Caesarian Section (C Section) rates in Ireland vary by unit and range from 18.9% up to 38.7% (2012 statistics). Many people end up needing a C Section for various reasons – some a bit dubious and some unquestionable. Always a contentious issue in the media where some women are branded “too posh to push”. We see stories of women paying for private care to get a C Section. I’ve often been asked, as a midwife, would I prefer to go for a C Section over a normal delivery? The answer was always “No way” and since having my normal delivery, my answer is unchanged. See my birth story here. Sometimes you have no option though so it’s handy to know a bit about the process just in case.
What exactly is a C Section?
-an operation by which a fetus is taken from the uterus by cutting through the walls of the abdomen and uterus. (www.dictionary.com)
Why would you need this procedure?
- Breech presentation of baby at 36 weeks gestation. You should be offered ECV (external cephalic version) which involves a skilled practitioner manually turning the baby around by putting pressure on abdomen under careful monitoring. If this is declined or doesn’t work, you will be offered an elective C Section.
- Twin pregnancy where the first twin is not cephalic (head first).
- Placenta praevia – where the placenta partially or completely covers the cervix as there is a high risk of haemorrhage.
- Morbidly adherrent placenta
- Women with HIV only if viral load is greater than 400 copies per ml or if not receiving anti-retroviral therapy
- Primary genital herpes infection in third trimester of pregnancy
- History of more than 1 previous C Section.
- In an emergency situation
- Other reasons exist too but those are the main ones!
What happens at a planned C Section?
- Your consultant should have discussed the reason you need the procedure and outlined the risks and benefits for you – if not then ask them to.
- It depends on your hospital but usually you will have an appointment to come in for pre-admission the day before your C Section. This appointment is to obtain blood samples, get your consent for the procedure, you might have your legs measured for pressure stockings (TEDS), you will be asked about allergies to medications and other allergies (eg latex), you will be given tablets to take the night before and morning of procedure and usually there is a standard antenatal check.
- On the morning of the C Section, you will usually arrive early to the hospital with your birthing partner. You will be fasting from the night before. On admission, a midwife will show you to your bed and you will have an armband applied – check that all the details are correct.
- You will be given one of those very flattering gowns to put on and a hat for your head. You will have nothing else on you apart from those 2 items. Some hospitals put on the TEDS stockings now and some after your C Section.
- You will have a set of observations taken (blood pressure, pulse, temperature) and either a CTG trace of baby’s heartbeat or just a listen in to the baby’s heart with a sonicaid or pinard. You might be asked for a urine sample. Bikini line will be checked and some hair might be removed with an electric razor around where the incision for the C Section will be made. No need to be embarrassed, this is done all the time and nobody passes any heed.
- You will be asked to remove any jewellery apart from a wedding ring which can be taped. You will be asked if you have any loose teeth, crowns or dentures. You will be asked if you have any artificial limbs or metal parts in your body. These are all standard questions for any surgery.
- There can be delays. Your C Section might be scheduled but emergencies happen and you may be waiting a few hours or you could even be postponed to another day in some cases – prepare yourself for this possibility
- Have a little bag for baby with one vest, one babygro, a hat and a nappy so your partner doesn’t have to go rummaging in a bag looking for things he’s possibly never heard of.
- When you are called to theatre, you are usually wheeled on your bed; your partner and assigned midwife stay with you. Feel free to ask the midwife any questions.
- You are checked in to theatre by the staff there, they will probably ask you all the questions you have already been asked. Your partner will be given a gown and hat to wear and be asked to wait outside until you have had your spinal anaesthetic.
- When you go into theatre you might be surprised at the sheer amount of people in there. Everyone has their own jobs and they are all usually happy to chat. Your midwife will stay with you but she will be checking the equipment and doing some writing.
- It can take 20-30minutes for everything to be ready. There will be an IV cannula put in your hand. You’ll have monitors stuck to your chest for your heartbeat and a blood pressure cuff on your arm. You will be sitting up for the spinal. You will be asked to curve your spine like a cat and there will be a bit of touching and prodding by the anaesthetist to find the right part of your spine. There will be a sticky plastic sheet stuck to your back to keep everything clean. You will feel a bee sting sensation when they numb your back with a local anaesthetic injection – this is just in the skin, not the spine. From then on you should just feel pressure but no pain, if there’s pain let the doctor know. The spinal starts working very quick once it’s in. You will feel a warm sensation in your legs and then things will feel numb.
- You will then be helped to lie back on the bed. A little screen will be put up so you can’t see anything past your chest. The theatre nurse or midwife will insert a catheter into your bladder – don’t worry, you won’t feel anything thanks to the spinal.
- Then the obstetrician will make sure you can’t feel anything before they start. It is only then that your partner is called in. In some rare cases the spinal isn’t effective and you may need a general anaesthetic, in these cases your partner will remain outside.
- From the moment the obstetrician starts, things happen very quick, baby is usually out within 5-10 minutes. The baby will be handed to the midwife who will help you do skin to skin.
- Different units have different policies regarding recovery areas. Sometimes your partner will go with baby back to the ward and once you are stable you will join them. Some areas allow baby to remain with mum in recovery area. Check beforehand what happens in your hospital so you are prepared.
What happens at an emergency C Section?
Not every labour goes to plan. It’s impossible to predict the outcome at the start of labour but these factors and others can increase your risk of an emergency C Section:
- previous C Section
- age > 40
- first baby
- maternal obesity
This is not to say you will need a C Section if you are in one or more risk category, it just increases the chances.
