Birth by Caesarean Section
A caesarean section is when your baby is born by an operation. You are taken to an operating theatre where the obstetric doctor makes a cut in your lower abdomen and then your uterus. When we plan a caesarean section in advance we call it an ‘elective section’. We schedule this operation at about 38 or 39 weeks gestation. This timing has proven to be most supportive of baby’s breathing at birth (38).
Alternatively, you may go into labour on your own and expect to progress to vaginal birth. But as events unfold it becomes clear that a caesarean section is the safer option for you, your baby or both. A baby born under these circumstances is born by an emergency caesarean. However, not all emergency sections are dramatic or the result of a life-threatening situation.
How will my C section feel?
If you have a Caesarean section, you will need total pain relief from the bust down. Most women have an epidural, spinal or combination of the two. This anaesthesia will allow you to remain awake during the operation. While there should be no pain, you will feel pressure during the operation from the pushing, pulling and stretching needed to get your baby out. If you have any pain the anaesthetist can give you another form of pain relief. However, they can switch to a general anaesthetic if necessary (39).
What is a general anaesthetic?
If you have a Caesarean section, you will need total pain relief from the bust down. Most women have an epidural, spinal or combination of the two. This anaesthesia will allow you to remain awake during the operation. While there should be no pain, you will feel pressure during the operation from the pushing, pulling and stretching needed to get your baby out (39). For this reason, the spinal or epidural is the preferred pain relief option for these births. A general anaesthetic also means a partner or support person cannot be present in theatre for the birth of your baby. It will also likely delay skin to skin time. You will receive help and support to make sure you are able to breastfeed comfortably after a caesarean section if you wish. You will need to speak to your pregnancy care providers about your options and the implications for all these options.
What happens before the baby is born?
Once your anaesthetic is onboard you will be laid flat and the table tilted slightly. This lean helps to keep your heavy uterus off the major blood vessels in your abdomen. The operating theatre staff will put a drape up so you cant look down and see the operation happening below. We will insert a catheter into your bladder to drain your urine, clip any hair that is in the way, and the doctor will paint your tummy with some antiseptic fluid. When everyone is ready the doctor will start by making a cut near the top of your bikini line and then down through the uterus. When they reach your baby, they will lift it out by hand, but forceps may be used for your baby’s head if it is a tight fit or your baby is extra slippery and wriggly. The baby’s umbilical cord will be clamped and cut, and quickly checked over. Delayed cord clamping may be an option depending on the circumstances of your operation. If you and your baby are both healthy and well your baby will be brought over for you to cuddle as soon as possible.
What happens after the baby is born…
The placenta and membranes are delivered next, and then your uterus and abdomen are stitched back up. If it is your first caesarean, it takes about ten minutes for your baby to be born from when they start the first cut. It then takes another half an hour or so to repair your tummy after the baby is out. This process takes longer with each subsequent caesarean section, as scar tissue can get in the way.
Sometimes they can remove your old caesarean scar, and sometimes they need to make a new one. Please discuss this with your doctor. During this time some services promote skin to skin in theatre, making room on your chest for baby to lay on. Operating theatres can be quite cold, so care must be taken to cover baby over with warm towels while he is skin to skin with you. Those babies who are not able to be placed skin to skin must be wrapped warmly and their head covered.
Why an elective caesarean section?
Here are some reasons you may elect to have a caesarean section:
- Placenta problems (eg placenta previa, where the placenta is blocking the baby’s exit)
- Multiple pregnancies – for some twins and almost always for triplets or more
- Previous vaginal or uterine surgery
- Malpresentation – your baby is in a position which makes vaginal birth difficult, dangerous or impossible
- Macrosomia (very big baby)
- Intra-uterine growth restriction (IUGR – very small baby)
Why an emergency caesarean section?
Here are some (but not all) reasons your baby may be born by emergency caesarean section:
- Very high blood pressure, severe pre-eclampsia or eclampsia
- Fetal distress (lack of oxygen to your baby) before you are fully dilated and/or the baby’s head is low enough to have an instrumental birth.
- CPD (cephalopelvic disproportion – a fancy way of saying your baby’s head isn’t going to fit through your pelvis)
- Lack of progress in labour
- Failed induction (we have tried to induce your labour and it hasn’t worked)
After your caesarean section.
When you are finished in the operating theatre you will spend some time in the recovery ward. Here they will check that your anaesthetic is wearing off as expected. We encourage skin to skin during your time in recovery and is a great time for baby to have their first feed. We will give you pain medication to stay ahead of the pain as your regional anaesthetic wears off. You will then go back to the postnatal ward where you will be settled in and the first few days begin.
Research has shown that women recover after caesarean section much faster with a lower risk of blood clots if they are up and around sooner rather than later (40). When you can get up and move around your catheter will be removed. This way you can get up and move around to keep your blood flowing through your veins. Pain medication is vital in these first few days to encourage and maintain mobility, so please make sure you take them at the prescribed time. If you wait until you are feeling the pain to request pain relief it is past the point where we can stay on top of it.
How will I feel?
How you feel about your caesarean section will depend on many factors. These factors include whether it was planned and the health of you and your baby. Your perception and understanding of the events are also an influence. For example, a woman who chose an elective caesarean may have had a very calm, fulfilling and empowering experience. This may leave her with very positive feelings about her birth. Yet, a woman who had planned a waterbirth and ended up with an emergency caesarean may feel very differently. They may feel disempowered or confused about the events. They may also feel guilty because they didn’t birth without help or get that important bonding time when their baby was born (18).
Women do sometimes get PTSD from their birthing experiences as well as having increased risk of postnatal depression. This disorder can affect subsequent pregnancies (6). Understanding why you needed a Caesarean section can help you put the experience in perspective. Talking about your feelings with your doctor or midwife will help. Seek help earlier rather than later if you feel you need it. Other mothers who have had caesarean births are also a great source of support. Please click here for more information on birth by caesarean section.
Dr Janelle McAlpine (PhD), Clinical Midwife
Photo by Reynardt used under license from Shutterstock.com