CAESAREAN BIRTH EXPLAINED

A caesarean birth is where you birth your baby through your abdomen. An obstetrician makes an incision along the bikini line into the womb. Approximately 25% births are by caesarean birth.
Why a caesarean birth?
A caesarean birth may be either planned or an emergency procedure. Planned caesareans are those that are discussed in your pregnancy. You will be given a date for your planned caesarean usually around 36 weeks pregnant.
Some reasons that you may choose a planned (also known as elective) caesareans are:
- Low lying placenta
-
Your preference
- Previous uterine surgery eg. previous cesarean
You can request to have a cesarean birth for your preference. Your obstetrician will talk you through the pros and cons for both a cesarean birth and a vaginal birth and then you can make an informed choice on whether a cesarean birth is the right choice for you.
What is an emergency caesarean?
Emergency caesareans (or unplanned) are any caesarean that wasn’t booked in your pregnancy. The chance of you needing an emergency caesarean if you are a first time Mum is 1 in 3 in the UK. It is 1 in 5 when you include women who have given birth before.
Emergency caesareans are split into 3 categories.
- Category 1 caesareans are when there is a complication in labour that is life threatening to you or for baby. When the decision is made to do a category 1 caesarean, baby is born within 30 minutes, often less. An example of this could be a cord prolapse.
- Category 2 caesareans are when there is a complication in labour that suggests caesarean birth would be a safer option, however there is no immediate threat to you or baby. These cesareans are done within 75 minutes. An example of this would be if you’re in active labour, but your labour has stopped progressing and other alternatives have been tried to keep your labour going. Another example would be a suspected infection where baby is starting to show signs of distress.
- Category 3 caesareans are when there are no complications, mother and baby are both well, but an early birth is required. An example of this is if you have had an induction of labour but the induction has not induced your labour and you would now like a caesarean. This would be done usually the same or following day.
What happens if I have planned a caesarean but then I go into labour?
If you were planning an elective caesarean, but went into labour before the operation, you will have the options of both a vaginal birth and caesarean birth discussed with you. You will then be able to choose if you want to have a caesarean at that time or go for a vaginal birth. It may not be appropriate for you to have a vaginal birth, such as with a low lying placenta, in which case you will have an emergency caesaraen.
What happens before a caesarean section?
Your obstetrician and midwife will explain why they advise a caesarean and explain what is going to happen and any possible risks. You will be asked to give your consent to the procedure.
Before surgery, you may need to change into a hospital gown. You'll need to take off, or tape, your jewellery. The theatre staff will ask you questions about if you have any dentures, caps or crowns on your teeth, any artificial limbs, any metal in your body including piercings and about any previous anaesthetics you have had.
In the majority of births, your partner will be with you during your caesarean. He will have to change into sterile theatre clothes. These will include a mask for his nose and mouth, a hat and special footwear.
You'll be given an anaesthetic this will usually be a spinal or an increased dose of your epidural which means it numbs the lower half of your body. Very occasionally general anaesthetic, which puts you to sleep, may be used if your Caesarean is an emergency. If you need a general anaesthetic then partners are asked to leave the theatre.
What happens during the caesarean?
So that you cannot see what is happening a screen will be put up at the top of your bump. The screen is then lowered as baby is born so you can see baby being born. You can make requests about the screen, if you would like it to remain up or down that is fine. After your spinal anaesthetic is working, your midwife will put in a catheter which will remain in until later in the day. Your obstetrician will then make a cut along the top of your knicker line, about 20 cms across.
You may feel a little movement or pressure but you should not feel any pain or discomfort during your caesarean. Your baby will be born usually within 5-10 minutes of the operation starting. You will be able to see your baby straightaway and hold your baby too. Sometimes baby will need to go the paediatrician if baby is needing some help taking his/her first breath. The operation in total usually takes about 40 minutes.
What happens after my baby is born?
Your baby will be placed directly on your chest so that you can skin to skin if you wish. If you aren’t feeling well enough to hold baby, baby will be given to your partner to hold.
Babies born by caesarean are often a little colder than babies born vaginally, so they need to be well wrapped up or placed against your skin to keep them warm.
Your baby will be given an Apgar score one minute and five minutes after he's born. The score measures your baby’s wellbeing. During all emergency caesareans, neonatal doctors (paediatricians) will be there at baby’s birth. So if there is any concerns about baby’s wellbeing they are on hand to help. Sometimes babies need some helping taking their first breath after a caesarean and in some births they need to go to special care for extra care.
You'll be given the hormone oxytocin to help your uterus contract and reduce blood loss. Your doctor will remove the placenta during your caesarean. This will be checked to make sure it is complete.
