Caesarean section

Introduction

If we have decided that the safest way for your baby to be born is by
Caesarean section this section answers some of the questions you may have.

If you are reading this following delivery of your baby by an unplanned/ emergency Caesarean section, the information should be equally helpful.

What is a Caesarean section?
It is an operation where the baby is delivered through an incision (cut) made in the abdomen and uterus (womb). The incision is usually made at the “bikini line” so that the scar will be in a place not often noticed.

Why is a Caesarean section needed?
There are many reasons but usually because it is thought to be safer for either the baby or the mother. It may be elective (planned and discussed during pregnancy), or emergency (a problem arises suddenly and needs urgent action). In either case there should be time for discussion with Dr Fogarty.

Why have a caesarean section?
The most common reasons a doctor will advise a Caesarean Section are

1 Two or more previous Caesarean Section
2 A First pregnancy where the baby is breech
3 Any pregnancy where the baby is “transverse” i.e. lying side to side
4 If there is concern about the baby’s well being

Can I request a Caesarean section?
This is a major operation and although it is very safe complications can occur. I am more than happy to discuss all requests so that your fears and questions can be addressed.

When do I need to come into hospital?
Normally at your last antenatal appointment I will arrange a delivery date. You should arrive at maternity admission for 8.00 am.

Will I need to have any tests performed?
You be asked to give a small sample of blood for haemoglobin (iron level) and to ensure the correct type of blood is available if needed. This is normally the only test required.

What preparation will I have?
Don’t bring any valuables into hospital. This includes jewelry as you may only wear your wedding ring to theatre.

All make up and nail polish should be removed before you go to theatre. On the morning of the operation please do not use talc or perfume following your bath. You will need to have some of your pubic hair removed so you may prefer to shave your bikini line before admission.

You must not eat or drink for at least eight hours before your operation so please fast from midnight.

You will be required to sign a consent form before surgery. If you request sterization at the time of Caesarean section then a separate consent form may be required.

What happens when I arrive in theatre?
You will be given a full explanation of all that is going to happen. This is a good opportunity should you have any final questions about your surgery.

An intravenous infusion (drip) will be attached to your arm. A blood pressure cuff is also attached to your arm, three small ECG pads are placed on your chest to record your heartbeat and oxygen monitor clipped onto your finger. Then your spinal anaesthetic will be given (see epidural section for further details). When this is working you will be catheterized. This means that a fine soft tube is inserted into your bladder to drain away urine. It will probably remain in place for 24 hours and is usually removed the morning after surgery. You will then lie down and a small oxygen mask put on to make sure you and the baby have no shortage of oxygen.
If your partner is to be present, he will be brought into theatre when you are fully prepared and just before the actual surgery starts

What about pain relief?
The preferred method of anaesthesia is a Spinal Anaesthetic – for this a local anaesthetic is injected into the lower part of your back. This will however make you feel numb from the breast down and your legs will feel heavy for several hours.

This anaesthetic is good because it allows you to be awake and experience the delivery of your baby, without any discomfort. It does not make you or the baby feel sleepy.

How long does it all take?
The spinal is usually inserted in 5 minutes and fully working in another 5-10mins
Once I start operating your baby will be delivered in about 5 minutes.
I will let you touch and say hello to the baby before the cord is cut. I will then usually let the midwives dry the baby, trim the cord and do its first check (APGAR score). Assuming all is well the baby will then be placed on your chest for the rest of the operation.
I will then deliver the placenta and suture up the incisions this usually takes a further 15mins.
Once I am finished we will move you back to your own bed and put the baby in beside you for a cuddle and a try at feeding (see Baby Friendly & Breast Feeding)

What happens following my operation?
You and your baby will be transferred into a recovery ward for at least one hour following your operation. When you are both stable you will then be taken back to the ward, where the midwives will help you to look after your baby until you feel confident to do so yourself.

Pain relief will be prescribed by the anaesthetist. If you find that this is not * effective, please tell your midwife. You will also receive Heparin injections every night until you are fully mobile to keep your blood slightly thin and so reduce the risk of DVT (clots in your leg veins)
Gradually over the first few days after the operation, you will start to feel like eating and drinking again. Please tell the midwife when you feel hungry.

Early mobilisation is important following any surgery, and the staff in the ward will help you to get up and about as soon as you feel able.

I usually use dissolving stitches and steristrips, which do not need to be removed

When may I go home?
There is no fixed time that you must stay in hospital, but the average stay is
3 -5 days. If you and your baby are well, and you have good support at
home, then you may want to go home early.

Do I have to come back for a check up?
When you go home a community midwife will visit you up to your 10th day or longer if necessary. My office will send out an appointment for your postnatal check up.

Complications of caesarean section
Although caesarean section is quite a common way to have your baby and spinal anaesthetics have helped the process there are still some risks.

BABY

1 Lacerations (cuts) to the scalp or face
2 Problems with breathing if the caesarean section is completed too early including a condition called transient tachypnoea of the newborn (TTN)

MUM

1 Anaesthetic complication including headache
2 Infection of the wound
3 Urinary tract infection
4 Anaemia
5 Deep vein thrombosis (clot in the calf vein of the leg)
6 Disturbance of sensation in the area of trhe wound including chronic (longstanding) loss of sensation and chronic pain

HOW DOES CAESAREAN SECTION COMPARE TO NORMAL VAGINAL DELIVERY?

You now have the main facts about caesarean section. If you have any queries please talk to our Doctor or Midwife.