In a Caesarean section, small horizontal incisions are made in your abdomen and uterus, and your baby is delivered through them.
The need for a Caesarean section may be apparent well before labour begins, so you, your partner, and your obstetrician have time to talk through what will happen - this is an elective Caesarean. In emergencies, the need only becomes evident once labour is under way.
Elective caesarean section
The most common medical reasons for choosing to have a Caesarean include your baby's head being too large to pass through your pelvis; your baby being in a breech position or lying across your pelvis; placenta praevia; and certain medical conditions such as active herpes type II infection. Some women also ask for Caesareans as they believe they are easier and they feel more in control. But the more Caesarean sections a woman has, the greater the risk of bleeding during the delivery, and therefore of needing a hysterectomy.
A Caesarean section may be necessary if you've had one for a previous baby - the worry used to be that the previous scar would very often open up again. Experience has shown that this does not happen with the horizontal cut now generally used instead of the vertical cut. So hospitals often allow a trial vaginal delivery to begin; if there are no problems, labour goes on as normal - called a “trial of labour” or vaginal birth after Caesarean section (VBAC).
Elective Caesareans are often carried out under a spinal anaesthetic. This has several advantages over a general anaesthetic: it's safer for your baby; you have no post-operative nausea or vomiting; and because you are conscious, you can hold your baby as soon as he's born. It's usually possible for your partner to be with you during the operation.
When you've had a Caesarean, you may feel disappointed or even cheated that you didn't have a vaginal delivery. It's natural to feel like this, and the best thing you can do is talk it all through with your partner. It also helps, of course, to prepare yourself in advance for this type of birth. Go and see the obstetrician with your partner and find out what the operation involves. If you can, talk to other women who've had Caesarean sections and get their advice.
Emergency caesarean section
This may be needed when something goes wrong during labour, such as a prolapsed umbilical cord, placental haemorrhage, fetal distress, or serious failure to progress in labour.
After a caesarean section
As is the case with any major surgery, it takes time to recover from a Caesarean, but even so you'll be encouraged to get up and walk around a few hours afterwards to stimulate your circulation. You'll be given pain relief if you need it, and the dressings will be removed after three or four days. Your internal stitches will be made with absorbable sutures, which will dissolve away naturally. Skin stitches may also be absorbable, but if not they will be removed within about a week.
What happens to you during a Caesarean?
A Caesarean operation usually takes 35-45 minutes, but the baby is delivered within the first five to ten minutes. The rest of the time is spent stitching you up.
Before the operation begins, a small amount of your pubic hair is shaved, you're given a spinal block, and an intravenous drip is set up to supply you with fluids during the operation. Then a catheter (a thin, flexible tube) is inserted up your urethra and into your bladder to drain it of urine. A small screen is placed in front of your face so you don't have to watch the operation. Your abdomen is cleaned down to prevent any infection. If the operation is urgent, for instance if your baby is in serious distress, you may need to have a general anaesthetic, but a spinal or epidural anaesthetic can usually be inserted very quickly.
The obstetrician makes a short, horizontal incision along the “bikini line” at the base of your abdomen, then makes a similar incision in the lower segment of your uterus. The amniotic fluid is drained off by suction, and the baby is gently lifted out. Then the cord is cut, the placenta is removed, and your uterus and abdomen are stitched.
The effects of a Caesarean on your baby
Not having to pass through the birth canal is both a benefit and a drawback for the baby.
A baby born by vaginal delivery has a rather squashed look at first, while a Caesarean baby has smooth features and a rounded head. But often the Caesarean baby needs more time to adjust to the world - first, because of her sudden entry into it, and second, because she's missed the journey through the birth canal that helps to clear amniotic fluid from her lungs and stimulates her circulation.
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