Expert / 18 April, 2023 / Beth Kitt
A planned caesarean might be your plan A, or it may be your plan E. Regardless of where it sits on your original birth plan, knowing what to expect is really important to support you in having a positive birth experience.
A planned caesarean (also called an elective caesarean) is when your caesarean is booked in on a date before you go into labour. The reasons you may be advised to have a planned caesarean may include; a low lying placenta or breech baby. You may also choose to have a caesarean birth if you are particularly worried about labour or if you had a previous traumatic experience.
Your plan for birth is usually discussed at your 36-week appointment. If it is decided between you and your obstetrician that you will be having a caesarean then your obstetrician will book this in for you and let you know the date at this appointment.
A few days before your planned caesarean, you will be invited to an antenatal clinic for your pre-op. A midwife will talk you through the process of what to expect on the day and what time to come in. Your midwife will take some bloods from you to check your iron level and also your blood group. You will be given some tablets to take the night before and the morning of your caesarean. These are to reduce any acid in your stomach. You will also be told when to stop eating and drinking in preparation for your planned caesarean. It is a good idea for your last drink to be a bottle of isotonic drink, this helps keep you hydrated for the rest of the time when you aren’t eating or drinking.
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When you arrive at the hospital, you will meet your midwife, who will be with you during your caesarean birth. She will do your observations, listen to baby’s heart rate and prepare you for theatre. You will be asked questions about any metalwork you have, such as piercings or jewellery. These will need to be removed or taped before theatre. You will be given a theatre gown to wear. You will only be wearing your gown in the theatre, so no underwear or a bra.
Bring a dressing gown to cover your bum for when you walk to theatre! There can sometimes be a wait to go into theatre. This will depend on how many women are due to have their caesareans the same day as you, what number you are on the list for that day and any emergencies that may come in.
Whilst you are waiting to go into theatre, the rest of the team will come to meet you. Your obstetrician will come and meet you and ask you again that you’d like the caesarean. They will talk you through the benefits and risks. Your anaesthetist will come and meet you and chat you through the spinal anaesthetic. You will also have a member of the theatre called an ODP who will come and meet you and ask you some questions to make sure you are ready and prepped for theatre. There will also be a midwife present, a scrub nurse and a theatre assistant. It can feel like a lot of people, but it is normal to have this many people and each one has their own role to play in your birth.
The usual choice of anaesthetic for a caesarean is a spinal anaesthetic. This is an injection that goes into the lower back. Before the spinal anaesthetic you would have a cannula put in your hand. This happens in all surgeries, and is necessary to provide you with fluids or drugs should you need them during your caesarean.
Once the cannula is in, you will be asked to get into position for the spinal anaesthetic. You will be asked to slouch your shoulders and curve your back so your back is shaped like a banana or a stroppy teenager! This opens the space in the bottom of your back, making it easier for the anaesthetist to find the right place in your back. You will then have freezing cold spray on your back and a numbing injection before the spinal injection goes in. This process usually lasts between 5 and 20 minutes.
Your midwife will then put a catheter into your bladder to keep your bladder out of the way during the surgery. The drapes will be put up and your caesarean can start.
It is important to remember that you still have choices throughout your caesarean birth. To make your caesarean a calm birth experience, there are a few things you can do.
You can ask for your birth playlist to be played on the speakers. If the hospital don’t provide speakers then you can use your own or use headphones.
Essential oils can be used in theatre on a taper or flannel for you to hold and smell. Frankincense is a good one to reduce anxiety. Just remember to remove the taper before baby’s skin to skin.
Dim lights are good for oxytocin. You could also take your baby’s hat with you so that you can visualise why you are doing it.
Ask your partner to massage your shoulders or stroke your arm to encourage oxytocin.
Baby is usually born within about 5-10 minutes after the first incision. During the process of the caesarean birth, you shouldn’t feel any pain whatsoever. You will feel pressure as baby is being birthed through your abdomen. This can be an unusual and sometimes uncomfortable feeling. Some people report it feels like “someone doing the washing up” in your tummy.
During your caesarean, at your head will be your birth partner and also the anaesthetist. You can ask the anaesthetist questions, they can update you on what is happening, and you can also tell them if you feel sick (which can sometimes happen – they can give you drugs to help with this).
When your baby is born you can choose whether you want the drapes lowered so you can see baby straight away, or whether you want baby brought around the drapes to you. Having the drapes lowered is a great opportunity to see baby’s first moment, so tell your birth partner to have the camera ready! Delayed cord clamping will happen for one minute after a caesarean. You can then have immediate skin-to-skin with baby.
The total time in theatre for a caesarean is usually around an hour. Even though baby is born quickly, the stitches afterwards can take some time. After, you go to recovery along with your baby and partner. Recovery is a hospital bay next to theatre.You will spend about 2-4 hours here before moving to a maternity ward.
You will be given regular pain relief in hospital whilst on the ward, and have your observations checked and your bleeding. It is still normal to bleed vaginally after a caesarean birth for up to 6 weeks after birth. You will be advised to stay in for a minimum of 24 hours after birth, but you can stay for more than this if you wish.
For more information about how to prepare for birth, how to keep your birth calm and what to expect after baby is born including recovery then head over to The Bump to Baby Chapter.
Article by Beth Kitt, midwife and founder of The Bump to Baby Chapter
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