What is a caesarean birth?
A caesarean birth is an operation in which an obstetrician makes a cut through your belly and uterus (womb) so that your baby can be born.
It’s the most common major surgery that women have. In Australia, almost one third of women give birth by caesarean every year.
What’s the difference between a planned and an emergency caesarean?
A planned or elective caesarean is scheduled to take place before your labour begins. Almost 60 per cent of babies born by caesarean section in Australia are planned.
An emergency caesarean is not planned before labour begins. It can happen if:
You were planning a caesarean, but went into labour before the operation. Your caesarean can go ahead within a few hours of your labour starting, as long as you and your baby are well.
You or your baby developed a complication during pregnancy or labour. This is more urgent and a caesarean should be done within about an hour.
You or your baby had a life-threatening complication during pregnancy which meant that you needed an immediate caesarean. Your baby should be born as soon as possible, ideally within 30 minutes.
Your labour has stalled, or is very slow.
Most unplanned caesareans give you, your partner and the maternity staff time to be prepared for the operation.
What will happen before my caesarean?
Caesarean Birth Plan Checklist
- Your partner should be able to stay with you from the beginning to the end of the operation, but…
- …if you have a general anaesthetic the obstetrician may not allow your partner into the operating theatre.
- Ask if your partner can be just outside the theatre door so he can hold your baby as soon as possible, if that’s important to you.
- Do you want a running commentary from the theatre staff about how your operation is going?
- Do you want music playing in the background to relax you and take your mind off the operation?
- Do you want the staff and the operating theatre to be quiet so that the first voice your baby hears is yours or your partner’s?
- Do you want to have a regional anaesthetic, which numbs your belly, and means you can stay awake for the operation? The sort of painkiller you will be given is most likely to be a one-off injection called a spinal, but could also be an epidural.
- Or do you want to have a general anaesthetic, which means you will be asleep during the operation?
- Do you want the screen to be lowered or to have a mirror ready, so you can see your baby being born?
- Do you want the screen to be kept raised until your cut is sewn up in case it makes you squeamish?
- Do you want someone to take photos or video of the birth? This may be important to you if you are under a general anesthetic.
Just after your baby is born, do you want:
- To discover the sex of your baby for yourselves, or to be told by the medical team?
- To have skin contact with your baby, or wait for your baby to be cleaned before a cuddle?
- Your partner to hold your baby if you’re under general anesthetic?
- To breastfeed your baby as soon as you can, or your partner to bottle feed your baby while you recover?
Caring for your baby. Do you want:
- To have your baby with you or your partner at all times?
- Your partner to stay with you if your baby is admitted to the special care baby unit (SCBU)?
- To breastfeed on demand and have help doing so, or to have help with formula feeding?
- Your partner or a midwife you know tointroduce your baby to you if were asleep for the birth, or if your baby has been to SCBU?
Your doctor or midwife should talk you through the procedure. They will:
- tell you what will happen during the caesarean section
- explain why they think you need the operation
- explain any possible risks to you and your baby
- ask for your consent, which you have the right to refuse
Before surgery, you will need to change into a hospital gown. You’ll have to take off jewellery, apart from a wedding ring, which can be taped over. If you have a brace or false teeth, you’ll need to remove these, too.
You will also need to take off make-up and nail varnish. This is so your skin tone can be monitored during the operation. You won’t be able to wear contact lenses. If you wear glasses, give them to your partner or midwife, so that you can put them on to see your baby.
In most cases, your partner will be with you during your caesarean. He will have to change into thin cotton theatre clothes. These will include a mask for his nose and mouth, a hat and special footwear.
During your caesarean you’ll lie on an operating table, which is tilted or wedged to the left. It’s tilted so the weight of your uterus doesn’t reduce the blood supply to your lungs and make your blood pressure drop.
Quite a lot of things will happen to prepare you for your caesarean:
You’ll have a blood sample taken. This is to check that your iron levels are high enough and you haven’t got anaemia. It’s important information for your medical team, because women who have anaemia can’t tolerate blood loss as well as those who haven’t.
A drip will be inserted into a vein in your arm. This will give you fluids and make it easy to give you drugs later if you need them.
You’ll be given an anaesthetic. This will usually be regional, which means it numbs your bottom half, via a spinal or epidural. It’s safer for you and your baby than a general anaesthetic, which puts you to sleep.
