Caesareans - get the facts to stay in control

Whether you are already planning an ‘elective’ Caesarean or a normal delivery, understanding what is involved in this common operation can alleviate a lot of fears. Obstetrician Meg Wilson has the essential facts for prospective Mums.  

Caesarean Sections - what to expect

Delivery by Caesarean section is a hot topic for debate between mothers, doctors, midwives and governments.

Crucially, Caesarean section has saved the lives of thousands of women and babies and has played a part in drastically reducing the number of deaths during childbirth. However, as with any operation, there are immediate risks and potentially long term complications which fuel the controversy about Caesareans – it is often a difficult decision for mothers and doctors alike.

Too posh to push?

In my experience, the ‘too posh to push’ attitude is very rare amongst British mothers - most women prefer to have a normal delivery but will undergo the procedure for the benefit of their baby or themselves if advised by a health professional.

The World Health Organisation has suggested that hospitals should aim to have a Caesarean rate of less than 10-15%, however in most NHS hospitals the rate is closer to 20%. Caesarean sections are only performed in NHS hospitals when there is a concern about the safety of mother or baby.

Whether you are already planning an ‘elective’ Caesarean, you have been given the option of Caesarean or you are planning a normal delivery, it is well worth understanding what is involved in this common operation as this can alleviate a lot of fears.

Understand the Process

Before you have a Caesarean section the reasons for this delivery should be explained very clearly to you and your birthing partner, and the doctors will only go ahead if you have agreed to the operation.

The major risks of Caesarean are blood loss and infection, but your Obstetrician will be doing everything they can to minimise these risks. You will also meet the anesthetist to talk about the anesthetic and pain relief for the operation. Most Caesarean sections are performed in an operating theatre located on the labour ward, probably even on the same corridor. This means you will have to be transferred to your local hospital if you are delivering at a birth centre or at home. Although the prospect of an operation may be terrifying, most women are pleasantly surprised that it was not as bad as expected - it can still be a very fulfilling experience for you and your birth partner.

Most Caesareans are performed under some form of regional anesthetic which will either involve using the epidural you had for pain relief in labour, or sitting you on the edge of the operating table and putting a ‘spinal’ anesthetic in your back. You will then lie down on the operating table and the anesthetist will spend time testing with a cold spray to check you are numb from the top of your tummy to your toes. This type of anesthetic means you are awake for your operation and can still be involved in the delivery of your baby. It is also much better for your baby because, unlike a general anesthetic, regional anesthetic it does not reach your baby.

You will also have a thin tube, called a catheter, in your bladder to drain urine and a drip in your hand to give you fluids and additional drugs. When you and the anesthetist are happy that you cannot feel anything, the Obstetrician will clean your tummy gently with an antiseptic. A large drape will then cover you and also act as a curtain so you are not watching what is happening.

You will feel the sensation of pressure but not the feeling of pain. People often describe it as ‘someone doing the washing-up inside their tummy’.

You will be talking to the anesthetist and your birth partner who will help you relax and take your mind off the procedure. The Obstetrician will test the sensation once more and if you are completely pain free the operation will start. This usually involves making a cut across the lower part of your tummy just above the hair line. In the future the scar will be hidden by your knickers or bikini.

The operation involves opening the various layers of the abdominal wall to reach the womb. The bladder lies in front of the womb and this is carefully pushed away before opening the womb. The obstetrician slips their hand into the lower part of the womb and levers out the baby’s head, or bottom if your baby is ‘breech’. The assistant pushes on the top of your tummy and the baby is gently pushed out. Sometimes the curtain can be lowered at this point if you would like to see the baby coming out - don’t be scared to ask for this.

Delivery

The baby is usually delivered within the first five to ten minutes from starting the operation. The baby will be handed to a midwife who will check that the baby is ok and wrap it up, if you are having an ‘emergency’ caesarean section there will be a baby doctor to do the check. Your birth partner can observe the baby check at the cot if you are relaxed enough to let them leave your side for a few minutes. The baby is then brought back to meet you whilst the operation is still going on and you can give your baby a cuddle.

The obstetrician will deliver your placenta after they have delivered your baby through the same cut in your womb. They will then carefully stitch up all the layers which were cut to deliver the baby. This usually takes about thirty minutes. The skin is closed with different types of stitches in different hospitals. Stiches can be ‘dissolvable’, ‘non- dissolvable’ which are removed after five days, or ‘clips’. After the operation is completed, a bandage covers your wound and the drapes are removed. Blood clots are removed from your vagina with a swab and you are covered with a blanket.

You will be taken to a recovery area where you can sit up in bed, cuddle your baby and see your friends and family. You can try to breast feed and have a cup of tea or a light snack. A midwife will monitor your blood pressure and keep a drip running into your hand. Your anesthetic will relieve any pain for another two hours, but your midwife will check that you do not require any extra pain killers.

Recovery and planning for next time...

Most people are in hospital recovering for about three days. The first day you will still have a catheter in your bladder and a drip in your hand. When these are taken out, you will be able to start to walk around the ward and by the third day most people are feeling confident enough to go home. After your Caesarean section you should have an opportunity to talk to the doctors and midwives involved with your delivery. You may have some more questions about the operation and recovery at home. It is also worth discussing how it would be sensible to deliver a baby in the future, if you have had just one caesarean section you may be offered to try a normal delivery in your next pregnancy (a Vaginal Birth after Caesarean or VBAC).

Most Caesareans are straight forward but of course some are more difficult depending on the reason for Caesarean and the circumstances of delivery. The best weapon to keeping control over your own delivery is to understand why they are performing the operation and what will be involved. Think about all the delivery possibilities during your pregnancy, so you are not asking all the questions when there is little time and you are tired. Remember this is your child birth experience, don’t panic and you will stay in control.