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Caesarean, or C section, births are becoming ever more popular – some pregnant women need one for medical reasons and others choose to have an elective caesarean.
In this article, experienced midwife Anne Richley explains everything you need to know about a C section procedure, including the three types of caesarean sections available, what happens, the scarring and C section recovery time…
C sections explained: The three types of caesarean
A caesarean section is a major operation, where an incision is made through the skin and muscle of your abdomen and into the womb to deliver your baby. There are three types:
Elective C section:
This is where the decision has been made before labour to deliver your baby this way. Reasons could include breech position (where the baby is in a feet or bottom first position), placenta praevia (when the placenta covers the cervix, blocking the baby’s way out), or if the mum is HIV positive. It’s normally done at around 39 weeks.
Emergency C section:
An emergency C section will usually take place when the baby shows signs of distress in early labour, or there has been little progress during labour.
Crash C section:
This is a true emergency where the baby has to be delivered at once. If an epidural isn’t in place, a general anaesthetic will be needed. Reasons can include placental abruption (when it separates from uterus wall), a prolapsed cord (when it falls into the birth canal ahead of the baby) or the heartbeat shows signs of serious distress.
C sections explained: What happens during a caesarean?
Any jewellery and nail polish should be removed. Once the anaesthetic has taken effect, a fine tube (a catheter) will be inserted through your urethra (space where you pass urine) and into your bladder. Your tummy will be washed with an antiseptic lotion, and if it’s an emergency operation the midwife will shave the top of your pubic hair. If it’s an elective caesarean, you can do this yourself at home the night before.
A screen will be set up so you can’t see the actual operation. The doctor makes a cut, most commonly just below your pubic hairline, through the skin. After this, the abdominal muscle is separated and a second cut is made through the womb. The doctor can then open the amniotic sac that your baby has been growing in, and there’ll be a gurgling sound as fluid is suctioned out.
You won’t feel any pain, but you may feel some pushing and ‘rummaging’, then pressure as your baby is lifted out – some women describe the feeling as if someone is washing up in their tummy!
Hospital procedures vary, but usually your baby is handed to you, assuming they don’t need to be checked by the paediatrician first. The doctor removes the placenta, then sews up the cut. The suturing (stitching) is the longest part of the procedure (in an emergency a baby can be born by caesarean within minutes) but the whole procedure takes about an hour.
C sections explained: What anaesthesia is used?
It’s usually recommended that a mum-to-be has a spinal anaesthetic or epidural so that she can stay awake during the operation and is able to hold her baby soon afterwards. Some women will be advised to have a general anaesthetic if complications are anticipated, such as if there’s a risk of bleeding heavily during the procedure, as can happen with placenta praevia.
A spinal anaesthetic is similar to an epidural but is quicker to insert and provides a short but very effective dose of anaesthesia, by injecting the anaesthetic into your spinal canal and then removing the needle. You feel completely numb from the top of your bump, down.
C sections explained: What will happen to my partner?
If you’re awake for the caesarean, your partner will be able to come into the operating theatre with you. He’ll be asked to change into ‘theatre blues’ (pyjama-like trousers and top), and may even get to wear a paper hat. Everyone in the room will be wearing the same outfits to reduce the risk of introducing infection into the operating theatre.
C sections explained: Can I choose to have a caesarean?
Since 2011, women can choose to have a caesarean on the NHS for free. Ultimately, though, it’s about making an informed decision. So the midwife and obstetrician will want to be sure you’re aware of the risks associated with a caesarean when there’s no medical need for one.
C sections explained: What happens afterwards?
You’ll need close care in the first few hours following the birth, as a caesarean is a major abdominal operation and comes with risks. If you’ve had a general anaesthetic, you’ll drift in and out of consciousness and feel very ‘hazy’. Your pain should be well controlled, initially with a spinal anaesthetic, an epidural or other intravenous drugs. But after a few hours, the midwives may suggest changing to a painkiller such as paracetamol with codeine or non-steroidal anti-inflammatories such as ibuprofen.
You’ll be encouraged to start moving around quite soon after the operation – certainly within 12 hours – and gradually all the ‘plumbing’ (catheter, drips, etc) will be removed. The majority of women will still be in some pain and will also suffer with wind pain, not only in their stomach but their shoulders, too.
C sections explained: How safe are they?
Caesareans can sometimes save lives, but there are still risks and it’s important to know about them so you can make an informed decision.
Increased risks to the mum can include anaesthetic complications, haemorrhage (severe bleeding), blood clots, damage to the bowel or bladder, infection and future complications with fertility.
When the mum hasn’t laboured there’s a risk that the baby will have breathing difficulties. But it’s important to keep this in perspective when a woman has had to have a caesarean because of other known risks.
C sections explained: Having a positive birth
A Caesarean should be a positive experience, and it’s still worth doing a birth plan in the event of this happening. Writing a birth plan will make you focus on what you really want to happen during your Caesarean and will help make it a positive experience. Here are some things to consider:
- Have you a favourite piece of music that you’d like your baby to be born to?
- Would you like the screen to be lowered as your baby is being lifted out, so that you can see them as soon as possible?
- If you’re going to be asleep for the birth, some women ask a member of staff to take photos of the baby being lifted out of the womb.
- Would you still like to find out the gender of the baby for yourself?
- Would you like skin-to-skin contact as soon as he’s born?
- If your baby is well, ask for him to stay with you in theatre. He can be weighed and measured there rather than being taken out of the room.
C sections explained: What will my caesarean scar look like?
There are different types of incisions, the most common being along the bikini line, in your upper pubic hair. Initially, the scar will look like a cut, around 15cm long, and there will be a dressing over it.
The day after the operation the dressing is usually removed and the midwife will check to see if the cut is healing well. The wound tends to be closed with a running stitch, although other varieties can be used. If they aren’t the type that dissolve, they’ll need to be removed, which is usually done around the fifth day by your midwife.
Over time, your scar will fade until it’s barely noticeable. Make sure you have a good look at it, you might need to use a mirror, as many women are left with a bit of an ‘over-hang’ after having a baby. This is because the uterus still needs to contract back into shape, which doesn’t happen immediately.
There’s a lot of pushing and pulling with a caesarean, so don’t be surprised if there’s some bruising around the scar area. While you’re in hospital it’s a good idea to shower each day to keep the wound clean, and gently dab it dry with a towel afterwards. Once home, many women prefer to have a soak in the bath each day, although you may need help when stepping into and out of the tub at
C sections explained: What to take into hospital for a caesarean
Pack plenty of big knickers. They are essential after a Caesarean, as you’ll have a wound along the top of your pubic hair line. You still need sanitary towels, as you’ll still bleed after the operation – as you would after a vaginal birth.
Be prepared for a longer hospital stay of around 4 days, so don’t forget to take extra clothes for you and your baby.
If you know you’re having a Caesarean, enquire beforehand about a weekly hospital car park pass for your partner – these usually work out cheaper.