On the occasion of April being caesarean awareness month, I thought I would share a summary of the book: 'Caesarean Birth - Your questions answered.' by Debbie Chippington Derrick, Gina Lowdon and Fiona Barlow.
Every birth is unique and everyone's experience of birth is unique whatever type of birth you have. Hopefully the below will give you some key information about caesarean births should this be the type of birth you are preparing for or have.
Timing & anaesthetic:
NICE guidelines recommends planned caesareans to take place anytime from 39 weeks because research shows that few babies born after 39 weeks have breathing difficulties.
3 types of anaesthetic: Spinal, Epidural, General Anaesthetic. Have an appointment with an anaesthetist to discuss your options
What happens before my caesarean?
Asked to go into hospital early in the morning - or the night before
Asked not to eat or drink after a certain time so that your stomach is empty for the operation
You will usually be given a time for your operation but it can be delayed by emergency cases or lack of postnatal beds
Plan how you will use the ‘waiting time’: relaxations, massage, music, books, magazines..
You will be asked to sign a consent form
Asked to take off jewellery, make-up and nail polish (so that the anaesthetist can monitor your colouring)
A sample of blood is taken to check for anaemia and sometimes to check your blood group
Area where the scar will be, may be shaved. Skin swabbed with antiseptic which may be bright orange
You will need a catheter
You may be fitted with white stockings to help avoid blood clots
The operating table is tilted /or wedged to the left. This relives pressure of the uterus on the vena cava, the major blood vessel taking blood back to the heart and helps prevent a fall in blood pressure
An IV drip is fitted usually on the back of your hand or arm.
A blood pressure cuff on your arm may be operated automatically and tighten from time to time
Electrodes attached to your chest monitor your heart rate and you may have a finger pulse monitor
A sticky plastic plate is attached to your leg, part of the equipment the surgeon uses to seal the blood vessels
Who will be there?
Anywhere from 6 to 16 people can be in the operating theatre. In addition to these medical staff there can sometimes be student midwives or medical students around but if you would rather not have them there, it’s your right to say you don’t want them there.
Making the birth special:
You can ask for a running commentary from a midwife
Quiet in theatre, particularly at the moment of birth
Have photos taken of the birth
Have the baby delivered to your chest
Lift the baby out yourself
Dim the lights at the moment of birth
Be the first person to ‘greet’ your baby
Have weighing scales and anything else for baby checks in sight
*** Health professionals can be wary of discussing caesarean preferences until they realise these are not medical requests but environmental ones
Will I feel the operation?
The effectiveness of regional anaesthetic varies and will be tested with a cold liquid or ice. Some mothers feel a sensation that they liken to having a pencil drawn across the abdomen. Feelings of tugging and pulling when the baby is born are very common
How long does it take?
For a 1st caesarean, 5 to 10 mins until the baby is born, although the whole operation can take up to an hour or more.
What happens to me after my baby is born?
Your placenta is removed through the caesarean incision and you will be given an injection of syntocinon which helps contract the uterus, closes the blood vessels which supplied the placenta and reduces the risk of PPH (postpartum haemorrhage = excessive loss of blood, more than 500ml)
the ‘closing up’ stage usually takes longer than the previous stage. There are two main sets of stitches. The incision in the uterus is repaired with soluble stitches and the second set of stitches closes the skin of the abdomen.
Where will I go after theatre?
You will probably be taken to the post-operative recovery room, or a labour ward room so your condition can be monitored before you are transferred to the postnatal ward.
Depending on availability, and the needs of other mothers, you may be offered a single room. You may appreciate privacy and quiet or you may prefer the company of other mothers on the main ward. Whatever type of room you’re in you should have a call bell that you can reach easily and without discomfort.Â
Will I be in pain afterwards?
You will be offered treatment for post-surgical pain. There are many post-caesarean pain relief options so you may want to find out what is available at your hospital.
Postnatal wards are often busy so if you’re in pain do speak up. If you try to be ‘brave’ you may end up in more pain, be less mobile and so less able to look after your baby.
Relaxation skills and other self-help methods for coping with pain may be useful here.
