Caesarean Section – Part 2: What will happen If I CHOOSE or NEED this procedure

Caesarean Section – Part 2: What will happen If I CHOOSE or NEED this procedure

Having spoken to many women about their birth choices, one of the issues they experience time and again is actually not knowing or understanding what happens when they need to have or choose to have a caesarean section! This isn’t from the point of the actual procedure, because almost all the women have some awareness that the baby is coming out of their tummy rather than their nether regions! No, this is from the perspective of when they have made the decision – what happens next?

Emergency Caesarean

If you have laboured and at some point during your labour it is discussed with you to opt for a caesarean section, there are a lot of decisions and small changes that take place to get you ready to meet your baby. As this is often a bit of rush, mainly because of the need to deliver the baby, often women feel they haven’t had all the necessary information.

So, following this discussion (including any risks and benefits to you and baby), the midwife will offer to help you change into a hospital gown. This is so there is free access to your back to permit an anaesthetist to perform a procedure called a spinal anaesthetic. However, you will only need this if you haven’t already got a form of pain relief called an epidural. If you have this, then this is used and converted to a spinal administer the medication for the caesarean.

If you haven’t got an epidural, this is usually done in the theatre (this procedure is covered in another blog).
You will, in most cases, be asked to have a catheter inserted into your urethra (where you pee). This is to empty your bladder and keep it empty so that the bladder doesn’t fill. The reason this is important is because if your bladder is full it rises just above the bony part of your pelvis at the front (called the symphysis pubis) and it is possible that the sharp scalpel can cut the bladder if it is full. Some hospitals will empty the bladder using a catheter which is not left in place, and if you have a preference you can ask for either if it is important to you. In addition you will be read a list of risks for the procedure of the caesarean and asked to sign a consent form. You will also be fitted for a pair of compression stockings which will be put on for you, and given an ant-acid to remove any acid from the stomach.

In an emergency it feels very scary and fast paced to get to theatre. In some cases there may not be time to do any spinal and as such you may need to have a general anaesthetic (where you are put to sleep for the procedure). But this is avoided as much as possible and so you can meet your baby as soon as possible.
An elective Caesarean Section

If you have decided to choose to have your baby by caesarean section it is often referred to as an elective caesarean section. At around 37 weeks you will be given a date for your caesarean, usually by your obstetrician or via your midwife, which will also require another date (slightly earlier) for something called a pre-op. This ‘pre-op’ is to a pre-operative appointment in which you will be asked to attend to go through what happens on the day of your caesarean. At this appointment the staff will take bloods, go through your notes with you, discuss the consent form (which you will be asked to sign on the day of your caesarean section) and in some cases you will be given an antacid tablet for you to take on the morning of your caesarean before you arrive at the hospital. The staff will go through when you should last eat and drink the night before and give you any information in relation to your individual needs.

On the Day

You will be asked to come in and shown to your bed on the ward. This may or may not be where you will be after your caesarean. You will be given a gown and some compression stockings (unless the hospital use an electric device which effectively inflates and deflates acting similar to the stockings) and talked through the procedure of the spinal anaesthetic. You will meet the anaesthetist and the Obstetrician performing the caesarean section. They will repeat all the information to make sure you are happy and if not already signed, ask you to sign the consent form for the procedure (there are variances in different regions and this pertains to the UK – it may be different in other countries, in which case I would love to know what these are).

Your partner will be given a set of scrubs (a top and bottom usually worn in theatre). I would advise that partners don’t wear anything except underwear under these as it can get hot in the theatres with all the people and lights and is often the reason partners faint!

It is possible to have a playlist playing in theatre, so ask at your pre-op appointment or on the day if this is important to you.

When it is your time, you and your partner will be escorted to theatre. You will also need to take clothes for your baby and possibly a nappy. I would recommend not taking your best outfit or the outfit you want to show your baby off in as baby may pee on this or there may be a bit of fluid/blood that could get onto them. Your partner may be asked to sit outside the theatre until after the spinal has been put into your back and is working. You will be supported by your midwife, but if you would like your partner to hold your hand, just ask. I have been in many different hospitals whereby both of these are carried out (again variances in regions).

If you would like have skin to skin with your baby in the theatre, let the staff know at this point. In some areas they don’t do this, and often it is because of risk of something happening such as you as the mum not being able to move much to make sure the baby is able to breath through the nostrils, however, show your awareness and ask your partner to make sure the baby’s head is turned to the side and keep a watch. Sometimes women can feel sick and ask that the partner perform skin to skin (it is their baby too). Either way, get this crucial part of building baby’s immune system started and request this to happen – optimise your birth.

Back to having the spinal in ….., you will then be assisted to lay flat on your back and tilted slightly to the left side on the theatre bed. There will be lots of staff – a couple of nurses, your midwife, perhaps a student midwife, the anaesthetist, a health care assistant, and two doctors. So before everyone enters the room you can ask the midwife to catheterise you (which is usual in elective caesarean sections – although you can ask to have an in/out catheter performed). Once this is complete, you will have surgical fluid rubbed across your abdomen with a sponge to remove any bacteria and keep the procedure sterile. When dry a drape will be applied. And then the doctors will check that you can’t feel anything. Once this is confirmed they will begin.

