Caesarean Section

What is a Caesarean section?

A caesarean is an operation to allow the baby to be born through the abdominal (tummy) wall instead of through the birth canal.

There are situations where a caesarean section may be appropriate for some women and not others.

When is a Caesarean necessary?

A caesarean is recommended if labour presents a risk to you or your baby there are many reasons why women have an elective caesarean these may include;

• Breech position (bottom or feet first).

• Transverse lie, where the baby is lying persistently. horizontally (across ways).

• Where the placenta covers the entrance to the birth canal.

• Medical conditions of the baby or mother which make a vaginal birth unsafe.

We do not perform caesareans ‘on request’ without a medical indication, as it is a major operation with risks, to both the mother and the baby.

Everyone is an individual. Whilst most women have normal deliveries sometimes delivery by caesarean section is more appropriate. We will do our best to make it a safe and satisfying experience for you.  If you are worried about anything in pregnancy then it is important that you discuss it with your midwife or doctor. They are there to support you through the pregnancy and birth.

When will you have the Caesarean?

Usually you will have the caesarean when you are 39 weeks pregnant because this is when your baby is most mature.  If you do go in to labour before your planned date the caesarean will still go ahead.

What anaesthetic is given for Caesarean section?

The operation is usually carried out under epidural, spinal or general anaesthetic.  You will have had the opportunity to discuss the options available with the anaesthetist. With an epidural or spinal anaesthetic, you will be awake and be able to share with your partner the exciting first minutes of your baby's life.

What are the Risks of a Caesarean section?

A caesarean birth involves major abdominal surgery, so the benefits need to be weighed against the risks in each individual case.  Most caesareans are straight forward, however, as with any surgical operation there is an element of risk depending on the reason for your caesarean section.

In general the risks include;

• Excessive bleeding during and after the operation.

• Injury to the structures near the womb (bladder or bowel).

• Difficult surgery because of scar tissue from a previous caesarean or surgery.

• Infection in the uterus (womb) or in the bladder.

• The formation of clots in the legs or lungs after the operation.

• A greater chance of caesarean birth in your next pregnancy.

• Your baby may have some breathing difficulties caused by lung fluid.

• Sometimes the baby can be cut as the womb is opened during the operation.

Will a Caesarean section be necessary in future?

Having a baby by caesarean does not mean that you will have to have a caesarean birth with subsequent pregnancies.

We do not routinely offer a caesarean section to women who have had only one previous caesarean section. 

 All women who have had one previous caesarean section will be referred to our specialist Vaginal Birth After Caesarean Section team (VBAC) to gain advice and support to achieve a vaginal birth.  We know that about three quarters of the women who choose this will be successful and deliver their baby vaginally.  

Preparing for your Caesarean section:

In the Antenatal Clinic you will be given:

• A date for your caesarean.

• An appointment to see the Anaesthetist to discuss the anaesthetic.

• You will be given forms to have a blood test either at the hospital or your GP’s surgery within 7 days of your caesarean.

• This information leaflet.

• Following an explanation from the doctor you will be asked to sign the consent form.

• To reduce the risk of infection we will ask you for a swab from your nostrils and from your groin to screen for MRSA.  You will be given an antibacterial wash (Octanisan) to wash in every day for ten days before your operation and to wash your hair with on alternate days, you can use your own shampoo after washing with the Octanisan.

• You will be advised to cease waxing or shaving the operation site five days before your operation date. This is to reduce infection to the wound area.

• You will be given some antacid tablets to take the night before your operation, these reduce stomach acid and sickness.

• You should not eat or drink anything from midnight the night before your operation.

On the Day of your Operation:

• Have a shower on the morning of your admission.

• Please come to Labour Ward, Broomfield Hospital at 7am.  If there are some emergency operations on that day your operation may be delayed, we will keep you informed if this happens.   

• We will use clippers to remove hair from the operation site.  This is to reduce infection to the wound. 

• Please remove nail varnish and jewellery your wedding ring will be covered with tape. 

• Bring your current medication with you and notify us of any allergies that you have.

We will check your temperature, pulse and blood pressure and listen to your baby’s heartbeat using a hand held sonicaid.  You will also be introduced to the team looking after you.

The Operation:

You will then be taken down to the operating theatre where the anaesthetist will start an intravenous drip to allow us to give you extra fluids. There are a number of staff involved in caring for you during your caesarean and they will introduce themselves to you.

