What Happens During A Caesarean Section?

Preparing to give birth is likely to produce mixed feelings of relief and excitement – but also some anxiety about the imminent delivery. Although some women elect to have a caesarean section for non-medical reasons, most doctors encourage women to give birth naturally. 

Natural childbirth carries fewer risks and complications compared to a caesarean section. However, when your delivery does not go according to plan, a caesarean section (or C-section) may be deemed necessary.

Your doctor may decide to perform this procedure if labour does not go according to schedule. It may also be performed in various other situations such as when the baby is in a beach position or is distressed. Some women may elect to have a caesarean section so that they can choose their delivery date or to avoid potential complications of vaginal delivery.

When Is A Caesarean Section Necessary?

Although you may have planned a natural childbirth, it is not always safe to give birth naturally. In the following situations your doctor may recommend a caesarean section:

• Labour is not progressing normally: This is one of the most common reasons for a C-section. Issues with labour progression include prolonged dilation (opening) of the cervix or a prolonged time of pushing after cervical dilation.
• The baby is in distress: This includes signs that your baby is not getting enough oxygen through the placenta. 
• The baby is in an unusual position: These include breech babies (babies whose feet or buttocks come first), or transverse babies (babies whose sides or shoulders come first).
• Placenta problem: This may happen if the placenta covers the opening of the cervix.
• Previous Caesarean Section: A C-section is often recommended if you have already had one previously.
• Prolapsed umbilical cord: This may happen if part of the umbilical cord slips through the cervix ahead of the baby.
• Health concern for mother: These health issues may include a heart or brain condition.
• Carrying more than one baby: A caesarean section might be necessary for women carrying twins, triplets or more.
• Birth canal blockage: A blockage may be caused by a large fibroid or conditions such as hydrocephalus, which causes the baby’s head to enlarge.

How Is A Caesarean Section Performed?

Before the operation begins you will be given a spinal or epidural anaesthetic, which numbs the lower part of your body. An epidural anaesthetic is the preferred method of delivery as it allows you to remain awake during the delivery. It allows the mother and baby to bond directly after delivery. Your partner may also join you for the birth if you have an epidural anaesthetic.

During the procedure, a screen is placed across your belly so that you cannot see the operation being performed. A catheter will be inserted into your bladder to drain urine while you are having the surgery. The baby is delivered through a 10 to 20cm cut that is made just below your bikini line. Occasionally a vertical cut below your bellybutton may be made.

If you have an epidural anaesthetic, your baby will usually be lifted for you to see as soon as he/she have been delivered, and he/she will be brought over to you to hold. It may be possible for you to start breastfeeding soon after delivery.

After the caesarean section, your uterus is closed with dissolvable stitches, and the incision in your tummy is closed either with dissolvable stitches, or stitches or staples. You may be given an injection of the hormone oxytocin once your baby is delivered to encourage your uterus to contract and reduce blood loss. The whole procedure usually takes around 40 to 50 minutes.

Recovering After A Caesarean Section

You will usually need to stay in the hospital for 2 to 3 days after having a caesarean section. Your doctor will discuss pain relief options with you, with breastfeeding in mind. You may also receive treatment to reduce the risk of blood clots, which may include wearing compression stockings or having an injection.

After the anaesthesia wears off, you will be encouraged to drink fluids and walk. This is important in preventing constipation and deep vein thrombosis. Your doctor will monitor your C-section cut for signs of infection. The bladder catheter will likely be removed around 12 to 18 hours after the operation.

You should be able to start breastfeeding shortly after the delivery. If you are a new mother, your doctor or nurse can teach you how to position yourself and support your baby so that you are both comfortable.

To promote healing after you go home, it is important to take it easy. You should not lift more than 25 pounds (11 kg) for the first few weeks. To help relieve pain, you may benefit from using a heating pad and taking pain medications such as ibuprofen. You should wait at least 1 week before you start driving and should wait at least six weeks before having sex.

You should check your C-section incision regularly for signs of infection and should seek urgent medical attention if you develop any of the following urgent symptoms:

• Your incision is red, swollen or leaking discharge
• You have a fever
• You have heavy bleeding
• You have worsening pain

Some women develop postpartum depression after childbirth. You should contact your doctor if you start to experience severe mood swings, loss of appetite, overwhelming fatigue, and depression after childbirth. Other indications that you may be struggling with postpartum depression include thoughts of harming yourself or your baby.

What Are The Risks Of Caesarean Section?

As with most operations, a caesarean section carries some risks. Babies born by C-section are more likely to develop breathing problems for a few days after delivery or they may be injured by instruments during the surgery. There are also several risk for mothers, including:

• Infection: An infection could develop in the lining of the uterus, in the urinary tract or at the site of the incision.
• Blood loss: There may be heavy bleeding during and after delivery.
• Reactions to anaesthesia 
• Blood clots: Deep vein thrombosis may develop in the legs or pelvis. This can be life-threatening.
• Surgical injury: A bladder or bowel injury may occur during surgery.
• Complications in future pregnancies: For example, a woman who has a natural birth after having a previous C-section may have a uterine rupture (the uterus tearing along the caesarean section scar line).