There are many reasons why you may choose or be recommended that your baby is born via caesarean section, some of which are for medical reasons, personal preference or, occasionally, for psychological factors. If you decide that a planned or elective caesarean section is the best way for you to give birth, you will have an appointment with your obstetrician (doctor), during which the advantages and disadvantages of having a caesarean section will be discussed.
Once you have made an informed choice surrounding this discussion, your surgery will be booked and a date will be given to you. If everything is normal with you and your baby during pregnancy, the date will usually be set for between 39 and 40 weeks of pregnancy. This is to enable your baby’s lungs to be as mature as possible to help to avoid any potential breathing difficulties at birth. Some hospitals, depending upon their guidelines, may offer you steroid injections 24-48 hours before surgery. This is to help your baby’s lungs to function more effectively after the birth.
A few days prior to your caesarean section you will go to the hospital for assessment, which will include some blood tests to check your blood group and iron levels.
On the day of your caesarean section
When you go into hospital
On the day of your surgery, you will usually go into hospital in the morning after fasting overnight. The procedure can be different, depending on how each hospital team works. Sometimes, if the theatre team are needed for an emergency, it may delay your surgery.
In the anaesthetic room
Once you are called into the anaesthetic room, the anaesthetist and their theatre assistant will help you into an upright sitting position in preparation for the spinal anaesthetic, which will numb your body from the waist down. This enables you to be awake for the operation and to meet your baby as soon as they are born. You will also need a cannula inserted (a needle into your vein) - usually into your hand - and a catheter fitted to keep your bladder empty - this is to avoid it being damaged during the operation. The anaesthetist will test your body with a cold spray to make sure you are numb and you will then be wheeled into the operating theatre.
In the operating theatre
You will be covered in sterile drapes, with a screen is placed in front of you, so you won’t be able to see the operation. Your birth partner will be able to sit right next to you and the anaesthetist will be monitoring all your observations throughout the operation.
The surgeons will apply cleaning fluid to your abdomen, then make an incision at your bikini line (usually between 10-20cms long). Your bladder will be moved away, the abdominal muscles parted, and another incision made into your uterus. At this point you may be able to hear a suction noise, as this is needed to clear your waters away once they are broken. You will feel some pushing and pulling sensations- some women describe it as feeling like washing up is being done in their tummy- and then your baby will be born.
It can take longer than you might expect to close your wound, as there are several layers to stitch. If you have had one or more previous caesarean sections, it may take a little longer for your surgeons to cut through the scar tissue inside - they will need to take time and care to do this.
It will take a few hours for you to regain your mobility afterwards. Remember that an elective caesarean is major abdominal surgery. You will need to make sure you take things slowly and take regular pain relief to help manage your recovery. Once your dressing has been removed and your skin has healed, you can use Spritz for Bits to help reduce any soreness and itching as your wound continues to heal.
How to personalise your planned caesarean section
You may want to have some of your wishes for your birth followed during your planned caesarean section. Women are now wanting their birth environment adapting in the operating theatre to enable a calmer and gentler birth for their baby to be born into. Most hospitals will discuss your choices with you and to try to accommodate these as much as possible.
Things you may want to consider:
Make a playlist of music you would like to be played during your birth- most hospitals will have the facilities to play your choice of music in the operating theatre.
You may want to have the drape lowered so you and your partner can see your baby being born- ask if this would be possible at your antenatal appointment.
Discuss your options surrounding delaying clamping of the umbilical cord - current advice from The World Health Organisation is for between 3-5 minutes. Benefits for your baby include prevention of anaemia and an increased transfer of stem cells.
If your baby does not need any resuscitation, then you should be able to have skin-to-skin contact immediately. Your baby does not need to be weighed before this happens and, if you have chosen to have the vitamin K injection, this can be given during your skin-to-skin contact.
Think about seeding the microbiome, this is a relatively new practice, as research discovered that babies born via caesarean section were more susceptible to infections than those born vaginally. Swabbing your baby with the friendly bacteria from your vagina is thought to colonise your baby’s skin and gut, helping to promote a healthy start to life.
Having a planned caesarean section should be a calm event, this blog is a step-by-step guide about what to expect, to enable you and your birth partner to relax and look forward to your baby’s birth. If you have specific wishes to personalise your birth, talk to your doctor and midwife about how this can be facilitated.