Expert / 6 May, 2021 / Dr Ellie Rayner
The majority of women in the UK will give birth vaginally, have a healthy baby and recover well with no long-term complications. However, around 1 in 4 babies are born by Caesarean, with the majority of these being performed as an urgent or emergency procedure due to concerns over the mother or baby’s wellbeing. If you are pregnant, or know someone who is, it can be useful to have an overview and understanding of what a Caesarean Section involves and what to expect both during and after the procedure so you can be as prepared as possible for every eventuality.
A Caesarean section is an operation where an obstetrician, a doctor who specialises in pregnancy, labour and birth, helps deliver your baby through a cut on your abdomen. There are two main types of Caesarean birth: an elective or an emergency depending on the urgency of the need to perform the operation. An elective caesarean, or category 4, is where you and your doctor decide to plan a Caesarean birth, before your labour starts. Whereas, if you have a Caesarean section at short notice, that is unplanned, then it is called an ’emergency’ and will be classified as a Category 1, Category 2 or Category 3, depending on the urgency.
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There are many reasons why a doctor may recommend a Caesarean section, either an elective or an emergency procedure and they will explain that reason to you in full and take your consent before starting the procedure. Doctors will not recommend a Caesarean section unless it is absolutely necessary for medical reasons because of the associated risks in the short and long term to you. Common reasons include concerns over your or your baby’s wellbeing (such as changes in their heartbeat pattern), your baby being in the breech (bottom first) position, your labour not progressing as we expect, your placenta-lying low down in the womb or complications in previous pregnancy or labour.
Most women who have a Caesarean section will have a regional anaesthetic, this is called a spinal anaesthetic. A specialist doctor called an anaesthetist will perform this procedure and this type of anaesthetic is safe for both you and your baby. They use an injection of a local anaesthetic and a strong painkiller into your back, using a very fine needle. This will numb the lower part of your body to ensure you are comfortable and pain-free throughout the operation but can still be awake for the birth of your baby. Sometimes it is not possible to perform the surgery under a regional anaesthetic, such as if the obstetrician is seriously concerned over the wellbeing of you or your baby and they may recommend a general anaesthetic. This is because general anaesthetics can be performed quicker in an emergency, but they will explain this to you at the time.
Once your anaesthetic is working fully, you will be covered in sterile drapes before the obstetrician makes a horizontal bikini-line cut around 15 cm, just above your pubic hairline. It usually takes around ten minutes to enter the layers of the tummy, to stretch the abdominal muscles to the side and make a small cut on your womb to reach the baby and deliver your baby through. During the operation, you may feel touch and pressure or a push and pull sensation, but this is completely normal and is to be expected. Once your baby is born, and if all is well, they will allow time for delayed cord clamping as standard. Once the cord has stopped pulsing, they will clamp and cut the cord and the baby will come round to you for immediate skin-to-skin should you wish.
The doctor will then gently remove the placenta, check the womb, and begin stitching your uterus closed. They will check that your ovaries and fallopian tubes are healthy and assess for any ongoing bleeding and if there are no concerns, they will then close the outer layers of your tummy and finally your skin. The stitches used on the inside of your abdomen will all be dissolvable. However, on the outside of your tummy they can vary, with some women having dissolvable and some removable stitches that your community midwife takes out in the week following your birth.
Before the operation starts you will have had a catheter inserted into your bladder to drain urine; this is a small plastic tube and stays in for several hours after your birth, often until the following morning. Before leaving the theatre, straight after the operation, the surgeon often cleans away and checks for any bleeding from the vagina, before you are transferred onto a hospital bed.
Any woman can choose to have a Caesarean section when there is not a medical reason for this, and this is called a Maternal Request Caesarean Section. They will be referred to the antenatal clinic to discuss their request with an obstetrician and consider the risks and benefits. Generally, a vaginal delivery is considered safer for you and your baby than a Caesarean section and it is for this reason why some obstetricians or some maternity units do not offer Maternal Request Caesarean Sections. If this is the case, you will be referred to a different obstetrician or a different Maternity unit that can support your request.
Caesarean section is major surgery and therefore the speed of recovery varies greatly from woman to woman and depending on the circumstances in which the operation occurred. After the surgery, you will be moved to a recovery area for several hours and then later to the postnatal ward. You will have your observations and vaginal blood loss checked regularly and you will be assisted with caring for and bonding with your newborn baby.
Your midwife will also weigh and offer you initial checks of your baby and assist you with feeding during this time if you would like them to. You will need to remain in bed until the anaesthetic has fully worn off and you will be encouraged to have something to eat and drink. Your tummy will feel bruised and sore, and you may find it difficult to sit up initially. You will be given regular pain relief while in hospital and encouraged to continue this once you return home, to aid mobilisation. The majority of women who have a Caesarean birth will be prescribed blood-thinning injections to take home with them to reduce the risk of blood clots, as well as being recommended to keeping well hydrated and to mobilise regularly. Most women whose procedure is uncomplicated will return home the next day, however, you can of course stay in the hospital longer should you need to, and your community midwife will follow you up after you have been discharged.
You will have vaginal bleeding, similar to after a vaginal birth, for between two and six weeks. This will usually start like a heavy period and get lighter and lighter. Generally, it can take around six weeks to fully recover from a Caesarean Section and during this time you should undertake light exercise, such as walking to help you recover. You should avoid heavy lifting or driving until you have fully healed.
If you have any concerns about your recovery you should contact your Midwife or GP. If out of hours or if you have a serious concern your maternity unit is always open 24 hours a day, so you can always give them a call for advice. If you would like any more information on Caesarean birth, talk to your midwife or doctor or head to the NHS web pages.
Dr Ellie Rayner, Obstetrician and Gynaecologist, Antenatal and Hypnobirthing Teacher and founder of The Maternity Collective.
Dr Ellie Rayner is a practicing Obstetrician and Gynaecologist and founder of The Maternity Collective. She is the only Obstetrician to offer private and group, expert-led Antenatal and Hypnobirthing Classes both Online and face-to-face. She is passionate about providing parent-centred, evidence-based care for all pregnancies and supports all methods of birth.
Follow Dr Ellie Rayner @maternitymedic for the latest evidence-based information on pregnancy, birth and women’s health issues.
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