Finally, your skin wound will be closed with stitches, staples, glue or a combination of these and you will have a dressing over the top. The dressings can come off somewhere between day 2 and day 7, depending on the type of dressing you have. When you're ready, you'll be moved into the recovery room where you, your partner and baby can be together.
What happens after a c-section?
In recovery, if you haven’t yet then you can have skin to skin should you wish to. This would also be a good time to give your baby his/her first feed. You midwife will be with you in recovery checking your vital signs (blood pressure, temperature and pulse) along with your vaginal blood loss, your caesarean dressing and your catheter to make sure you are passing urine.
Initially after your caesarean, you may start shivering. Your body temperature drops during the operation and also from affects of the the anaesthetic. The shivering is usually harmless and only lasts about half an hour. The midwife or nurse will warm you up with blankets and fluids.
Pain relief after a c-section
Your midwife will ensure that you are comfortable and give you pain relief. During the first few hours you will be comfortable as you will have your spinal anaesthetic still working. This tends to wear off within 3-5 hours. It is a good idea to take pain relief regularly after this time. The pain relief you will be offered is paracetamol, ibuprofen, dihydracodeine and morphine. Taking one of these regularly every few hours will help with your recovery. Codeine and morphine can make you constipated so when you feel like you are on top of your pain relief these 2 medications should be the ones that you stop first.
You may also be given an injection and stockings to prevent the risk of blood clots. The injection you will have once a day, and the stockings you will be advised to wear for a week.
When can I go home after a caesarean?
You can usually go home after 24 hours after your caesarean. You may want to stay in longer than this for pain relief and support from the midwives on the ward.
How safe is caesarean birth compared with vaginal birth?
Most women in the UK recover well and have healthy babies whether they have a vaginal birth or a caesarean birth. A caesarean birth though is a surgical procedure, and like all types of operations, it does carry some risk of complications. If you are feeling worried about birth, whether that be via caesarean or vaginal birth, then have a chat with your midwife or obstetrician.
What are the main risks of a caesarean section?
Blood loss
Women lose, on average, more blood during a caesarean birth than a a vaginal birth. At the time of birth your blood loss will be monitored and extra drugs are available to reduce your blood loss. After your caesarean birth, you will be offered a blood test to check your iron levels. Having low iron levels can make you feel tired, short of breath and also can slow your recovery process so it is important to know your iron levels and have treatment accordingly.
Infection
There is a risk of wound infection, the symptom are; redness swelling, discomfort and discharge from the wound. There is also a risk of getting an infection in the lining of the womb, the symptoms would be increased vaginal bleeding and increased vaginal discharge. If you have any of these symptoms or you feel feverish, have a high temperature or generally unwell it is very important that you seek advice from your doctor or midwife.
Pain
The main disadvantage of Caesarean birth is increased pain after the operation. You're more likely to have pain in the wound and discomfort in your belly for a few weeks after the operation, but prior to leaving the hospital you will be given medication to reduce this discomfort.
Blood clots
All surgery carries a risk of developing a blood clot. If the clot lodges in the lungs it can be life-threatening. Signs of a problem include shortness of breath, chest pain or pain or swelling in your calf. Call your doctor if you have any of these signs after your caesarean.
Injury
Serious complications are thankfully rare. They include: injury to the bladder, to the tubes connecting the kidneys to the bladder (ureters) or to the bowel. Very rarely the womb must be removed (hysterectomy) to stop severe blood loss.
Anaesthetic complications
Most Caesareans are done with a spinal or epidural anaesthetic, so without putting you to sleep. These are safer for you and your baby compared to putting you to sleep with a general anaesthetic. However, having any anaesthetic involves a small risk. Rarely the anaesthetic can cause a severe headache (1 in 100) or long term nerve damage (1 in 10,000).
What are the risks to my baby after a Caesarean?
Occasionally some babies have breathing problems after a Caesarean, but this is more common in babies born before 39weeks. Rarely babies have a cut to the skin which may have happened accidentally when the womb was opened, this usually heals very quickly.
Will having a caesarean affect future pregnancies?
Once you've had one Caesarean, you're more likely to have another Caesarean in future pregnancies. However, for many women a vaginal birth is possible after a previous Caesarean (VBAC). Those who plan for a vaginal birth after a caesarean have a chance of an emergency caesarean of around 25%.
Having had a Caesarean slightly increases your risk of having a low-lying placenta (placenta praevia) in future pregnancies. There is a small risk (quoted between 1 in 98, RCOG and 1 in 250, UKOSS) of the scar on your uterus breaking open (uterine rupture) in future pregnancies or births.