Caesarean; section; Caesar; operation; placenta; praevia; breech; c-section; elective; cervix; canal; pelvis; small; general; anaesthetic; epidural; block; VBAC; previous; choices; LSCS;
A Caesarean is an operation where an incision (a cut) is made through the abdomen and uterus to deliver the baby. A caesarean may also be called a Caesarean operation, Caesarean section, C-section, LSCS or just a section.
Some Caesareans are planned and some are emergencies. A Caesarean must be done in a hospital's operating theatre. About 30% of births in South Australia are by Caesarean section.
Why are Caesareans done?
Some Caesareans are elective which are planned during pregnancy, and others are done in an emergency.
If a Caesarean is planned your doctor should give you all the information necessary to help you make your decision.
A planned Caesarean will not be done before 38 weeks of the pregnancy, unless there are concerns about your health or your baby's health.
Some of the reasons you may need a planned Caesarean include:
- The placenta (the afterbirth) is over the cervix (a condition called placenta praevia) so your baby may not be able to be born vaginally.
- Your baby is not lying head down, such as it is in a breech position, so a doctor may recommend you do not try to deliver your baby vaginally.
- You needed a Caesarean with your last baby, for example because your cervix did not open properly, or because your baby was too big or in the wrong position to fit through your pelvis.
- Not all babies need to be delivered by Caesarean section if a previous baby was delivered by Caesarean, but you will need to discuss this with your doctor. Have a look at the topic 'Next birth after Caesarean section'.
A Caesarean may be done as an emergency when your baby needs to be born quickly and it is not safe to wait until you have gone into labour, or induction of labour is not advisable, or you may be in labour and there is some concern at the time for your health or the health of your baby.
Who will do the operation?
Only medical practitioners who have specialist training (or someone being closely supervised by a specialist) can do caesareans. This may not be your own doctor.
Types of anaesthetic
Before you have your operation, your doctor and the anaesthetist will talk with you about the type of anaesthetic you will need.
There are 2 main types of anaesthesia that can be used:
- With a general anaesthetic you will be asleep for the operation.
Epidural or Spinal block
- If you have an epidural or spinal block, you should not feel pain from your waist down, but you may feel some pressure and will still be awake for the operation.
- In some women, an epidural or spinal block may not be enough, and the option to have a general anaesthetic may then be offered to you.
You will be asked to sign a consent form to have an anaesthetic, after a discussion with the Anaesthetist.
If your caesarean has been planned, your doctor will book a date for you to go into hospital for the operation. This date for the operation will be before your baby is due.
- Before you go to hospital, you will be told how long you need to fast for (not eat or drink).
- When you get to hospital, a midwife may clip the top of your pubic hair where the incision will be made.
- You will be asked to have a shower and get dressed into a gown and hat for the operation.
- A urinary catheter (small tube) will be put into your bladder. This will be joined to a plastic bag that will hang on your bed. This is to keep your bladder empty and out of the way so the surgery on your uterus can be performed safely. This is usually taken out within 24 hours after your operation.
- When you are in the operating room, a doctor will put a drip in your hand.
- If you have decided to have an epidural or spinal block, or a general anaesthetic this will be done after you have been transferred into the operating room.
- The midwife will listen to your baby's heart on arrival in the theatre and then again after the anaesthetic is put in.
It is usually OK for you to have one person with you during the Caesarean if you are going to be awake. This could be your partner, mother, another relative or friend. They may be able to take some still photos in the operating theatre, so remember to ask the theatre staff if it is OK when you arrive.
What happens after a Caesarean?
- If you are awake for the operation, you will get to see your baby as soon as he or she is born. You can usually hold your baby for a short time. Your chosen support person may be able to hold the baby for you if you don’t feel able to.
- If you have a general anaesthetic your baby will be ‘roomed in’ with you (ie your baby will stay with you) once you are feeling well, or you may visit your baby on the way to the postnatal area if it is necessary for the baby to stay in the nursery for the baby's health, or because you have health problems.
- Usually your baby will be weighed and measured next to your bed in the theatre.
- The midwife attending the birth will help you with your first breastfeed or discuss feeding options with you.
After the operation you will be taken to a recovery room for a while, where the nurse will make sure you are OK before you are taken back to the ward.
- You may be feeling tender and sore, and may need pain relief.
- You will be bleeding from your vagina, just like women do after a vaginal birth. This bleeding is like a menstrual period at first, but the bleeding gets less over the following few days.
- Depending on the time of your operation, you may be offered the opportunity to get out of bed with the help of the midwives. You may be able to shower with assistance.
- It is important to move your legs around and do some deep breathing and coughing, and to get up as soon as you can tolerate it. A physiotherapist will see you to help you with this.
- Remember you have just had a big operation, so don't overdo it.
- The catheter will be removed as soon as possible, but if you are unable to pass urine, it may be needed for a little longer.
- You will be able to start drinking fluids soon after your arrival back to the ward. If you are able to tolerate this your drip may be removed.
- Usually you start eating food after you have passed wind, because this means that your bowel has started working again. If you start eating too soon you may get more wind pains.
- There will be a dressing covering the cut on your abdomen.
- You will have stitches or staples on the cut. These will usually be taken out in a week. Sometimes dissolving stitches are used that don't need to be removed.
When can you go home?
- You will be able to go home with your baby once you are mobile and able to care for your baby independently This usually takes 4-5 days (but may be as long as a week) after the Caesarean. A Caesarean section is a major operation and you will need time to recover.
- You may have felt OK in hospital, but when you get home you may feel a bit wobbly and very tired.
- Spend your time looking after and getting to know your new baby, and recovering from your operation.
- It's helpful if your partner, parent or friend can stay with you and help out with the chores while you rest and look after the baby for a week or so
What if you have had a Caesarean before?
If you had a Caesarean last time, it doesn't necessarily mean that you will need a Caesarean for this baby. It depends on the reason you had to have the Caesarean last time. There is information about this in the topic 'Next birth after Caesarean section'.
- If it was because you or your baby got very sick, or your baby was lying the wrong way, you may not need to have another Caesarean if everything goes well this time.
- Talk with your doctor why you needed a Caesarean last time. Then you can talk about whether you can try to have your baby naturally this time. This is called a VBAC – a vaginal birth after Caesarean.
In South Australia - for more information, contact Cares SA, a community organisation that provides support and education for women about Caesareans. http://www.cares-sa.org.au/
You can access the Dept of Health website for the pamphlet Vaginal birth after Caesarean section and www.health.sa.gov.au/ppg for other information on the site which health care providers use to advise you on what the evidence is about your options regarding VBAC.
How will you feel after your Caesarean?
Most women feel very happy when they have their baby in their arms at last, especially if there were problems in their pregnancy or labour. But later, some women may feel sad, or even angry or confused that they could not have their baby naturally. Some women don't know why they needed to have a Caesarean, and they may worry that this will happen again with their next baby.
If you feel confused or upset about what happened at the birth, it is important to talk to your doctor or a midwife about it. This may help you understand why you needed help to give birth to your baby.
If you decide to have another baby, it is important to talk to your doctor about what might happen for the next birth.
In South Australia Cares SA, a community organisation that provides support and education for women about Caesareans may be helpful. http://www.cares-sa.org.au
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