Some women will give birth via Caesarean section (c-section) and this can be planned or unplanned. If you have a c-section planned, it’s much easier to prepare for it but in the event of an unplanned c-section, it’s always good to know what to expect just in case.
C-sections may be scheduled in for a variety of reasons such as if you have had a previous c-section and VBAC (vaginal birth after caesarean) isn’t advised. This is often the case with women who have previously had a classical (vertical) incision rather than a lower horizontal one or women who previously had a c-section but are now pregnant with twins or a breech baby. In those situations VBAC would not be recommended. Other reasons for a planned C-section may include an unstable lie- baby could be laying across the uterus in a transverse position which would make vaginal birth difficult., and placenta previa when the placenta is too close or covering the cervix.
C-sections are major abdominal surgery and should not be taken lightly. Your experience and recovery will depend on many factors and everyone’s experience is unique. If it has been suggested that you have a planned c-section, do ask the reasons behind the suggestion and if you are unsure at all make sure you do your research before making your own informed decision.
What Happens In the Operating Theatre?
The operating room can look quite daunting at first with all the equipment and people but when you get to know what it’s all for, it wont seem too scary! Most operating rooms will only allow one person to come and support you and most women will have the father of the baby or partner in with them. The reason there is a limit is because there isn’t much space in the room.
During a c-section there are a number of people in the room and these include (UK):
- Surgeon (obstetric doctor)
- Surgeons assistant, often a more junior doctor
- ODP (operating department practitioner)
- Midwife to receive the baby
- Paediatrician in the case of an emergency c-section or known problem with the baby.
- Runner or maternity assistant
When you are taken into the operating room a spinal block anaesthetic will usually be given if you haven’t already got an epidural in place. If it’s an emergency c-section and you have an epidural, it may just be topped up. You will need to have a cannula in your hand or arm for a drip and this will be done prior to the epidural/ spinal going in. Access to your veins are important as it means the anaesthetist can administer medications quickly as and when necessary.
When the an anaesthetic is given, you will be laid down and after a few minutes the surgical team will test how effective the block is before they begin. This is usually done with a cold spray or by gently pinching your skin. Drapes are put over your body so that the only area visible within the sterile environment is your abdomen. A screen is also put up so that you can’t see the operation taking place! There may be lots of machines beeping but this is totally normal. Some operating rooms allow music to be played so request this if it is something you would like during the birth.
Your partner should be able to sit close to you at your head end. The anaesthetist has a job to ensure that you are stable throughout so use them as the person to communicate any concerns to if you are feeling unwell at any stage. A catheter will be place into your bladder as you will not feel the need to pee and the midwife or assistant will shave any pubic hair that is over the bikini line to make the surgery easier, cleaner and reduce the chance or ingrowing hairs afterwards. Your abdomen will be cleaned with a special antibacterial wash (often orange in colour) to reduce the risk of any infection.
Once the surgery begins, the baby is often out in under 10 minutes. You will remain in the operating room for another 45 mins- 1 hour whilst the surgeons finish suturing your wound and checking that all is well with you. When the baby is born, the cord is cut – you can requested delayed cord clamping so long as baby doesn’t need immediate resuscitation or any other urgent care. Once the cord is cut your baby will be passed to you. Holding your baby after a c-section is a great way to get the naturally oxytocin hormones flowing to help with keeping your womb contracted, bonding and breastfeeding. If the baby needs immediate support at birth, they will be taken to a special cot that has lights, heating and all the equipment to support the baby. As soon as they are stable, they will be brought over to you.
You may be given analgesia in the form of a suppository which will help when the spinal or epidural wears off you will also be given other drugs including an oxytocic to contract your womb and fluids to keep you hydrated. When the surgery is complete, you should be wheeled on the bed to a recovery area where you are closely monitored by a midwife or nurse for a certain period of time.
How Quickly Will They Perform The Operation?
Most hospitals will have a grading system to categorise how quickly a c-section is to be performed
- Category 1 — immediate threat to the life of the mother or baby.
- Category 2 — there are problems affecting the health of the mother and/or baby but they are not immediately life threatening.
