剖腹產爭議就很大，會做的人認為不難做，併發症可控制在很低的範圍。不會做、不想做的人認為不需多此一舉，徒增困擾。然而一般剖腹產造成腹腔的沾黏，是不爭的事實，甚至碰到過嚴重沾黏到腹腔進不去，唯有從腹膜外才可下刀剖腹的情形。
目前科技追求微創，傷口越小越好，傷害性越小越好，不用打開心臟就可以用心導管治療心臟病是更好。同樣的，不用打開腹腔，不會動到腸子，自然不會腹腔沾黏，不會影響腸子蠕動，豈不是更佳。

腹膜內與腹膜外剖腹生產比較表

【腹膜內剖腹生產】	【腹膜外剖腹生產】
一般的傳統剖腹生產，容易學，但併發症多。	手術技巧性高的剖腹生產手術。
容易造成骨盆腔和腸子沾黏，以及脹氣和疼痛。	不會有骨盆腔和腸子沾黏等後遺症。
手術後禁食數日。	手術後馬上進食，不用等排氣，復原快。
手術紗布可能遺留在腹腔內。	不會將紗布遺留在腹腔內。
中年後可能出現嚴重沾黏、腹痛和腸阻塞等症狀。	醫術較差的醫師，可能造成孕婦膀胱破裂、輸尿管損傷和大出血等併發症。
手術時間30分鐘。	手術時間短，22~25分鐘。
排氣後才能拔除尿管。	尿管早日拔除。

c-section procedures <diagram>

剖腹產詳細過程
當婦科專家們在大力倡導自然分娩時，還是有很多產婦在選擇剖腹產。那麼剖腹產的過程到底是怎樣的呢，孕媽媽們不妨先看一下圖解，然後再決定是否要選擇剖腹產！什麼是剖腹分娩？剖腹分娩就是通過在腹壁開刀來做為生產的方式，這是因為當在等待自然分娩但又危及母體與胎兒的生命時，就需緊急把胎兒娩出體外，這時就必須進行剖腹分娩。

How is a C-section carried out?

圖解剖腹產圖解

Under cases of C-section the type of anesthesia is used for the purposes of carrying out administration of anesthesia. Whenever you have an epidural catheter in your place you can resort to extra medication which can be administered by the catheter to make you numb totally for enabling you to be devoid of pain below the chest level.
In case if you do not have an epidural you can administer quicker and easier form of anesthesia in your spinal cord. Under both the conditions invariably you can witness a lot of pain relief and you can be aware of the entire procedure. In rarest of rarity cases between life and death minutes can bring a whole lot of difference for the purposes of being asleep during the course of surgery when inducement can be administered by the induction of anesthesia.
For drainage of fluid a nurse will normally utilized a catheter in your bladder for continuous lying on the back when the bladder sits on top of the uterus. Whenever it is full this will be in the way of proper surgery. The nurse also takes care of cleaning up your hair for enabling operations to be performed.
While you lie on the operation bed you will be placed proper administration of anesthesia by attachment of various monitoring devices which should be used for controlling your rate of heartbeat, pressure on the blood, as well as the oxygen content in your blood. You will also be supplemented with a placement of whole body when you have an intravenous line in position for receiving any medication or fluids which you might require during the course of surgery. The procedures and equipment may be fearsome but they are totally devoid of causing pain.
They will take precautions for washing you with the soap as well as surgical drapes will be placed all over your body except on the portion of your head. When the surgery is started you will not be in a position to feel it. Throughout the whole procedure you should ensure that if you are awake, proper attendants should be placed for the purposes of enabling your safety at all times.
A C-section gets completed within an hour and it takes less than a few minutes to take the baby safely out. The rest of the time you are required to take care of sutures for the abdominal tract. Next C-sections take longer time however, for the purposes of taking care of the tissues impregnated with scars.
Once the surgery is completed your recovery room can be taken care of by taken into it after several hours of observations. You can also take precautions for getting the baby nursed for the first time.
The recovery period for C-section is slightly longer than the normal delivery. You are required to be in the hospital for 3 to 4 days and you will most possibly take pain in medication for easing out the pain in the incision.
In spite of awe inspiring techniques as well as equipments and conditions the object of this exercise is to cater to the needs of the well being of the child as well as the mother. This can be achieved by a proper induction of the role of C-section.
To conclude, C-section is very important for the purposes of playing a dominant role for the purposes of the well being of the mother and child.

C-section – series

Normal anatomy

C-section – series : Normal anatomy

Indications

C-section - series : Indications
Sometimes the baby is in a position, like breech (buttocks-first) or transverse (cross-wise), that makes a vaginal birth risky. Other times certain medical conditions, such as placenta previa (placenta is attached too low, blocking the baby’s exit) or placenta abruptio (placenta is partially or completely detached, threatening the baby’s oxygen and nutrient supply), make vaginal birth nearly impossible.
A Cesarean section delivery is performed if a vaginal birth is not safe or possible for the mother or the baby.

