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Caesarean section

Most expectant mothers anticipate that their baby will be born by a normal vaginal delivery. However, when preparing for labour, you should find out as much about caesarean sections (also referred to as a 'C- Section' or 'Section') as you can, including the reasons why this operation may be performed.

A caesarean section may be the safest option for you and/or your baby in situations where a vaginal delivery may be risky or impossible to achieve. Sometimes these risks are known from the outset and your doctor may arrange for you to have a planned or elective caesarean. Where unforeseen risks arise during labour, an emergency caesarean may be performed.

Under what circumstances would I have a planned c-section?

An elective caesarean section is planned in advance and is usually done at around 38-39 weeks gestation. Some of the reasons why you may need an elective caesarean include:
  • The baby is in a breech (bottom-first) or transverse (sideways) position;
  • The baby has been diagnosed with a foetal illness or abnormality;
  • The mother's pelvis is deemed too small to allow the baby to pass through;
  • The mother has a history of multiple caesareans;
  • The mother has an infection that may be passed on to the baby if it is delivered vaginally.
Wherever possible, an elective caesarean is performed under regional anaesthetic using an epidural or spinal block. This means that you are awake and alert during the operation but you will not feel pain as you will be numb from the waist downwards.

Whilst the operation is being performed, a screen will be put up in front of you to prevent you seeing the procedure. However, the surgeon will explain what is happening at each stage of the operation and may remove the screen temporarily so you can see your baby being born. In normal circumstances your partner will be allowed to stay with you in the operating theatre.

Having a caesarean section under a regional anaesthetic has a number of advantages over those carried out under a general anaesthetic. For example, you will be able to remain alert during the operation and you will be able to see and hold your baby immediately. There are also normally fewer post-operative side effects such as nausea and vomiting.

Why might I need an emergency caesarean delivery?

Most caesarean sections are performed as a matter of medical emergency, when obstetric complications arise either with the mother or her baby. These complications include foetal distress, prolapse of the umbilical cord or antepartum haemorrhage.

An emergency caesarean section is often done under general anaesthetic as this can be done quicker than a regional anaesthetic. However, some emergency caesarean sections are performed using a spinal or epidural anaesthetic.

Following an emergency caesarean section, it is important that you discuss with your obstetrician why the operation was necessary.

What does C-section surgery involve?

Although many caesarean sections are performed every day, they are still considered a major surgical procedure. It can take up to one hour to perform a c-section, even though your baby is normally delivered within the first 5-10 minutes.

Prior to the operation an intravenous infusion will be set up and a urinary catheter will be inserted into your bladder to drain urine. The incision is usually horizontal just above the symphysis pubis (along or below the bikini line). In certain circumstances the incision may be vertical. Most women having caesarean sections are given antibiotic cover at the time of operation to prevent infection.

Post operatively you may also be prescribed heparin injections and elastic stockings to reduce the chance of developing blood clots (thrombosis).

How long does it take to recover from a caesarean?

Most women remain in hospital for 5-7 days following a caesarean section. The stitches are usually removed on the fifth day. Many surgeons now use subcuticular stitches which are inserted just underneath the skin and are not visible. In most instances these suture do not need to be removed as they dissolve over time. Although you will be left with a scar, it should become barely noticeable once healed.

During the first few days after the operation, you will have some degree of pain and will most likely require painkillers. Some women have difficulty sitting or standing up straight. If you are breastfeeding, you may find it difficult to find a comfortable position; many women find it easier to breastfeed whilst lying on their side. Although it will be painful, you will be encouraged to get up and walk around quite soon following surgery. This will get your circulation moving and helps prevent blood clots. However, it is important to take things slow and easy.

You will be advised not to lift any heavy objects or undertake any strenuous physical activity for at least six weeks. You are usually advised not to drive for at least four weeks following a caesarean section and some insurance companies have certain guidelines so check these before you begin driving again.

You should start gentle postnatal exercises about 4-6 weeks following surgery to get your muscles back in proper working order.

I had a caesarean for my first baby. Will I be able to deliver vaginally this time?

Having a caesarean section for one baby does not necessarily mean that you cannot have a vaginal delivery in the future. This depends very much on the reason for the caesarean section in the first place. If the operation was performed because your baby was becoming distressed or if there was an obstetrical emergency such as prolapse of the umbilical cord or antepartum haemorrhage there is no reason to assume that your next baby cannot be delivered normally.

Women who have already had two caesarean sections, or in cases where the cause of your first caesarean still persists i.e. your pelvis is too small or the baby is again not presenting head first may be advised to have another caesarean.

If you wish to have a vaginal delivery following a previous caesarean section your doctor will discuss all the pros and cons with you. There is some risk of a weakness in the uterine wall from the previous caesarean tearing open during labour. Usually this can be detected early by careful monitoring in labour and in the event of a uterine tear, a caesarean section will be performed immediately.

The chance of a normal vaginal delivery following a previous caesarean section depends on a number of factors. If you go into spontaneous labour then you should have about an 80% chance of having a normal delivery. If however your labour needs to be induced then the chances of you having a normal delivery is around 50%. By weighing up these options you and your obstetrician should decide beforehand if it is best for you to have an elective section or whether you should try to have a normal vaginal delivery

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