- Category 3 — the baby needs to be born early but there is no immediate risk to mother or baby.
- Category 4 — the operation will take place at a time that suits the woman and the caesarean section team
Category 3 and 4 C-sections are usually planned in advance but category 1 aims to take place within 30 minutes of the decision being made. A category 2 C-section is also urgent but as they are not immediately life threatening may take place after 30 minutes. An example of this is when I had a c-section for my twins at 34 weeks gestation. I went in over the weekend for a routine ultrasound which showed that one of the twins’ placentas was not functioning properly. They had been monitoring his growth over the previous few weeks. A decision was made to perform a c-section that day and I gave birth a few hours later.
What Happens When I Leave The Operating Room?
When the surgery is complete, you should be wheeled on the bed to a recovery area where you are closely monitored by a midwife or nurse for a certain period of time. During this time you should be able to have skin to skin contact with your baby and offer your baby their first feed. If breastfeeding, many women find it easier to do on their side after a c-section. If you find this tricky, you can always try the classic cradle hold but be sure to keep a pillow on your lap as the pressure of the baby can cause discomfort in your wound.
Food and drink is not usually offered straight away as there is an increased risk of you vomiting with all the drugs you have had in surgery. You will probably have the chance to drink after 30 mins- hour and eat a little after that.
In the UK women are taken to the postnatal ward after the have been observed in recovery and they are well. You may stay in hospital anywhere between 1- 3 days or longer if indicated.
How Can I Prepare For My Scheduled C-section In Pregnancy?
If you know you will be having a c-section well ahead of the date, there are several things you can do to prepare. Below are some C-section preparation tips that you might find helpful!
Write a birth plan to include some of the following
- Who will be your birth partner
- Whether or not you want music
- Photos – discuss with the midwife/ doctor about the possibility of taking photos. Remember that not all staff will want to be pictured but taking pics of just you or your baby shouldn’t be a problem
- Do you want the screen lowered so you can see your baby being born – if you don’t want to have a screen at all, speak to your doctor to find out if this will be possible
- Requesting delayed cord clamping if this is something you want
- skin-to-skin contact with your baby in theatre or skin-to-skin contact between your baby and your birth partner.
What to prepare in your hospital bag
- Books/ magazines to help pass the time before going in to the operating theatre
- cotton or disposable knickers that come up to your waist above your wound. Regular ones will cut in causing soreness
- A dressing gown and slippers
- A nightdress if you don’t want to wear the hospital gowns for after. you will have a catheter for at least 12 hours after your c-section so wearing pj’s might be a bit tricky.
- Loose, comfortable clothes that won’t put pressure on your wound.
- A feeding pillow
- Enough toiletries to last up to 4 nights in hospital. This includes sanitary towels. You should not use tampons after giving birth regardless of whether it’s a c-section or natural birth as it increases the risk of infection.
- Wet wipes and flannels for freshening up until you’re able to have a shower
- chewing gum to get the bowel working and peppermint tea. Your bowels can slow down after surgery which can cause painful trapped wind as it can take several hours or days for your digestive system to start working properly again.
Avoid make-up, nail polish or contact lenses during the operation. You will also need to take off any jewellery you may be wearing.
Preparing for when you go home
Recovery from a c-section generally takes longer than a vaginal birth so it’s important to have things prepared at home to make things more comfortable when you return.
- Try and keep things close to you on the sofa or bed so that you don’t have to keep getting up or reaching over.
- Have plenty of pillows available for the bed and sofa.
- Stock up on paracetamol for pain relief, maternity pads and breast pads.
- Prepare meals during the last few weeks of your pregnancy and freeze them so that you don’t have to cook.
- Use a large sports bottle to keep drinks in and keep it with you
- You may be given pressure socks to wear at home to help prevent blood clots in your legs. Ask for a spare pair so that you are able to wash them
Ask for support from your partner and family in the early days/ weeks as you may find simple tasks such as walking around difficult. Don’t lift anything heavier than your baby for the first few weeks. This can be difficult if you have a toddler but get as much support as possible from your partner.
Remember to give yourself time to recover after a c-section. Your focus in the early days should be on resting yourself and caring for your baby.