When might it hurt most?
Changing positions in bed, getting in and out of bed and moving around can hurt at first.
When you laugh or cough, it often helps to hold a pillow over your wound to support it.
Some women say they need to pass wind frequently after a caesarean, peppermint tea helps.
An obstetric physiotherapist may visit you to suggest exercises and show you how to move more easily.
Will I bleed afterwards?
Some caesarean mothers are surprised that they bleed but ‘lochia’ is a natural discharge of blood that helps to clear the uterus. Some women discharge clots of blood with the lochia, small clots are normal. If you’re worried ask your midwife.
Will I have stitches?
In the case of a usual bikini line cut you will have a skin wound of about 15 - 22cms long, generally on a horizontal line in your upper pubic hair, covered by a dressing.
The internal tissue will be stitched with dissolving stitches, which you may notice discharged with the lochia.
A midwife will usually remove your stitches around 5 days afterwards.
Is there a risk of infection?
If you have any worries about your scar, particularly if it’s inflamed or sore, mention this to your midwife or doctor straight away. If you have any other concerns or discomforts, bring them to the attention of the midwife / doctor.
In hospital showering may be preferable to bathing. Normal hygiene at home will be adequate.
What do I need in hospital?
Maternity pads.
High-waisted knickers that reach over the top of the scar, bikini briefs can be very uncomfortable. Avoid knickers made of nylon or lacy fabric as they can catch on, or irritate stitches, scabbing.
A short sleeved nightie: easier when coping with a drip and a warm hospital ward. Silky materials make sitting more difficult as they slip against pillows and sheets.
Ask for a footstool to make it easier to get out of bed.
Will I have to use a bedpan?
Depending on hospital policy your catheter may be removed before you leave theatre but it is common to leave it in place for up to 24hrs due to concerns about the return of bladder control and possible damage from excessive fluid retention.
The timing of opening your bowels for the first time varies considerably from woman to woman and often doesn’t happen for a week or more. Something to discuss with your midwife.
How soon can I get up?
One of the first challenges is standing. You should get plenty of assistance and encouragement from the midwives very soon after delivery and certainly within 24 hrs. Moving around improves blood circulation and prevent blood clots.
Standing upright can be unexpectedly difficult and walking can be slow, exhausting and sometimes painful but gets easier the more often you try. It will also help you to recover quickly, both physically and emotionally.
You need to take extra care with your posture, especially when sitting or moving.
What exercises should I do?
At first, you may be recommended breathing exercises and ankle circling, both important after the operation.
Pelvic floor exercises to help strengthen the pelvic floor and help prevent stress incontinence (the leaking of urine when you cough, laugh, sneeze or run).
How will I cope at home?
Take stairs carefully and slowly and plan what you carry up and down - including your baby. Some women have felt more secure sitting on their bottom and coming down or coming down backwards. Others appreciate having their hands free to use the banister for support.
Simple tasks like filling a kettle or getting up out of a chair are also a strain. Heavier household chores are best avoided in the early weeks.
Tasks that involve stretching up, such as hanging laundry, reaching high cupboards or even changing a light bulb may also be beyond your capability for some time. If you have to bend down, to load the washing machine for example, it’s better to bend your knees than bend your back.
Coping with a toddler as well as a baby can be very exhausting. You will need to take great care lifting or carrying the toddler. Think about a picnic on the floor rather than lifting your toddler into a chair.Â
Have nappy changing stations at the right height on every floor of the house / apartment.
What problems can occur during recovery?
If you suffer any undue pain or signs of possible infection such as a raised temperature, redness, soreness, discharge or a dragging sensation in your abdomen tell your midwife / doctor.
Urine infections are more common after catheterisation.
Who can help?
After a caesarean you need extra support and help. Unfortunately, many people still misunderstand the needs of women who have had a caesarean operation. Some people may treat you as helpless, while others expect you to be running around as if nothing has happened… Both extremes are usually unrealistic.
Your community midwife will visit you until about 10 days after the birth and sometimes up to 28 days.Â
Your Health Visitor will usually take over from the midwife after about 10 days.
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