This morning I assisted Dr. Faile in the c-section for the woman with the pregnancy in her umbilical hernia.
The first problem to solve was figuring out how and where to make the incision. We decided to stand the hernia/uterus upright (which was my job to keep it steady) in order to make the incision more inferior. 
The skin overlying the hernia was incredibly thin. Only a superficial cut with the scalpel and we were already in the abdomen, with the uterus directly beneath the skin.
In order to get better access to the uterus, we brought it outside of the abdomen. The veins on either side of the uterus were massively dilated (>10x normal size) from the amount of pressure and stress they have been under for the past several months (sort of like hemorrhoids of the uterus).
The rest of the c-section was business as usual. The baby was breech (but I guess that made her head down into the hernia). After delivery of the baby and placenta, we repaired the uterus. We stuffed it back into the abdomen and focused on the hernia repair. A hernia is caused by a defect in the fascia (connective tissue overlying the muscles.)
We dissected back the tissue to reveal the fascial plane all the way around the incision. Some relaxing incisions were made along the sides to allow for a repair with less tension. Because the uterus was so large, the repair was still a bit tight. 
Finally, we tented up the excess skin and cut most of it off. The edges were then sutured together.
Both mother and baby were doing well this evening. The baby was a little girl. She was 7lbs, 6 ounces – a healthy size. At first she had a little difficulty breathing, but perked up and was ready to nurse.
Please pray that the woman will recover well from her surgery and that the baby will continue to thrive.