A B C D E F G H I J K L M N O P R S T U V W

CAESAREAN SECTION

What is a Caesarean Section ?

A Caesarean section is the operation in which a baby is delivered through a cut in the womb. By far the commonest way of doing this is to make a cut across the lower part (or lower segment) of the womb. It is likely to be done in between 5% and 15% of pregnancies, depending on the circumstances.

Why is Caesarean Section performed ?

Caesarean sections are performed for either planned or emergency reasons. Reasons why planned (elective) Caesarean section is being suggested in your case may be a low-lying afterbirth (placenta) which covers the neck of the womb, (cervix); this condition is called placenta praevia. You may have a pelvis which is thought to be too small for the baby to pass through: perhaps this was identified in a previous pregnancy. If your baby has not grown well inside your womb, he or she may not tolerate labour and a vaginal delivery quite so well. It is also recommended if you have had two or more pregnancy complications such as a previous Caesarean section, high blood pressure, diabetes, a twin pregnancy, or a baby which is presenting bottom (or breech) first. The commonest reason for an emergency Caesarean section is a failure of the labour to progress normally. When this happens, the neck of the womb stops opening or opens only very slowly. Usually this is because the womb is not contracting properly or because the pelvis is too small for the baby to pass through. The other common reason is that the baby is unable to cope with the labour and becomes distressed. This can be seen by measuring your baby's heart rate during labour.

Preparations needed for a Caesarean Section

You should expect to stay in hospital for at least 5 days, depending on what help is available on return home. It will also depend on how well the baby is after delivery. It will take about 6 weeks to recover fully from the operation. For a planned Caesarean section, you will be admitted the day before operation. One of the doctors who will be doing your Caesarean section will visit you, to discuss the operation. You will be asked to sign a consent form. Any tests that need to be performed, such as blood tests, will be arranged. The anaesthetist will also visit you to discuss your anaesthetic. You will be advised by the hospital what you may eat or drink before the operation. A small area of pubic hair will be shaved and, just before your operation, a catheter is usually placed in your bladder.

What happens during a Caesarean Section ?

The anaesthetic used can be either regional or general. Most Caesarean sections are performed under a regional anaesthetic as this is usually safer. In regional anaesthesia, an injection is given into the spine and you stay awake. Although you will be able to feel "pulling" sensations, you will not feel pain. The anaesthetist will be constantly on hand throughout the operation to check that the anaesthetic is working properly. Your partner may join you in the operating theatre: indeed, this may be encouraged. The cut in the skin is made from side to side in a line that would be just covered by a bikini. Occasionally the scar will be up and down. Within just a few minutes, your doctor will cut across the uterus (womb) and your baby will be born. It will be checked by a doctor or midwife, and may then be handed to either you or your partner. After an injection to help the afterbirth to separate from the womb, the afterbirth is removed. The womb and the wound are then sewn up in layers. It actually takes rather longer to sew up than to deliver your baby. Either clips or stitches are used to close the skin.

Possible complications of a Caesarean Section

There are risks associated with the anaesthetic. There is also a risk of a blood clot forming in the legs, which can spread to the lungs and be serious. For this reason, you will be encouraged to get out of bed as soon as you are well enough. Bleeding from the womb after the operation can occur, particularly if an emergency Caesarean section was performed because the labour did not progress properly. For this reason, a hormone is often given to contract the womb for a few hours after the operation. Infections (for example in the bladder or womb) are quite common, but easily treated. Antibiotics may be given at the time of the operation in order to try and prevent these occurring.

What happens after a Caesarean Section ?

You will be encouraged to nurse and to feed your baby. Fluid may be given to you through a needle in a vein (a drip) until you can drink without feeling sick. As the anaesthetic wears off, you will be given whatever is necessary to relieve pain. The skin stitches or clips will be removed on about the 5th day after your operation.

What about future pregnancies ?

As there is always a slight risk of the scar on the womb rupturing, patients who have had a Caesarean section should have any future labour and delivery in hospital under the care of a doctor. Many women do have a vaginal delivery after a Caesarean section, but this depends on why the Caesarean section was performed in the first place. You may wish to discuss this with your doctor before leaving hospital, or at your 6 week post-operative check-up. After two Caesarean sections, most doctors would suggest that all future deliveries are then done by Caesarean section.

Going Home after a Caesarean Section

A Caesarean section is quite a major operation. You will almost certainly need some help, especially for the first few days. You may be advised not to drive until you are confident that the wound is well-healed (usually by four to six weeks). The support of family and friends is vital at this time. Bleeding will probably take a bit longer to settle than with a vaginal delivery. If it persists for more than two weeks, you should see your family doctor : and infection may be responsible for prolonged bleeding. If at any time you find that your wound feels either hot or sore, do contact your doctor.