What is a Caesarean section birth?
Caesarean section is an operation that involves cutting through the abdomen and the uterus (womb) to deliver the baby. The incision is usually made in the lower part of the abdomen, just below the bikini line. Since it is very low and across, it is almost invisible once it heals.
What is an Elective Caesarean section?
When the caesarean delivery is planned before you go into labour, it is called an elective caesarean. It may be recommended in certain cases in which it is unsafe for you or your baby to have a vaginal delivery.
What is an Emergency Caesarean section?
This is required if complications develop and your baby needs to be delivered immediately. This may occur during labour or sometimes, before labour.
What is a Classical Caesarean section?
In the normal Caesarean section, (also known as lower segment Caesarean section) the cut on the uterus is made in the lower part and across. When the cut on the uterus to deliver the baby is made in the upper part and in the midline, it is termed a Classical section. This type of section is performed when the lower part of the uterus is not well formed (preterm deliveries) or when the lower part is not easily accessible (fibroids, placenta previa), etc.
It is of utmost importance for you to know whether you have had a Classical or Lower segment caesarean section. This is because, whilst you can try for a normal delivery after having had one lower segment caesarean birth, you must always have a Caesarean birth after a classical section. This is because the lower segment heals better than the classical type of section, hence the risks of rupture of the scar are much higher in a Classical section.
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When is a Caesarean section required?
There are many instances where a Caesarean section may be needed to deliver your baby, as explained here-
- If the relative size of your pelvis is small as compared to your baby’s head and a vaginal delivery will not be feasible (cephalopelvic disproportion)
- The baby is in a breech (head up, bottom down) or transverse (across) positions inside the uterus by the end of the 38th week.
- The placenta is situated low down in the uterus and covering the cervix either completely or significantly enough to obstruct safe delivery of the baby (placenta praevia).
- Haemorrhage or excessive bleeding from the vagina before onset of labour.
- Cord prolapse, where your baby’s umbilical cord protrudes out of the uterus and cervix. Exposure of the cord to the vagina / outside causes it to go into spasm. This can cause decrease in oxygen and blood supply to your unborn baby and cause it to become distressed. Severe growth restriction of the baby, hence your obstetrician may advise that the baby is not put through the stress of labour.
- You develop very high blood pressure with protein in the urine and are unwell (a condition called severe pre-eclampsia).
- Meconium staining of the liquor. Fetal distress can cause the baby to pass stools (meconium) inside the amniotic fluid, which can find its way into the baby’s lungs and result in severe breathing problems at birth. To avoid this problem, a Caesarean may be recommended if the colour of the liquor is found to be green (the colour of meconium).
- Your cervix does not dilate and your baby is getting distressed.
- You are carrying twins, the first of which is in such a position, that it needs to be delivered by Caesarean section (breech / transverse)
- You have an active Herpes genitalis infection, as this can be transmitted to the fetus, if delivered vaginally.
- You are HIV positive.
How is a Caesarean operation performed?
A caesarean is preferably carried our under epidural or spinal anaesthesia. However, if there is an emergency and your baby needs to be delivered very quickly, a general anaesthetic may be used. If you are already on epidural in the second stage of labour (if epidural analgesia has been given for painless labour) when the caesarean is called for, it will be topped up and you will be ready for’ the operation.
Under an epidural effect, you will not feel any pain sensation but will be conscious. Only the upper part of your pubic hair will be clipped. You will have an intravenous (IV) drip providing you with essential fluids. A catheter will be inserted in your bladder to empty it out, so that it does not fill up during surgery and obstruct the surgery. A 4-5 inch incision will be made just above the pubic hairline. Your baby is delivered out of the womb. The entire operation takes about 45 minutes to an hour of which 30 minutes are spent in closing the wound. If you are awake during the operation, the doctor will inform you of the progress all the time. Your husband may be with you during the operation if an epidural is being used, depending on the discretion of your Obstetrician. If general anaesthetic is used, you will not be conscious during the operation.
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What is the post-operative care required?
- You will be in the hospital for about 3-4 days following delivery.
- You will be encouraged to move as soon as you possibly can, which is usually after 24-36 hours.
- The operated wound will hurt, but usually, good pain relief is available and should be asked for and given by the doctors.
- Usually, you can have a light diet / meal about 6 hours after the operation and normal diet from the second day onwards.
- The stitches will be removed five days after the operation if they are not soluble ones. Keep the area clean and dry. Modern stitches are not visible and do not need removal.
- You can have a bath once your wound dressing has been removed.
- Remember to dry the wound with dry towel and contact your doctor if it becomes red or tender as it could be an infection requiring antibiotics.
- Avoid straining and lifting heavy objects for at least six weeks.
- Although you can start gentle pelvic floor exercises almost immediately after the operation, you may not feel upto it for a couple of days. Don’t try anything more intense till after your postnatal check, about 6 weeks after the operation.
- You should not drive a car for six weeks.
- It is important not to put any strain on your abdomen for the prescribed time.
How to breastfeed after a Caesarean section?
You will be encouraged to breastfeed after a caesarean section. However, if you had an elective caesarean and were not in labour, it may take a while for your breasts to start producing milk. Also, if you had a general anaesthetic during the operation, you may not feel up to breastfeeding for some hours afterwards and you may be better off waiting for some time.
Most mothers are worried about which position is best for feeding without discomfort. Breastfeeding may put additional strain on your abdomen and your stomach muscles are sore after the operation anyway. Remember to put a pillow under your baby and you can feed him from one side rather than holding him in your lap, which may cause you a lot of pain and put strain on your incision. Sleeping on one side and holding the baby against your breast helps. Though I usually recommend my patients not to sleep and feed, because occasionally a patient is tired due to lack of sleep. This may make her accidentally fall asleep on top of the baby and cause a disaster. This has happened and still keeps happening- so please be careful. The nurse will help you find a comfortable position for breastfeeding.
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Labour Delivery
