Caesarean section

Caesarean section

A caesarean section or C-section as its often referred to is the surgical delivery via incision of the mother’s abdomen and uterus. Sometimes this is a planned elective C-section or an emergency/unplanned C-section depending on the circumstances.

This is when an obstetrician performs the delivery of the baby normally with mother awake during surgery using anaesthesia or an epidural. The mother can see, hear and understand what is happening during the whole length of the delivery time and sometimes a partner, family or friend can be present to witness the birth. It is uncommon for a mother to be unaware through a general anaesthetic when having a C-section and normally nobody other than the obstetrician, surgical or birthing team will be present if so.

A doctor will plan a C-section with the mother for reasons with risks to mother and/or baby.  For instance,

  • if the baby is in a bottom-down, or a breech position.
  • If the baby appears to be sideways (transverse) or keeps changing position.
  • If the carrying mother has a low-lying placenta (Placenta praevia).
  • If the mother has an infection such as herpes simplex virus or HIV that could be passed on to the baby during a vaginal or natural birth.
  • Previous surgery or illness that could put both at risk such as ileostomy patients who need reconstructive or reconnection at a later date. Those mothers with an illness like Fibromyalgia, ME etc that would be too tired to deliver naturally.
  • Sometimes a small minority of mothers have a phobia of giving birth (tokophobia).

 

If a C-section happened and wasn’t planned, then this would be classed as an unplanned C-section but if there was risk and immediate urgency or life threatening this would be called an emergency C-section. Example of this would be,

Unplanned

Your labour stalled or is going very slowly during the vaginal birth.

You had a planned C-section, but your waters broke earlier than expected.

Emergency

You had a serious life-threatening complication during labour causing risk for you or baby.

 

 

Before surgery

You may have already been advised that you need to deliver the baby via caesarean section. If not you obs team, midwife or doctors will advise you of the risks and what will happen and you will create a birthing plan together. There are obviously more risks with surgical intervention such as a C-section then a natural birth. Make sure you and your partner ask the right questions and understand what is being said. You will be given scans, blood tests and all sorts through out the pregnancy but if you have a planned C-section you may need more than someone having a natural birth. This is to make sure that you are fit for surgery. You may not get a date for the surgery till your third trimester, and you will be given plenty of information of what to expect, to do, take and bring on the day. If not please ask your team looking after you so that you understand and are prepared for at least a night in hospital.

Your midwife may tell you not to wax or shave your genitalia due to infection risks.

You won’t be able to wear make up due to monitoring your vital signs during the surgery and you will have to remove contact lenses, braces and any false nails before surgery. If you wear glasses take these with you for your birthing partner to hold for after so you can see your baby. Some piercings will need to be removed or if not taped up to avoid damage.

You will be advised not to eat on the day at least 2 hours before and will probably be given medication to take beforehand at home. Please ask you midwife about prescribed medications that you are already taken.

You will need to change into a gown and you may need to have further tests like bloods, doppler (baby’s heartbeat) or blood pressure to make sure that you are still fit for surgery. Someone will give you stockings to wear and may administer an injection to reduce blood clots. You will have a cannula inserted into your hand or arm this may be used for fluids and medication. There may be a bit of waiting around till you go into surgery and you may not be able to wait with your partner or birthing partner at times, but they will be present with you for the birth if you are not having a general anaesthetic. They too will need to wear scrubs and take precaution to stop cross contamination in theatre. The midwife or obs team may ask this person accompanying you to bring baby’s hat and clothing such as a baby grow.

You will be on a titled operating table to stop the baby from being squashed from the weight in your abdomen. A catheter will be inserted to drain your urine from your bladder as you won’t be able to move or feel the need to go to the toilet if you have an epidural. Antibiotics will be given to prevent infection and anti-sickness to stop nausea from the medication. You may feel sticky electrodes, a finger monitor and a blood pressure monitoring cuff this is for staff to check your vital signs throughout surgery. If oxygen is needed you may have to wear a mask or nasal cannula/specs to keep you oxygenated.

 

Surgery

An incision (bikini cut) will made along the pubic line after being shaved and cleaned with antiseptic solution once you are fully numbed. You may have a screen up whilst the procedure is being carried out, but the team will lower it when your child is being delivered for you to see. Two horizontal cuts are made, the first into the abdomen wall and the second to the womb or uterus. Muscles and ligaments are parted rather cut and the surgeon will use his or hers fingers to stretch and open the areas rather than cut which will cause less bleeding. You may feel pressure on your lower waist from the team aiding the baby to come out and you may also hear slurping from the suction machines getting rid of waste. Vertical cuts are made if your baby is lying back downwards, very premature, or if mother has a low-lying placenta or if mother has adhesions or growths in the womb. Forceps may be used if the baby is breech or very premature and the team are having trouble delivering the baby’s head.

This part happens very quickly and can seem very busy and a blur with nerves and excitement.

 

 

After delivery & recovery

Your obs team will show you baby and a midwife or paediatrician will probably check the new-born over. You or your partner may be able to have skin to skin contact to warm the baby up as a baby born via caesarean can be a little colder than a baby born naturally. The midwife or paediatrician will check the baby using an Apgar score usually one minute and five minutes after birth to check its wellbeing and it will be assessed to see if it needs any special care. The mother is given a special drug oxytocin to help deliver the placenta and to limit blood loss. The placenta and umbilical cord is removed with a little tug and the uterus and abdomen closed in layers either by dissolvable or non-dissolvable stitches or staples. This should be quite straightforward unless you have had previous surgeries to the area. The wound will be dressed, and any dressings will be attended to when you are eventually discharged home. You may be taken into special care if you yourself have been unwell or had any complications during the procedure.

You will likely be moved into the recovery area where you can begin to have skin on skin or even breast feed your child for the first time. This is great for bonding and your partner should try skin on skin too. You may be shivering from the surgery, this is all normal and expected due to your body’s temperature dropping in surgery. You will continue to have fluids and observations made till you are moved on to the ward. Pain relief will be administered, as well as blood clotting injections and you may not have feeling back in your legs straight away, so you may find that you need the catheter for several hours yet.

Often if everything has been normal and your birth has been carried out with no major problems for you or your baby you may be both discharged after a night or two and when you are back to eating, drinking and toileting regular again. Your district/ community midwife or health visitor will be notified of your return home where the after care for you and your baby will take place. You should receive a baby book for 0-5 years medical records to be recorded. This is essential for hearing checks, doctor’s checks, inoculations and immunisations, teeth, library books, baby’s stages etc.

 

Written by J Gibbs

 

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