Miriam's casebook - An emergency Caesarean
Fran's first child is now three years old. Both the pregnancy and birth went smoothly. Her second pregnancy was also healthy and she and her baby were both doing well. Three days before her expected date of delivery, she went into labour, which progressed perfectly normally until the end of the first stage, when Fran was suddenly told she would have to have an emergency Caesarean section.
Being well-informed on Caesarean
Fran was glad she'd taken the trouble to find out about Caesarean sections in advance. About 25 per cent of babies in the UK are born by Caesarean section. A Caesarean is either planned, known as an “elective” Caesarean, or may need to be carried out as an emergency because the baby has to be delivered quickly.
Fran's waters broke halfway through the first stage of labour, when her cervix was only 4cm (1 ½ in) dilated. Following the rule that every mother must have an internal examination as soon as her membranes have ruptured, the midwife examined Fran at once. She discovered a prolapsed cord - a loop of the umbilical cord coming through the cervix into the vagina in advance of the baby. This is an extremely dangerous situation because, as the baby's head presses down on the undilated cervix, the prolapsed section of the cord is squeezed tighter and tighter, cutting off the baby's blood and oxygen supply.
During the examination, the midwife touched the cord and could feel that it was pulsating. This was reassuring as it meant that Fran's baby was still receiving enough blood. However, within a couple of minutes the sonicaid picked up that the baby's heartbeat was starting to dip and the baby was showing signs of considerable fetal distress. Fran's obstetrician told her she needed an emergency Caesarean section to protect her baby's wellbeing.
Preparing for birth
While the operating theatre was prepared, Fran was asked to lie on her front with her buttocks in the air, relieving the pressure on the cord. Meanwhile, the midwife kept her fingers in Fran's vagina in order to keep the baby's head pushed up away from the cervix.
Fortunately, Fran had chosen to have an epidural anaesthetic early in labour, so she didn't need to have a general anaesthetic. And there was the bonus that she'd be awake during the birth.
The surgeon made a standard transverse incision through which Fran's baby was gently lifted out. As soon as the baby's head was delivered, the anaesthetist gave Fran an injection of syntometrine. This stimulates uterine contractions, making it easier for the placenta to separate from the uterine wall and follow the baby out through the incision. Once the baby was safely delivered and Fran was being sewn up, her partner Jonathan was able to hold their baby before taking her for her mother to see for the first time. Although Fran was disappointed about not having a normal vaginal delivery, she and Jonathan had shared the experience of Eleanor's birth and Fran had held Eleanor in the first few minutes after her birth.
After the operation, Fran returned to the postnatal ward with Eleanor where she could concentrate on feeding her and getting to know her better.
Going home from hospital after a Caesarean
Fran found getting back to normal after the Caesarean was almost the hardest part. I suggested she join a self-help group for post-Caesarean mothers, where she'd get useful advice on how to handle the postnatal period. Fran also worried that her next baby would have to be delivered by Caesarean, too. I reassured her that most mothers can have normal deliveries following Caesareans, although there may be good reasons for having another one.
I reminded Fran that she had undergone serious abdominal surgery, so she needed plenty of rest and time for her scar to heal. When her stitches were removed, five days after the operation, she was told that the scar would heal in three weeks and would fade after six months. Fran was surprised to find herself losing blood from her vagina, just as she did after her first child, which was a vaginal delivery, but I explained that this is quite normal.
Starting to breastfeed after a Caesarean
I explained to Fran that if she was going to breastfeed sitting up, she must sit up straight. Her abdominal wall was tender so she used pillows to prop Eleanor up level with her breasts. She also found it comfortable to breastfeed lying on her side, resting on one elbow, with Eleanor on a pillow next to her.
Taking things gently
Fran found standing up quite difficult because her stomach hurt, but I encouraged her to try and stand up perfectly straight as soon as she got out of bed, and to place her hands over her incision, supporting it, whenever she wanted to laugh or cough. I told her that the more she managed to move around, the speedier her recovery would be.
After her stitches were removed, she was allowed home, but was told to rest and to be very careful when lifting anything. She had to avoid any strenuous exercise and driving for at least six weeks, and was advised not to drive until she felt fully recovered.
Delivering Fran's baby
Some aspects of Eleanor's birth were of course very different from that of a baby who is pushed down the birth canal. Once the incision was made in her mother's abdomen, the surgeon slipped a hand under her head and applied forceps in order to pull her head out gently. Next, her shoulders were manoeuvred carefully through the incision and her body was then gently pulled out. In the first moments after delivery, she was held with her head downwards while her mouth and pharynx were cleansed of fluid with a soft catheter attached to suction apparatus. Once she had taken her first breath, the cord was cut and she was checked to make sure that all her systems were functioning properly (see Apgar score). Once she was breathing normally, she was handed to her father for a cuddle.
Miriam's top tips
Up to 25 per cent of all babies born in the UK are delivered by Caesarean section. My advice is to:
- read up on Caesarean sections as part of your information-gathering about pregnancy and birth
- ask questions about Caesarean birth at your antenatal classes and when you visit your labour ward so you are aware of what's involved
- be sure to allow yourself plenty of time to recover fully if you do have a Caesarean section - it's a major operation and it takes time for your body to heal.
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