Procedure, part 1

C-section - series : Procedure, part 1
Many doctors prefer using general anesthesia, which renders the patient unconscious, for emergency C-sections because it can be administered quickly and takes effect almost immediately. When the C-section is planned, the doctor may order regional anesthetics (a spinal or an epidural), which numbs only the lower portion of the body.

Procedure, part 2

C-section - series : Procedure, part 2
After the anesthesia takes effect, the surgeon makes an abdominal incision. In non-emergency C-sections, the surgeon usually makes a horizontal incision (a bikini cut) across the abdomen, just above the pubic area. In an emergency situation, the surgeon occasionally needs to make a vertical cut, from below the navel to just above the pubic area. A vertical cut sometimes allows quicker access to the baby.

Procedure, part 3

C-section - series : Procedure, part 3
Next, the surgeon opens the uterus with either a horizontal or vertical incision, regardless the direction of the skin/abdominal incision. A vertical incision on the uterus causes less bleeding and better access to the fetus, but renders the mother unable to attempt a vaginal delivery (must have another repeat C-section) in the future.
If you end up with a horizontal incision, you will have the option of either going through a trial of labor (TOL) or electing a repeat c-section.
The reason for the differences between the two is that patients with vertical uterine incisions have a much higher chance of rupturing the uterus (8-10%) in the future pregnancies, compared to only 1% in those with horizontal incisions.

Procedure, part 4

C-section - series : Procedure, part 4
Finally, the surgeon cuts through the amniotic sac enclosing the baby. He then allows the amniotic fluid to escape.

Procedure, part 5

C-section - series : Procedure, part 5
The surgeon reaches into the uterus and lifts the baby’s head. An assistant pushes down on the mother’s upper uterus to help guide the baby out.

Procedure, part 6

C-section - series : Procedure, part 6

The surgeon will clamp and cut the umbilical cord.

Aftercare

A typical hospital stay after C-section delivery is two to three days. Usually, the doctor encourages the mother to get up and move around soon after surgery to aid healing and to prevent complications. For the first few weeks, the abdominal incision will be sore. The scar will lighten as it heals.

圖解剖腹產手術在妊娠後期，胎兒在子宮內呈頭低位。剖腹產手術適用於孕婦不能經陰道分娩，或陰道分娩危及孕婦或胎兒的安全時。剖腹產手術的主要適應症如下：(一)危及胎兒： 1、血氧含量降低；2、心率過低或過高； 3、子宮異常：子宮過小、疤痕子宮或子宮畸形；4、多胎妊娠；5、子宮頸異常：宮頸口過松；孕婦患活動期生殖器皰疹感染；6、胎盤及臍帶異常：前置胎盤、胎盤早剝；7、發育異常；(二)危及孕婦： 1、頭盆不稱(胎兒頭過大，不能通過骨盆)；2、產程過長；3、胎位不正：臀位、橫位；4、高齡產婦(年齡大於40歲)；5、孕婦處於危急狀態(妊娠毒血症，先兆子癇，子癇，高血壓)

剖腹產切口為橫切口，位於下腹部陰毛上方。腰麻(孕婦清醒，胸部以下無痛覺)；切開子宮，吸乾羊水，取出嬰兒;清除嬰兒口腔及鼻腔的液體，夾住臍帶並剪斷，把嬰兒交給兒科醫生或護士護理，保障其呼吸順暢，產婦這時是清醒的，可看見她的嬰兒及聽到其哭聲。剖腹產手術現已變得相當普及(在美國占所有分娩個案的20%)，這是由於診斷手段的提高，令醫生可準確判斷其病人經陰道分娩是否安全。一些產科醫師相信，剖腹產手術是某些分娩個案(如胎兒臀位、孕婦過往有剖腹產史、或高齡產婦)最安全的分娩方式。產婦不運動，不側切胎兒生不出術後處理大多數產婦及嬰兒術後情況良好。但產婦的恢復較自然分娩者所花時間稍長。平均留院時間2~4天。術後當天即鼓勵產婦行走以加速恢復。可口服止痛藥止痛。

What is a Caesarian Section

Caesarian section is one of the most common operations performed nowadays. The caesarian rate in the United States of America has been increasing over a decade to a present peak of few percentages. Although maternal mortality from caesarian section is low, it is still higher than from vaginal delivery. Further, the morbidity from infections, wound dehiscence, thrombotic events as well as recovery time is greater than that of vaginal delivery.
The most common signal for primary caesarian section is that of failure to progress in labor. Failure to progress can be caused by some problems. If the pelvis is too small or the fetus is too large depending on the viewpoint taken, the diagnosis is Cephalopelvic Disproportion, which leads to failure to progress. If the uterus simply does not generate enough pressure during contraction, labor can stall and lead to failure to progress. If labor seems to be stalling, there are a number of measures that can be taken to augment it. Usually, two hours without cervical change in the setting of adequate uterine contractions in the active phase of labor was deemed failure to progress or active phase arrest, often leading to caesarian delivery. However, a recent study recommends that it is reasonable to wait up to four hours for cervical stage in the active phase of labor leading to a vaginal delivery in the majority of these patients.

