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Caesarean Section

About one in five women in Australia will give birth by caesarean section and the figure is rising. Find out what this involves.

Caesarean is delivery of a baby through a cut in the abdominal and uterine walls. It is also called a lower uterine segment Caesarean section, a Caesar, or C/S.

Performed by a specialist obstetrician and an anaesthetist, a Caesarean section is an operation requiring considerable skill. It is usually performed only if the mother and/or baby’s health is likely to be seriously compromised by a vaginal delivery. It some cases a Caesarean can be a life-saving operation for the mother and/or her baby.

Situations where a Caesarean may be necessary

  • labour not progressing at all
  • baby in abnormal position
  • problems within the placenta
  • history of cervix, uterus or bladder surgery
  • baby in distress
  • toxaemia or severe hypertension
  • baby too big to fit through pelvis
  • umbilical cord threatening baby’s safety
  • delivery of multiple birth
  • very low weight baby
  • women suffering from active herpes, HIV or venereal disease
  • women suffering from renal disease
  • following an amniocentesis revealing a damaged baby
  • women suffering from gestational diabetes

Anaesthetic

An elective Caesarean can be carried out under an epidural or spinal anaesthetic allowing full consciousness throughout the delivery. Epidural anaesthetic is given at a higher dose than that administered for pain relief only. It is common to have post-operative nausea and vomiting, as is often the case with general anaesthesia.

Occasionally if there is an emergency situation, it is necessary to have a general anaesthetic. This is usually a low dose as to not affect the baby and so you are only unconscious for a few minutes. It is possible to have your partner in the room and arrange for your partner to hold the baby following birth.

A spinal anaesthesia is an injection into the cerebrospinal fluid in the lower spine to numb from the waist to the knees. It takes effect within five minutes and is therefore useful when time is short. Spinals are considered potentially dangerous because the blood pressure drops, reducing oxygen supply to the baby. It is advisable to lie flat and avoid lifting the head quickly for eight hours following delivery to avoid a post-spinal headache.

Procedure

Incisions for caesareans are either vertical or horizontal. Although the classic caesarean is a vertical cut, most are horizontal as they are believed to be less likely to break than a vertical scar and are considered more cosmetically pleasing, located in the lower abdomen near the line of pubic hair.

It is common to be given antibiotics before the operation to prevent post-operative infection. A midwife may shave some pubic hair and insert a catheter to empty the bladder. In an operating room, sterile drapes are pulled around and a half-screen is erected so you do not have to see the surgery. Your abdomen is washed with antiseptic solution.

Your anaesthetic will be administered and when this has taken effect, a series of small cuts will be made through the layers in the lower abdominal wall to reveal the uterine wall. A horizontal slit is made, accessing the bag of waters which will be pierced with a noisy gush as the amniotic fluid is sucked out. The baby will be eased out of the opening, occasionally using forceps to deliver the head. You may wish to watch. Generally from your position, you will be unable to see anything gruesome.
What you will see is your baby being born.

When a baby passes through the birth canal in a vaginal delivery, the mucus is usually forced out. Because this cannot occur naturally in a Caesarean birth, mucus is often sucked from your baby’s nostrils and mouth using a suction tube. Sometimes oxygen is given to the baby via a small tube and once your baby is breathing, it will be handed to you or your partner. If the baby is very small or show signs of difficulty breathing, it may be taken to a special-care unit. The first step takes about 10 minutes.

In an emergency, the process from the beginning of the surgery to birth may only take four minutes.

Following the delivery, you may be given an injection of oxytocin to encourage the placenta to peel away from the uterine wall. It will then be lifted out through the abdominal opening.

The suturing of the opening can take as long as an hour as each layer is stitched together separately with great precision. Sometimes a small tube is left in place to drain any oozing blood and amniotic fluid. Dissolvable stitches are used in the inner layers. The skin is drawn together and secured with nylon sutures, small metal clips or a dissolvable thread.

Lou gave birth to her son through an emergency Caesarean. She recalls "Within minutes I saw my baby’s bottom rising up out of my stomach… My partner and I gazed awe-struck at the sight of our son while the doctors sewed me up". To find out more about her experience of a Caesarean delivery read her fantastic birth story.

Aftercare

A Caesarean is a surgical operation and requires a period of recovery. Whatever anaesthetic you have had, you will be drowsy. You may feel sick and weak for the first few days, however, it is important to get up and move around to help prevent thrombosis. Any movement is likely to be painful. When arising, it is best to first roll gently to one side and lever yourself to a sitting position. If you have had a general anaesthetic, fluid may have collected in the lungs, forcing a cough. It is best to spit out any fluid.

Vaginal bleeding is likely as blood pools in the pelvic region. Slow breathing may help with pain control as you move around but if the pain in unbearable you may wish to ask for pain relief. Dressings will be removed three or four days later and because a Caesarean involves cutting through layers of abdominal muscle, your tummy will initially feel large and saggy.

It is advisable not to lift anything heavy for up to six weeks following the operation. The recovery period is an ideal time for you and your partner to spend time with your new baby.




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