Understanding caesareans

With one in four women in the UK giving birth by caesarean each year, it’s important to understand what’s involved. Our midwife explains…

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Your scar will be abour 15 cm long after your operation

What is a c-section?

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).

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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.

How long will recovery 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 your birth didn’t go as you’d planned. 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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What happens during a c-section?

  • A catheter will be fitted. Once you’re numb from the anaesthetic, a fine tube will be inserted through your urethra into the bladder.
  •  The top of your pubic hair will be shaved. If it’s a planned section, you can do this at home. If not, your midwife will do it and the area cleaned with antiseptic.
  • A screen is set up. This will be placed over your chest so you can’t see the actual operation, although you can ask for the screen to be lowered as your baby’s lifted out.
  • Two cuts will be made. The first cut is through the skin and a second is made through the womb.
  • You’ll hear a gurgling sound. As the doctor opens the amniotic sac and fluid is suctioned out.
  • You may feel some tugging. You won’t feel any pain, but some women say it’s like someone’s doing the washing up inside their tummy as the baby’s lifted out.
  • Your baby’s cord is cut. If there are no complications, you can now cuddle your baby.
  • The doctor will remove the placenta and sew you back up. Your baby can be born in minutes, but the whole procedure will take about an hour from when you first go to theatre.

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