Insider guide to caesareans

In this no-holds-barred guide, midwife Anne Richley explains exactly what happens before, during and after a c-section

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Pregnant woman in blue hospital gown

Caesarean birth basics

A caesarean is where an incision is made through the skin and muscle of your lower abdomen, and into the womb, in order to deliver your baby. There are three ‘types’ of caesarean:

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*Elective caesarean. This is where the decision has been planned in advance by the mum-to-be and her obstetrician. It may be because the baby’s lying in a breech position, the mum-to-be has had a previous caesarean, has active herpes or has chosen for personal reasons not to give birth vaginally.

*Emergency caesarean. The baby may have started to show signs of distress in early labour or there might have been little progress during labour.

*Crash caesarean. This is a true emergency. If you don’t have an epidural in place, you’ll be given a general anaesthetic, as the baby needs to be delivered immediately. This may be because of a placental abruption (where the placenta separates from the womb wall, which results in bleeding), a prolapsed cord (where the placental cord falls into the birth canal ahead of the baby’s head, potentially cutting off his blood supply) or the baby’s heart rate is showing signs of distress.

Will you feel it when you have a caesarean?

It’s usually recommended that the mum-to-be has a spinal anaesthetic or epidural so she can stay awake and hold her baby soon after the operation. Some women will be advised to have a general anaesthetic if complications are anticipated. For example, they may be at risk of bleeding heavily during the caesarean, which can happen with a condition such as placenta praevia (where the placenta covers part or all of the cervix).

A spinal anaesthetic is similar to an epidural but is quicker to administer and provides a short but effective dose of anaesthesia. It makes you feel numb from the top of your bump, down. As the anaesthetic travels around your body, it may feel strangely like liquid ice coursing through your veins.

What’s involved in a caesarean?

Once the anaesthetic has taken effect, a fine tube – a catheter – will be inserted through your urethra (space where you pass urine) and into your bladder. Your tummy will be washed with an antiseptic lotion, and if it’s an emergency operation the midwife will shave the top of your pubic hair. If it’s an elective caesarean, you can do this yourself at home the night before. A screen will be set up so you can’t see the actual operation.

The doctor makes a cut, most commonly just below your pubic hairline, through the skin. After this, the abdominal muscle is separated and a second cut is made through the womb. The doctor can then open the amniotic sac that your baby has been growing in, and there’ll be a gurgling sound as fluid is suctioned out. You won’t feel any pain, but you may feel some pushing and ‘rummaging’, then pressure as your baby is lifted out – some women describe the feeling as if someone is washing up in their tummy!

Hospital procedures vary, but usually your baby is handed to you, assuming he doesn’t need to be checked by the paediatrician first. The doctor removes the placenta, then sews up the cut. The suturing (stitching) is the longest part of the procedure – in an emergency a baby can be born by caesarean within minutes – but the whole procedure takes about an hour.

Can you choose to have a caesarean?

In the UK, there’s no automatic right to an elective caesarean, although it can usually be negotiated with the obstetrician. Ultimately, though, it’s about making an informed decision. So the midwife and obstetrician will want to be sure you’re aware of the risks associated with a caesarean when there’s no medical need for one.

Can your partner be present at a caesarean birth?

If you’re awake for the caesarean, your partner will be able to come into the operating theatre with you. He’ll be asked to change into ‘theatre blues’ (pyjama-like trousers and top), and may even get to wear a paper hat. Everyone in the room will be wearing the same outfits to reduce the risk of introducing infection into the operating theatre.

What happens after you have a caesarean?

You’ll need close care in the first few hours following the birth, as a caesarean is a major abdominal operation and comes with risks.

If you’ve had a general anaesthetic, you’ll drift in and out of consciousness and feel very ‘hazy’. Your pain should be well controlled, initially with a spinal anaesthetic, an epidural or other intravenous drugs. But after a few hours, the midwives may suggest changing to a painkiller such as paracetamol with codeine or non-steroidal anti-inflammatories such as ibuprofen.

You’ll be encouraged to start moving around quite soon after the operation – certainly within 12 hours – and gradually all the ‘plumbing’ (catheter, drips, etc) will be removed. The majority of women will still be in some pain and will also suffer with wind pain, not only in their stomach but their shoulders, too.

How safe is a caesarean?

Caesareans can sometimes save lives, but there are still risks and it’s important to know about them so you can make an informed decision.

Increased risks to the mum can include:
*Anaesthetic complications.
*Haemorrhage (severe bleeding).
*Blood clots.
*Damage to the bowel or bladder.
*Infection.
*Future complications with fertility.

When the mum hasn’t laboured there’s a risk that the baby will have breathing difficulties. But it’s important to keep this in perspective when a woman has had to have a caesarean because of other, known risks.

How can you prepare for a caesarean?

*Pack plenty of big knickers. They are essential after a caesarean, as you’ll have a wound along the top of your pubic hairline.
*You still need sanitary towels, as you’ll still bleed after the operation – as you would after a vaginal birth.
*Be prepared for a longer hospital stay of around four days, so don’t forget to take extra clothes for you and your baby.
*If you know you’re having a caesarean, enquire beforehand about a weekly hospital car park pass for your partner – these usually work out cheaper.

What does a caesarean scar look like?

There are different types of incisions, the most common being along the bikini line, in your upper pubic hair. Initially, the scar will look like a cut, around 15cm long, and there will be a dressing over it.

The day after the operation the dressing is usually removed and the midwife will check to see if the cut is healing well. The wound tends to be closed with a running stitch, although other varieties can be used. If they aren’t the type that dissolves, they’ll need to be removed, which is usually done around the fifth day by your midwife.

Over time, your scar will fade until it’s barely noticeable. Make sure you have a good look at it – you might need to use a mirror, as many women are left with a bit of an ‘over-hang’ after having a baby. This is because the uterus still needs to contract back into shape, which doesn’t happen immediately.

There’s a lot of pushing and pulling with a caesarean, so don’t be surprised if there’s some bruising around the scar area. While you’re in hospital it’s a good idea to shower each day to keep the wound clean, and gently dab it dry with a towel afterwards. Once home, many women prefer to have a soak in the bath each day, although you may need help when stepping into and out of the tub at first.

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Planning for a caesarean birth

Writing a birth plan will make you focus on what you really want to happen during your caesarean and will help make it a positive experience. Here are some things to consider:
*Have you a favourite piece of music that you’d like your baby to be born to?
*Would you like the screen to be lowered as your baby is being lifted out, so that you can see him as soon as possible?
*If you’re going to be asleep for the birth, some women ask a member of staff to take photos of the baby being lifted out of the womb.
*Would you still like to find out the gender of the baby for yourself?
*Would you like skin-to-skin contact as soon as he’s born?
*If your baby is well, ask for him to stay with you in theatre. He can be weighed and measured there rather than being taken out of the room.

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