You will then have your spinal or epidural, this is a special needle which will be inserted in your back.  Anaesthetic drugs are injected around the spinal nerves so that the operation is pain free.  Once the anaesthetic is working, your abdomen will feel numb.  Before starting the operation a catheter will be placed in your bladder to keep it empty (this usually stays in for about six hours).

After this your partner will join you in theatre. They may bring in the baby’s clothes and a camera as the baby will be weighed and dressed in theatre.

Although you are awake during the operation you will not see anything because a small screed is put in front of you.  The obstetrician will make a cut  through your lower abdomen.  You will feel a lot of pulling and pressure, your baby will be born in a few minutes.  The midwife will bring your baby to you as soon as possible so you can have your first cuddle with your baby.

You will then be given an intravenous injection to help deliver the placenta and it will take 30 to 40 minutes for the doctor to complete the operation and close the wound. You will be given some more pain relieving drugs for when your anaesthetic wears off and antibiotics to prevent an infection.

If you need to have a general anaesthetic your partner will be taken to the recovery room and the baby will be taken straight to them until you wake up.

After the Birth:

You will be cared for in the recovery room, where you will have the opportunity to feed your baby and your midwife will help you with this. Then you will be transferred to the Post Natal ward, and be introduced to the midwife caring for you. 

Your anaesthetic will gradually wear off and you may have a tingling sensation in your legs.  The long acting painkillers given to you in theatre should last for about 8 hours after the operation.  After about six hours you will be able to get up and have a bath after your catheter is removed.  You will still have bleeding, as you do when you have a vaginal delivery.

You will be given painkilling tablets with a full explanation, together with some leaflets so that you can self administer them. If you have any concerns about this then you should ask your midwife.

A complication of this operation is thrombosis, a small clot forms, this can occur in your leg or more worryingly in your lung. 

To reduce these complications you will be encouraged to drink plenty of fluid, to start mobilizing as soon as is possible and you will be given daily injections of clexane for a maximum of three days or until you have been discharged home

Your baby will stay by your bedside during your stay in hospital.  You and your partner will be supported in the care of your baby by the midwives and the midwifery support workers. 

Partners can visit from 09:00 to 20:30 hours.  Grandparents only visiting times are 19:00HRS to 20:00hours. Please restrict your visitors to three and we cannot allow other peoples children to visit the ward, under 16 years of age.  

Keeping hands clean is an effective way of reducing infection, we ask you and anyone who is visiting you to use the special hand rub at the main entrance to the Maternity Unit, on entry to every ward and again when leaving the ward or hospital.  If your hands are visibly dirty then wash them using soap and water.

Ask your relatives to send flowers to your home because they are not allowed on the ward also ask your partners to take any unnecessary items home to keep your bed space clear of clutter.

Looking after your Wound:

There are three different methods of wound closure, dissolvable sutures, sutures that have to be removed and clips, these will be removed after the fifth day.  You will have a waterproof dressing covering your wound keeping it clean and dry for about five days.  There is a small risk of infection following a caesarean, if you notice any redness, oozing, pain or offensive smell from the wound you should contact your midwife.  You will notice a loss of sensation/feeling in the area around the scar, this is normal and shouldn’t be permanent.

After you are discharged from Hospital:

You will usually stay in hospital for one to two days if you feel that you need further support you can go to  St Peters, Maldon. 

Following discharge from the hospital you will be supported by your community midwife you can discuss with her how often you would like her to visit you.  If you are making a good recovery and your baby is feeding well, the midwife will discontinue these visits between 10 to 14 days.  Your care is then handed over to your Health Visitor  who you may have met during your pregnancy.

Post natal Check up:

You will need to make an appointment to see your GP six weeks after your caesarean section.  Here you will have the opportunity to discuss your future health care needs such as contraception and whether you need to have a cervical smear.

When will you be able to drive?

You will only be able to drive when you can move about without pain and perform an emergency stop with out hesitation.  This usually takes about six weeks, however, it is advisable that you check this with your car insurance company.

Contact details:

• Antenatal Clinic : 01245 513289 or 513664

• Labour ward : 01245 513056 or 513057

• Post Natal Ward : 01245 513052 or 513567

• Infection Prevention Team