Caesarean birth

Elective and emergency caesareans

There are two kinds of caesarean. An elective caesarean – a caesarean that is carried out before labour begins. And an emergency caesarean -one that is carried out as a result of some complication arising during labour. It may not necessarily be an emergency situation. Your carers may have been discussing the possibility with you for some time before finally deciding that it is necessary.

Your obstetrician might advise you to have an elective caesarean if:

• You have serious pre-eclampsia which is threatening your own health and the well-being of your baby
• You have a serious medical condition which means that you should avoid the stress of labour
• You are expecting triplets, quadruplets or more
• The placenta is positioned across the neck of your womb, making it impossible for your baby to be born vaginally
• Your baby is lying across your tummy and cannot be turned to a head down position
• Your baby is too big to be able to get through your pelvis
• Your baby is in the breech position. Whether all breech babies should be delivered by caesarean is a matter of debate. Some obstetricians prefer to turn babies into a head down position at the end of pregnancy (this is called external cephalic version or ECV), or to give the mother the chance to try for a vaginal delivery with her baby in the breech position. If your baby is breech, you might like to do a bit more research around the subject, and discuss what you would like to happen with your obstetrician and midwife. The research is currently unresolved about whether it is safer to deliver breech babies vaginally or by caesarean.

An emergency caesarean might become necessary after labour has started because:

• Your baby’s heartbeat shows that she is not coping well with contractions (in medical terms, the baby is described as being ‘distressed’ or ‘compromised’)
• The cervix stops dilating or dilates very slowly so that both mother and baby become exhausted
• The placenta starts to come away from the wall of the uterus and there is a risk of haemorrhage (bleeding)
• The baby does not move down into the pelvis, indicating that the pelvis is too small for the baby to get through, or the baby is is in an unusual position

Nationally, around 24 per cent of all women giving birth have caesareans, though this varies a lot between hospitals. There’s some debate about how many of these operations are really necessary, and it’s certainly the case that while there are some situations in which it’s only possible for the baby to be born safely if a caesarean is done (or because it’s in the interests of the mother’s health), there are others in which the need for a caesarean is more debatable and about which different doctors have different opinions.

Whether you are offered an elective or an emergency caesarean, make sure that you understand the reasons why. Even in an emergency situation, there’s nearly always time to give the mother and her birth partner a brief explanation of why a caesarean is considered necessary.

If you know in advance that you’re going to have a caesarean, you can find out what your options are, and plan for it. But even if you’re not expecting to have one, if you’ve given it some thought beforehand, you’ll be better prepared if you find yourself faced with one.

What happens during a caesarean?

If you are having an emergency caesarean, a lot of things will happen very quickly. If you are having an elective caesarean, the atmosphere will be rather more calm.

The preliminary procedures are as follows:

• You need to sign a consent form for the operation (if you are too ill, your birth partner will be asked to sign for you)
• You will have a drip put into your arm or the back of your hand
• The top few centimetres of your pubic hair will be shaved off. (If there is time, you may be invited to do this for yourself!)
• You will be asked to drink a small quantity of medicine to neutralise the acid in your stomach
• You will be asked to remove all your jewellery. If you have a special ring you want to keep on, the midwife will tape over it
• An anaesthetist will give you an epidural or spinal anaesthetic, or a general anaesthetic
• A tube (catheter) will be put into your bladder to empty it

What kind of anaesthetic?

Nowadays, most hospitals do caesarean sections (and many other operations) under local rather than general anaesthetic. This means that you will be awake when your baby is born. You will probably lose less blood if you have a local anaesthetic and your recovery will be quicker because you will be able to get up and about much sooner.

Local anaesthetic:

A local anaesthetic means an epidural or a spinal. If you are in labour when the decision is made to deliver your baby by caesarean, you might already have an epidural in place for pain relief. In this case, it is often possible simply to top up the epidural for the operation. Or you could have a spinal anaesthetic which is a single injection into your back. Spinals take effect quickly, give excellent anaesthesia for the caesarean and wear off over a period of five to six hours, offering you some pain relief after the operation.

General anaesthetic:

You may feel that you would be absolutely terrified if you had to be awake during a caesarean and that you would definitely prefer a general anaesthetic. In this case, you will be asked to breathe some oxygen through a mask for a few minutes before the anaesthetic is given into the back of your hand.

As you drop off to sleep, the anaesthetist will press on your neck. This is to prevent the contents of your stomach being regurgitated into your lungs. Then you will be aware of nothing until you start to come round about an hour later, after the surgery is over.

You will probably feel groggy for quite a while and perhaps not very interested in your baby. If you want to breastfeed, make sure that your midwife knows this before you have the caesarean so that she can put your baby to the breast while you are regaining consciousness. Breast milk is produced whether or not the mother is awake.

The operation

It will only be about 10 minutes from when the surgeon makes the incision to your baby being born. If you are awake during the operation, you will see a large number of people filling the operating theatre (perhaps as many as 10):

• Your birth partner
• Anaesthetist Surgeon
• Assistant surgeon
• Theatre nurse
• Midwife (one per baby)
• Paediatrician (one per baby, so if you are expecting triplets, there will be three paediatricians)
• Operating department assistant (ODA)
• Medical student(s) (although not necessarily)

These people will be wearing masks and gowns.

You will hear:

• The clinking of surgical instruments
• The beeping of the monitor which records your heartbeat
• The sound of suction as your waters break
• Slightly muffled voices talking about the surgery

You will feel:

• Sensations as if someone is rummaging around in your tummy! This isn’t painful, but it’s an odd feeling and might be frightening if you were expecting to feel nothing at all

After the birth

When your baby is born, you will get a quick glimpse of her as she is held above the screen which has been placed between you and the surgeons. Then she will be taken to another part of the operating theatre where a paediatrician will check her over to make sure that she is breathing properly and is healthy. So long as your baby is well, she will be brought straight back to you so that you and your partner can cuddle her during the rest of the operation.

The surgeon will remove the placenta and then it takes about 40 minutes to sew up each of the layers of muscle, fat and skin which have been cut through in order to deliver your baby. The final skin layer may be closed with staples, a long running stitch or individual stitches.

What will the scar be like?

Generally, a bikini cut is made horizontally just below the level of your pubic hair. When the hair grows back and the scar has turned silver it will be barely noticeable. Occasionally, a vertical cut is made down the middle of your tummy, or a horizontal cut on your skin and a vertical cut through your womb. This is rare, but it’s sometimes the only way to deliver the baby or babies, and is most likely if your baby is premature. If a vertical cut was made on your skin, the scar will fade in time, but it will be more noticeable than a bikini scar.