Lifting the lid on caesareans

With around one in four women in the UK giving birth by c-section each year, it's important to understand what's involved. Our award-winning midwife Anne Richley explains...

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The facts

What is a c-section?

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A caesarean involves major surgery, where a surgeon makes a cut into your belly and womb, and then lifts your baby (or babies!) out. There are two types, commonly called elective and emergency. This can be misleading as it makes it sound like you can just pick a day to have your baby, like choosing the colour of a sofa. The actual medical terms are planned (what you’ll know as elective) and unplanned (emergency).

Why you might have a planned c-section

If your baby’s in the breech position or in a sideways position (transverse), or the placenta is lying low in the uterus and blocking your baby’s exit (called placenta praevia), you might be advised to have a planned c-section.

Women who’ve had a previous caesarean might opt for one again, although in most cases they’ll be encouraged to aim for a vaginal birth.

Why you might need an emergency c–section

Labour can be unpredictable, and an emergency caesarean can be lifesaving for some women and babies. It’s usually nowhere near as dramatic as this though, and the doctor will have time to give you an epidural or spinal anaesthetic so you can be awake for the birth.

If your labour’s progressing slowly, or the midwife discovers your baby’s not in the right position, or there are significant changes in your baby’s heart rate, you could end up having an emergency c-section.

Can you choose one?

Like all surgery, a caesarean isn’t without risks. These can include complications due to the anaesthetic, haemorrhage or severe bleeding, blood clots, damage to the bowel or bladder, infections and future fertility complications.Some newborns will have breathing problems and need to have special care before they’re reunited with mum.This all means you won’t automatically be given a caesarean on request, at least not on the NHS.

You’re perfectly within your rights to discuss a planned c-section with your obstetrician, but he can refuse if he can’t see a valid medical reason for doing it. Some women have a genuine fear of childbirth, called tokophobia, and this should be taken seriously, with counselling offered.

The recovery process

How long will it take?

You’ll be encouraged to get out of bed within 12 hours, and will probably feel ready to go home after two or three days. Your midwife will give you some gentle postnatal exercises that you can start straight away, but anything too strenuous will have to wait a good few weeks.

You shouldn’t drive until you feel confident you can do an emergency stop, and for many women this isn’t until six weeks later.

Your operation scar

The most common cut is around 15cm long and made along the bikini line in your upper pubic hair. The dressing is usually removed the day after the operation and your midwife will check to see if it’s healing well.

Some stitches will dissolve on their own, while others will need to be removed by your midwife, usually after five days. Your scar will fade over time, until it’s barely noticeable.

How you might feel

It’s not unusual to feel disappointed if things didn’t go according to your birth plan. You can go through your notes with a midwife or doctor in the hours, weeks or months following the birth, to try and understand why it was necessary. There’s a lot of emphasis on ‘achieving’ a natural birth, but the main goal should really be to have a healthy baby – and a healthy mum.

What about next time?

If your second baby is well positioned and there are no medical problems, you can go for a vaginal birth after a caesarean (VBAC). There’s a very small risk of the scar breaking down during labour, and while this is serious, it’s also pretty rare, and it’s more likely to happen if labour is induced. Some women in this situation will opt for a planned caesarean rather than chance going through labour, only to end up with an emergency c-section before the planned b-day.

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