The caesarean should feel sensations of pushing and pulling but no pain. In a few moments your baby will emerge. Usually once the baby is born, the time is recorded and the baby is placed either into a sterile drape over a cot or handed to the midwife. The baby is then taken to a specific area to be dried, have the cord shortened using cord clamps – and if your partner would like to cut the cord this can be done here which is similar to cutting the cord in a non-operative delivery. Then the nappy is put on. If you have opted to have vitamin K by injection, this may well be given here. Although I used to wait until in recovery when the baby was feeding (feeding stimulates endorphins which are natural pain relief hormones for baby, so it is kinder to give the injection at this time). Then the baby will be left unwrapped and given to you under the drape for skin to skin, or your partner to go under the scrubs for skin to skin.

At this time the doctors will deliver your placenta and stitch up the areas. When finished you will be transferred to another bed and moved to the recovery room to continue observations and so you can feed your baby.
Once the recovery nurse is happy that your observations (blood pressure, temperature, heart rate, respiratory rate) are all stable, you will be transferred to the ward. Your baby can remain in skin to skin even at this point. This is important because skin to skin helps to regulate the baby’s temperature, heart rate and breathing and kick starts their immune system from the microscopic bacteria on your skin. Baby’s who are born vaginally have this kick start from bacteria in the vagina.

Over the next few hours you may notice that your baby seems a bit mucusy because the fluid in the lungs hasn’t been squeezed out like a baby that has been born vaginally, and it is important to reassure you that this is normal and happens in almost all baby’s born by caesarean section.

Please be aware there will be regional/geographical differences in this

If you would like to discuss your birth options, create a bespoke birth plan, or book onto my birth preparation package contact me using my email [email protected] or visit my facebook page @naturalpregnancyandbirth

Caesarean Section: Part 1

Caesarean Section: Part 1

April is Caesarean Section Month

So I thought I would do a series of blogs to help you understand a little bit more about your body and perhaps help you to make any decisions about the type of birth that is right for you.

So where do we start?

Well, let me ask you a question – If I asked you ‘How would you like to give birth to your baby?’. Would you have an answer for me? An answer which is based on your understanding of your genetic history and your body – Or would your answer be that which I typically hear all the time –

‘Whatever the Dr says is best, I just want what is best for me and my baby’

I have worked as a midwife in the theatres supporting women and their partners to welcome their babies into the world for elective as well as emergency caesarean sections. As a community midwife I have supported women who have opted to have a caesarean birth over vaginal delivery for reasons unique to them. Fundamentally, the important aspects for women and their partners is information and knowledge. Many women don’t know that it is a choice, but they don’t also know that there are certain times when the choice becomes necessity due to a cascade of medical interventions!

The World Health Organisation (2015) states Caesarean sections are effective in saving maternal and infant lives, but only when they are required for medically indicated reasons.

They recommend caesarean rates should be at population level, however rates above 10% is NOT associated with reductions in maternal and newborn mortality rates. However, it is important to note here that these figures are in consideration of when there are medically presented issues where the mother and or baby risk and do not take into account the psychological impact of issues such as Post Traumatic Stress Disorder (PTSD), tokophobia (an extreme fear of giving birth) or previous abuse.

While a caesarean section can be an essential and lifesaving surgery, it can put women and babies at unnecessary risk of short- and long-term health problems if performed when there is not medical need. To put this in context, in the UK many regions average a caesarean section rate of 30%, with some reaching 50%. So, even if you are planning to have a vaginal birth, it may be a possibility that you could end up with a caesarean section.

Therefore, women need information and to plan for the birth they want, which MUST include OPTIONS when your baby or your body decides not to follow natures plan! Women plan for everything else like a wedding – so with so much at stake, why don’t women plan for birth?

So, with this in mind let me ask you another question –

Do you know how labour works and what parts of the body you need to ensure successful birth?

This may seem a strange set of questions, but there is more to it than hormones and contractions. You may find that there is something preventing you having a vaginal birth so you may not ‘choose’ to have a caesarean section, it is more that is has been chosen for you – which may bring fear of the procedure or the unknown of the procedure.

You may find you have one of the four ‘true’ pelvis’ (Stables & Ranking, 2010). YES that is right – pelvis’ can be shaped differently (See below).
In the UK pelvic imagery isn’t something we use to determine the shape in women having their first baby, or for a woman having a second or subsequent baby seeking VBAC (vaginal birth after caesarean section) who may then go on to have another caesarean section if vaginal birth doesn’t occur.

Then there is the uterus itself – there are deviations such as bicornate uterus or uterine bands which may prevent you having a vaginal birth.

In addition you may have a placenta which lies low in the uterus covering the internal part of the cervix (the opening where baby comes through and referred to by midwives and obstetricians as the OS) which also means you will need to have a caesarean section.

So you see – you may not have a choice, due to some of these factors. However, If you opt to have a caesarean section, it is important to remember that labour is controlled by hormones, so obviously these hormones won’t play a part in the labour itself, and this can include to initiate milk if you wish to breastfeed.

There are things you can do to prepare for this – which I advise all my clients from 37 weeks. This is called milk harvesting and collects colostrum which you can feed to your baby and which will help you in the early days following your baby’s birth.

You may have reasons other than physical ones to have a caesarean section such as a previous traumatic delivery, so you want to avoid a vaginal delivery. Sometimes, it is due to past experiences that you are worried will bring things up for you and which you want to avoid.

I have helped many women overcome these issues using treatments through complementary therapies such as hypnotherapy for PTSD symptoms and pain management, as well as managing anxiety and fear of surgery, so they feel they have choices.

If you would like to find out more about my packages please contact me via email at: [email protected] or alternatively join my free private Facebook Community, the link is here, I would love to see you there.

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