Caesarean section

Approximately 20 percent of all deliveries are carried out by Caesarean section.
A Caesarean section is a surgical procedure, performed under general or local anaesthesia, during which a baby is delivered through an incision performed in the uterus.
  • It can be performed in an emergency, during labour, or scheduled beforehand: approximately 40 percent of Caesarean sections are scheduled before labour and 6 percent are real emergencies decided during labour.
  • The obstetrian makes an incision in the abdomen, usually below the bikini line.
  • Later on, he breaks the waters and removes the amniotic fluid.
  • The baby is extracted and born.
  • The end result of a delivery by caesarean section is identical to that of a vaginal birth.
  • The incision is stitched up: the stitches are removed about 10 days later.

Common reasons for a Caesarean section

  • Emergency situations requiring a quick delivery for example
    • Fetal distress (an important increase or decrease in the baby's heartbeat for example)
    • Significant bleeding of the mother.
  • presentation of the baby:
    • Breech birth (bottom first).
    • shoulder first
    • By the forehead.
  • A large baby.
  • The mother's pelvis is too narrow.
  • Concerns for the baby's health especially a very low birth weight
  • The placenta is low lying and blocking the cervix.
  • Hypertension and pre eclampsia can cause complications during labour.
  • Multiple babies: the delivery of twins can increase the chance of having a caesarean section.
  • Genital herpes which is likely to infect the baby at the time of delivery (non-exhaustive list)

General Information about having a Caesarean section

  • Planned caesarean sections are normally carried out under a spinal or epidural anaesthetic. Emergency sections are more commonly performed under a general anaesthetic.
  • For most planned Caesarean sections the father or your partner can stay with you throughout the procedure. Only in emergency situations will this not be possible.
  • Having a Caesarean section is like having any other type of major surgery and you will be required to remove jewellery, make up, contact lenses, false teeth etc and you will wear a hospital gown.
  • Before surgery a number of things will happen to you;
    • A blood sample will be taken to check for anaemia and to check your blood group.
    • You will be asked to put on special white elastic stockings to help your blood circulation.
    • You will have a drip in your arm for fluids and drugs if needed.
    • You will have a catheter inserted into your bladder to keep your bladder empty.
  • During surgery you will be carefully monitored therefore will be attached to monitoring equipment for blood pressure, ECG - sticky electrodes on your chest to check your heart rate, a probe on your finger to measure your pulse.
  • Breastfeeding - for a planned Caesarean section under a spinal or epidural anaesthetic you can feed your baby almost immediately after giving birth. This is usually in the recovery room shortly after the Caesarean section has finished. Following an emergency section, depending on the type of anaesthetic and reason for the section will depend on how soon you will be able to breastfeed your baby. Do tell your midwife that you intend to breastfeed your baby.
  • Your stay in hospital will be longer following a Caesarean section - usually 4 - 5 days.

How long should I wait before having another baby after a Caesarean section?

You should wait for a year before having another baby to make sure the scar has healed properly. But some mums do become pregnant again before a year has elapsed.
It is always recommended to seek medical advice.

Will subsequent babies be born by Caesarean section?

Apart from the reasons mentioned above for having a Caesarean section, having a second child does not always require another Caesarean section. However, the risk of uterine rupture is slightly higher, when comparing a trial of labour with repeat elective caesarean section

The maximum number of Caesarean sections

Three to four Caesarean sections are considered to be a maximum because of the risks inherent to the scar.

Risks of a Caesarean section

Whether planned or an emergency, all women are fully informed and consented before having a Caesarean section, as there are risks to having what is considered major surgery.

Because of the very reasons why a caesarean sections are performed, it is difficult to evaluate the maternal and fetal risks between a caesarean section and vaginal birth. Thus, without the option of caesarean births the mortality rate for both mothers and their babies would be much higher.

As with any major surgery caesarean section has its complications;
  • A late haemorrhage which can be severe.
  • Infection of the scar as well as an increased rate of hospital acquired infections
  • Decrease in fertility.
  • A scarred uterus makes future deliveries more difficult.
  • There are risks for the baby too such respiratory distress, breathing difficulties or even death.

What to consider when planning Caesarean section

  • It is important to evaluate the need for performing a planned Caesarean section.
  • Discuss the reasons and risks regarding Caesarean section with your midwife and obstetrian. This enables you to make informed choices about your care.
  • Enquire how many births are Caesarean sections at your chosen maternity unit. The WHO recommends a rate of Caesarean sections of approximately fifteen percent. This rate also varies according to the type of maternity unit.
  • Woman aged 37 to 40 years, giving birth to their first child after having had difficulties in conceiving (fertility problems) will often decide to have a Caesarean section.

Do not hesitate to discuss this problem with your doctor or your midwife.

Document produced in collaboration with Claire Gabillat
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