The procedure is exactly the same as an elective C Section as described above except that all the pre-assessment things have to be done quickly so you might have a doctor explaining the procedure while someone else is taking blood samples, someone else is getting you into a gown, someone else is filling in a checklist asking you when you last ate and drank. It may seem chaotic but everyone has a role and they work as a team. Emergency C Sections are categorised based on urgency so some might need to happen ASAP and they are running with you to theatre and others are not as urgent and there will be time to prepare you. It is scary but it happens and everybody wants your baby delivered safely so don’t worry about your birth plan, you have done all you could do but your baby has a different birth plan to you.
In very urgent situations you will be put under general anaesthetic because there isn’t time to site a spinal. In these cases your partner will have to wait outside. He/she will be updated as soon as it is possible. In these situations, it is important for you both to get a full debriefing from your doctors to explain everything that happened and why. Your partner will probably be more traumatised than you.
How to make a C Section more baby friendly
- A lot of hospitals are realising that babies born by C Section shouldn’t have to lose out on that initial skin-to-skin contact. This can be facilitated in most Irish units now. Make sure to have a birth plan, even if it’s a planned C Section specifying you would like skin-to-skin immediately after delivery. This won’t be possible with a general anaethetic but there’s nothing to stop dad doing skin-to-skin
- Delayed cord clamping can be requested
- You can request specific background music (you may have to discuss this with your obstetrician antenatally) and this would only apply to an elective C Section
- You can also specify that you want the dad to announce the sex or that you want to be shown baby so you can see for yourselves without being told
- If you plan on breastfeeding, it’s a good idea to express some colostrum before your planned C Section so that if there are any delays, your baby is given your breastmilk as opposed to formula if this is your wish.
- You will be stuck in your bed for a large part of the day and night following your C Section so why not keep baby skin to skin for as long as possible unless you feel sleepy. It will keep your baby at the optimum temperature and they will be happy to hear your familiar heartbeat.
Recovering from a C Section
Regardless of the type of birth you had, you will be a bit sore for a few days afterwards but that’s why we invented pain relief medicines! Don’t be a martyr, take whatever is offered to you and take it regularly. I’ve seen some people even set alarms on their phones so they don’t miss a dose and it’s not a bad idea. The trick is to take the tablets before the pain builds as it’s harder to control if it gets too bad. You should also get a prescription for pain relief for when you get home. When you have used it all, you can ask your GP to prescribe you more if needed or buy paracetamol over the counter in your pharmacy.
You will remain in your bed until you have full sensation back in your legs (which happens quite quickly) and for a minimum of 12 hours although usually until the following day. You might feel anxious about getting up but the sooner you do it, the better you will feel. You will be assisted out of the bed to the shower. The hardest part is changing positions – moving from lying to sitting, sitting to standing or standing to sitting.
You will have a wound from the C Section which will be covered with a dressing – these vary by hospital. This will also be checked regularly after your C Section for bleeding. In some units, depending on dressing, it is removed 24 hours later, 48 hours later or up to 5 days later. Once removed, your wound will be exposed. It is a good idea to wear underwear and clothes that are loose around the wound – we’re talking big granny pants and leggings, give the thongs and skinny jeans a miss for a while! Most wound closures are by dissolvable sutures so you don’t need to do anything apart from keep area clean and dry. In some instances there may be sutures to be removed or clips to be removed – your midwife or PHN will do this. If you have any concerns about your wound when you get home, you can call your maternity unit or see your GP or PHN.
You will have a catheter in, which drains urine from your bladder into a bag which hangs off your bed. This is so you don’t have to get up to go to the toilet and to monitor your urine output. This will usually be removed before you get up unless there has been any trauma to the bladder – in those cases it may have to remain for a few days but you can still be mobile. It is important to pass urine within a few hours of the catheter being removed, if you have any problems, let staff know immediately.
You will have had IV fluids running until you are able to eat and drink. Even when these are finished, the IV cannula is left in place until you are able to pass urine once the catheter comes out. It is also useful for administering some forms of pain relief such as IV paracetamol. Some people believe there is an actual needle in there hand/arm, there isn’t. A cannula is just a tiny flexible tube in your vein, a needle is used to insert it then removed straight away so don’t worry if you hit it off something or be afraid to bend your hand or arm.
You will still have some blood loss from your uterus so you will have maternity pads in place and the staff will check them for excessive blood loss and change them regularly until you are up and about. It is important to keep changing them regularly yourself.
Listen to your physio – most C Section mums will be seen by physio before discharge home. He/She will advise you on gentle exercises and how to support your wound when moving about. If you notice any urinary incontinence please say so, this is the time to start to sort it out.
Just remember that there are layers beneath your wound also sutured. It takes weeks for everything to heal so refrain from lifting toddlers, housework, bending to washing machines or dishwashers, lifting shopping bags or any bags if at all possible.
Having any type of surgery increases your risk of blood clots. You should wear the compression stockings for 6 weeks. Keep hydrated and mobilise if you notice swelling in the feet. But if you notice one leg swollen more than the other or any redness anywhere on leg then seek medical advice as soon as possible.
I’m trying to keep the recovery part just for CS mums. I will do a general blog post about surviving the first few days after having a baby (regardless of type of delivery) at a later date.
One important piece of advice. You are in the hospital. If you have any concerns about anything (even if not maternity related) please highlight to your midwife or doctor. This is the place to be to get referrals to dieticians, physio, dermatology, smoking cessation, mental health, etc. A lot of the time you will even be seen by the relevant profession before discharge home instead of waiting months for referrals once you are out of the system!
Have you any tips or advice for people undergoing CS? Please comment below, by email or on social media.