Other common signals for primary caesarian section are breech presentation, abruption of placenta, status of fetus, fetal intolerance of labor, prolonged second stage, active herpes lesions, or failed operative vaginal delivery. The most common signal for caesarian section is a previous caesarian section.

cesarean delivery

Reasons for a Caesarian Section – Some reasons which necessitate caesarian delivery are indicated here:

A cervical tumor may impede the process of delivery, making a caesarian section necessary.
If the head of the baby has become enlarged because of the presence of excessive fluids in the skull, the fluids may have to be let out by puncturing the scalp, or alternatively, delivery has to be effected by caesarian section.
The arm of the baby may sometimes protrude through the cervix along with the head. In such a condition, caesarian section becomes inevitable.
Sometimes the baby lies in a transverse position in the uterus, instead of the normal head down position. If the baby cannot be manipulated into the normal position, it becomes necessary to affect delivery by caesarian section.

In addition to the above reasons, if the pelvic bones of the mother are too narrow, or her general condition of health as unfavorable to a normal vaginal delivery, or if she has high blood pressure, or she has previously has a caesarian section, or if the baby is getting asphyxiated in the womb for some reason, caesarian section must be resorted to.

Cesarean Section Risks Procedure Complications

When the cesarean is performed you have to weigh the pros and cons of the procedure. This also involves having a glimpse of the added benefits as well as the risks of going a cesarean operation for giving birth to a child. Sometimes the merits of this exercise more than offset the risks of the exercise and give soothing comfort to the offspring in a systematic manner. But normal births are more advantageous without anything said against it.

This is major surgery in spite of the fact of advancement of medical science risks are prevalent. The estimated risk of death after a normal birth is less then one in ten thousand as against 2,500 in the case of cesarean surgeries. There are a lot of estimated risks for a majority of sections of women population. Some medical conditions, such as cardiac problems expose the risk of normal births which are a degree superior to the cesarean births. Under such circumstances normal births are more risky.

There are a lot of risks for the baby such as breathing problems, premature birth, fetal injury, low apgar scores, affecting anesthesia levels which are attendant problems and risks for a baby during the birth time.

Sometimes there are risks for mother also which can be enumerated in the following paragraphs. These risks are increased blood loss, infection, decreased bowel function, longer medical stay, and risks due to additional surgeries, respiratory complications, blood clots, Reactions to anesthesia as well as injury on the bladder or bowel are the various risks involved for mothers which need to be taken care of at the time of surgery with all the precautions intact with all the technologies involved for the purposes of tackling this critical situation.

Cesarean Section Stiches
If all these precautions are taken this surgery is considered relatively very safe. In spite of more complications it involves at the time of delivery. Your recovery time is more prolonged than a normal delivery. The most universal complications for the mother are outlined below. These involve maternal death, heavy blood loss, infection, nausea, and vomiting, severe headache after the delivery, as well as blood clot in a vein.

Cesarean Section Process
These complications may have to be counter balanced by way of taking further precautions in times of surgery and its aftermath after taking into account all the medical technologies available vis-à-vis all the complications for arriving at a balanced approach.
There are certain risks which affect the infants also such as lung immaturity, neonatal care, as well as getting bruised up during the delivery.

Cesarean Section Scars
These risks have to be carefully controlled at the time of birth with the expertise of gynecologists as well as advancement in medical sciences.

Most women recover from these births even without complications. The only word of caution is that this has to give more time for convalescence for getting all the incisions or scars to heal up eventually.

There are a lot of risks involved in these cesarean sections but with the expertise of doctors as well as advancement in medical sciences and facilities available in hospitals for mitigating risks these can be combated successfully to add an feather on the cap of medical sciences.

Cesarean section

The uterus is exposed through the abdominal wall, and an incision is made in the uterine covering.
The muscles of the uterus are separated, producinga hole for the delivery of the infant.
The infant is delivered throughthe opening in the uterine wall, after which, the uterus is stitched closed.

There are many reasons to deliver a baby by Cesarean section, such as abnormal position of the baby, or abnormalities of the placenta and umbilical cord.

Related Pictures & Images

Breech – series	Cesarean section	Cesarean section	Cesarean section	Childbirth
Delivery presentations	Emergency Childbirth	Emergency Childbirth	Epidural – series