Caesarean

Labour and birth

Babies delivered by caesarean section, are not born vaginally but lifted out of the uterus through a surgical procedure. The surgery is usually performed when a vaginal birth would put the mother’s or the baby’s health at risk (although there’s some controversy about the way that risk is assessed). Some mothers choose to have a caesarean section and don t want to experience labour or a vaginal birth. They usually make this decision as a result of much consideration and discussion with their partner and maternity care provider.

The caesarean operation is often performed under an epidural anaesthetic (or spinal block), so that the mother is conscious for the birth of her child but does not feel the pain of the surgery; however in some cases, the anaesthetist and obstetrician may decide a general anaesthetic is preferable.

These days, the operation is considered extremely safe, with a very low mortality rate.

However, a caesarean birth is still not as safe as a vaginal birth, it does involve a longer and more uncomfortable recovery time and it is associated with complications for both mother and baby, so it is not usually performed without good reason.

Caesarean section can be scheduled before labour commences (this is called an ‘elective’ caesarean) or may be unplanned until a complication occurs part-way through labour and an ‘emergency’ caesarean is done.

Reasons for Elective Caesarean

A caesarean section is recommended when vaginal delivery might pose a risk to the mother or baby. Ultrasound scans and other tests during pregnancy can reveal a range of reasons for a planned caesarean delivery; some of these include:

• if the baby has a known high-risk condition and needs to be delivered quickly
• if the mother has a known high-risk condition (like pre-eclampsia or placenta praevia) or a condition that may be transmitted to the baby during birth – such as HIV+, Hepatitis or genital herpes
• if the mother has a pre existing medical condition where labour and vaginal birth may not be recommended
• if the baby is in a breech (feet-first) or transverse (sideways) position and lodged too deeply into the pelvis to turn
• triplets or higher multiples (and often even with twins)
• if the mother has had a previous caesarean birth or previous uterine surgery

Reasons for an Emergency Caesarean

If labour is not progressing normally and complications have occurred, a doctor may decide to perform an unscheduled Caesarean section to reduce the risk to the mother or baby. Reasons for caesarean delivery include:

• if the baby goes into distress during labour and needs to be delivered quickly
• if the mother’s health deteriorates during labour (for example, elevated blood pressure, exhaustion, pre-eclampsia or eclampsia or other reasons)
• very rare but extremely serious problems like cord prolapse (where the umbilical cord is pinched and oxygen to the baby cut off) or uterine rupture
• if the baby moves into a position during labour that makes vaginal delivery impossible, difficult or dangerous
• very prolonged labour that does not seem to progress
• failed induction of labour

What to expect:

Before the operation, the area of your abdomen where the incision will be made (usually around the bikini line) will be shaved and swabbed to improve access and prevent cross-infection from the countless bacteria that live on your skin. You’ll be given an anaesthetic (either an epidural or a general anaesthetic.) A cannula is usually placed in your arm with a saline drip, to maintain your fluid levels (which usually stays in for around 24 hours), and a catheter inserted into your urethra to drain your bladder (this one stays in for around eight hours). Preparations for surgery may all happen in seconds if it’s a critical emergency.

You will usually be in the operating theatre for up to an hour. Unless you are rushed into surgery very quickly, your partner is usually encouraged to stay with you for the birth (but will have to be gowned and scrubbed.)

The surgeon makes a cut (usually a horizontal cut, through the abdomen into the lower section of the uterus, across the bikini line). The baby is lifted head-first through the incision, often with the assistance of forceps, and amniotic fluid removed from baby’s nose and mouth before the baby’s body is lifted free. If the baby is bottom done e.g. breech, they may be delivered bottom first.

Delivering the baby is quite fast and happens in the first five to ten minutes. Then, the placenta is removed and an injection of oxytocin administered, to contract the uterus and reduce blood loss. Most of the operating time will be spent stitching and/or stapling the uterus and various layers of abdominal tissue, muscle and skin.

Babies delivered by caesarean section often have smooth, round heads compared to vaginally-born babies, who can be a bit squished-looking at first. But without the pressure of the birth canal to help empty fluid from the lungs, many caesarean babies have excess mucous and fluid in their lungs and need to be suctioned to help them start breathing. However there are usually no long-term problems.

The midwife or paediatrician will bring your baby to you for a cuddle as soon as possible, or your partner may hold the baby until you are able.

Following the operation, a small tube may be inserted to drain fluid from the wound. You will usually be encouraged to get up and walk within eight to twelve hours to help you recover faster and to prevent blood clots.

You’ll still experience vaginal bleeding for some weeks following a caesarean, as with a vaginal birth, as the uterus sheds the build-up of blood cells that has protected the baby throughout pregnancy.

Most hospitals suggest you stay three to five days following a caesarean birth, although stays may be shorter if there are no complications.

Recovering from a caesarean operation will take longer than a vaginal birth, with most doctors recommending that you take breastfeeding-safe pain relief for at least a few days after the operation and avoid heavy lifting or even driving for the next six weeks or so, with full recovery taking up to twelve weeks.

Looking after a new baby (with the sleeplessness and lifting involved) can be very draining after a caesarean operation, so it’s worthwhile trying to arrange as much support as possible.

By Fran Molloy – journalist and mum of 4