A thin tube, or catheter, will be inserted into your bladder via your urethra. This will make sure your bladder is empty. It can be put in after the painkiller is working so that you don’t feel it.
The area where the cut will be made will be shaved and cleaned with antiseptic.
You’ll be given either white stockings, extra fluid or blood-thinning injections. This will reduce the risk of a clot forming in one of your leg veins (deep vein thrombosis).
You’ll have a cuff put on your arm to monitor your blood pressure.
Electrodes will be put on your chest to monitor your heart rate. You may have a finger-pulse monitor attached, too.
A sticky plastic plate will be attached to your leg. This is the earth for the electrical equipment used by your obstetrician to stop bleeding during the surgery. Don’t worry, the earth plate won’t affect you.
You’ll be offered:
- an injection of antibiotics to ward off infection
- anti-sickness medicine to stop you from vomiting
- strong pain relief during and just after the caesarean
- pain relief for lasting soreness
- oxygen through a mask, if your baby is in distress
You may be surprised how many people are needed to do a caesarean section.
What happens during my caesarean?
A screen is put up over your chest so that you can’t see the operation. In most hospitals it will lowered as your baby is born and you can ask for it to be done if it isn’t offered. Your anaesthetist will check that your painkiller is working properly.
Once you’re numb, your doctor will make a straight cut, called a bikini cut, into the skin of your belly. It is usually two fingers’ width above your pubic bone, at the top of your pubic hair.
This sort of cut is less painful after the operation and looks better as it heals than a cut down the middle of your tummy. Layers of tissue and muscle are opened to reach your uterus. Your tummy muscles are parted, rather than cut. Your bladder will be moved down to expose the lower part of your uterus.
The cut to your uterus is usually small. Your doctor will make it bigger using scissors or fingers, so that it is torn. This causes less bleeding than a sharp cut. The opening to your uterus is usually in the lower part. This is why the operation is sometimes called a lower segment caesarean section (LSCS).
If you have a lot of fluid, you may hear and sense it whoosh out through the opening. Your obstetrician will lift out your baby. You may be aware of the assistant pressing on your belly to help your baby be born. If your baby is breech, he will be born bottom first.
This all happens quickly. It’s possible that only five or 10 minutes after arriving in theatre you will be able to meet your baby.
If you’re having twins the lower twin is born first, just as if you’d given birth vaginally. Sometimes, forceps are used to bring out your baby’s head carefully. They are usually only needed when your baby is in a breech position or is premature.
Surgeons may make a larger, vertical cut in your uterus if:
- your baby is very premature, or is lying across your uterus
- you have a condition such as a low-lying placenta or growths, known as fibroids
What will happen after my baby is born?
Your baby may be placed on your chest for you to cuddle, or he may need to be checked by a midwife or paediatrician. Your partner can usually hold your baby if you are unable to. If you’re having twins, you may be cuddling one baby each sooner than you expected! Babies born by caesarean tend to be a little colder than babies born vaginally, so they need wrapping up well.
Your baby will be given an Apgar score one minute and five minutes after he’s born. The score measures your baby’s wellbeing.
If there has been concern about your baby’s health, a paediatrician will do the checks. Some babies need oxygen or to go to special care for a while.
You’ll be given the hormone oxytocin via a drip. This will help your uterus contract and reduce blood loss. Your doctor will gently tug the umbilical cord to pull out the placenta. This will be checked to make sure it is complete before you’re stitched up.
You’ll be in theatre for up to an hour. This is because it takes much longer to close you up than to open you up. The process may take longer if you have had one or more caesareans. It depends on how many bands of scar tissue (adhesions) you have from previous operations.
Your doctor will probably use a double layer of stitches to repair your uterus. The cut in your belly will be closed in layers. Finally, your skin wound will be closed with stitches or staples. When you’re ready, you’ll be moved into the recovery room where you, your partner and, if all is well, your baby or babies can be together.
You may start shivering, because your body temperature drops during the operation. The anaesthetic affects your body’s ability to regulate your temperature, and theatres are often kept cool. The shivering can be unnerving, but is usually harmless and only lasts about half an hour. The midwife or nurse looking after you will warm you up with blankets and fluids.
If you want to breastfeed, it’s a good idea to try while you’re still in the recovery room. Your midwife will help you get comfortable for breastfeeding and to take care of you straight after the operation.