Antenatal education is often focused on vaginal deliveries, however 1 in 4 babies born in the UK will be birthed via caesarean section, sometimes planned and often not. It is important to discuss what may happen during a C-section so that the birthing person can feel as prepared as possible should their birth plans take an alternative route.
An elective caesarean (a pre-planned c-section) is usually organised for the 39th week of pregnancy. A pre-op appointment will be arranged to discuss the details, risks and plan for the day, this is a good opportunity to ask any last minute questions. If the procedure is not an elective section it is referred to as an emergency caesarean section (EMCS) however this does not necessarily mean it is a blue light emergency situation, perhaps labour has been particularly long and the birthing person is fatigued, having discussed all the pros and cons the labouring person may make an informed decision to proceed with a caesarean section, this is often recorded as an EMCS. Emergency c-sections have 3 levels of categorisation dependant on the level of urgency required, level 1 represents an immediate threat to life.
It is important to note that any category of caesarean section is considered to be major abdominal surgery with procedure requiring not only cutting an opening through the womb but even displacing the bladder. The decision to have a c-section should not be taken lightly and where possible only take place after an informed discussion with your care providers.
When the time comes a gown will be provided and the pregnant person escorted to the operating theatre. Birth partners are asked to remain outside the theatre initially.
A spinal or epidural anaesthetic, which numbs the lower part of the body will be administered in the lower back. It is common to be asked to curl forward and remain still during this part of the preparations. A localised anaesthetic means the birthing person will be awake to welcome their baby into the world. Once prepped a birth partner can enter the room, sporting their own shoe covers, gown and rather fetching hat! Sadly, if the caesarean procedure must be performed under general anaesthetic your birth partner will not be present.
The operating table may be slightly tilted to minimise the pressure on the inferior vena cava. A screen is placed across the lower half of the body. A 10 to 20cm incision is made in the tummy and womb – this will usually be a horizontal cut just below the bikini line, a small area of pubic hair may need to be shaved. Once the opening has been made it usually takes 5 to 10 minutes to the birth of the baby and it is expected to feel some pressure and tugging at this point. Provided there are no complications the baby will usually be brought straight over to meet his/her parents.
An injection of the hormone oxytocin will be given once the baby is born to encourage the womb to contract and reduce blood loss. The wound is usually closed with dissolvable stitches, however, sometimes stitches or staples that need to be removed after a few days will be used, this will be discussed ahead of discharge if necessary. The whole procedure tends to take around 40 to 50 minutes.
After the operation the patient will be moved from the operating room to a recovery room where the medical staff will keep an eye on them for a few hours whilst they recover from the anaesthetic. A catheter will have been inserted to help empty the bladder for the procedure, this is removed around 12 to 18 hours after the operation.
Mum and baby tend to stay in hospital for 3-4 days and will be encouraged to rest and take regular pain relief.
In the case where a birth has not gone as planned it may be beneficial to have a birth debrief to discuss what factors led to any decisions that were made with your maternity care team, contact your local hospital to arrange this.