Caesarean delivery (Cesarean or “C-section”) is the delivery of a child / children through a horizontal incision in the skin, abdomen and uterus. Much has been written in the press on the increasing frequency of C-section and the unnecessary medicalisation of childbirth. Currently around 20 – 25% of pregnancies in Belgium are delivered by C-section.
Reasons for C-section
Although there are some absolute reasons for performing a C-section, often the decision is based on a combination of individual factors that are unique to your situation. It is important that you are involved in the decision and feel comfortable with your choice.
- Conditions of the mother – The woman may have medical conditions that worsen as pregnancy progresses or a condition that will not allow the woman to tolerate labour and vaginal delivery. In addition, there may be problems with the uterus or other pelvic organs, which would prevent a successful vaginal birth (such as a previous caesarean section).
- Conditions of the fetus – The baby may have medical conditions that result in its inability to tolerate the stresses of labor. The baby may also be coming down through the birth canal in an unusual position so that a vaginal birth is not possible.
- Obstructed labour – It is not uncommon that the baby cannot be delivered vaginally because it ‘will not fit’ through the birth canal. This may be due to the baby’s size or the shape / size of the mother’s pelvis. However it is most common that obstructed labour occurs due poor positioning of the baby (a ‘back-to-back’ position). Obstructed labour is difficult or impossible to predict and the most reliable test for the pelvis is labour itself.
- Conditions of the placenta – In some cases, the placenta may be in the way of a vaginal delivery (placenta praevia) or may separate prematurely (placental abruption) which would require cesarean delivery.
For a healthy woman with an uncomplicated first pregnancy her risk of a C-section is around 15%.
Risks of C-section
Although C-section is a very safe procedure when carried out in the developed world, it carries a higher risk than vaginal delivery. There is an increased risk of bleeding, infection, deep vein thrombosis and anaesthetic risks. In addition, a C-section in one pregnancy leads to specific complications for subsequent pregnancies such as uterine scar rupture or the placenta ‘sticking’ abnormally to the inside of the uterus (placenta accreta); Fortunately these serious complications are rare but they are increasing in frequency with the increasing C-section rate. For this reason, doctors try where possible to achieve a vaginal birth.
The Operation and the Operating Room
In general, you will be allowed one person (usually your partner) to be present in the operating room with you during the procedure. That person will sit at the head of the table next to you, out of the area in which the surgery will be performed. Almost all C-sections are performed with you awake under spinal or epidural anaesthetic. In this case you will hear people talking and feel pulling and pushing but you should not feel any pain. The operation is performed by myself and one of my colleagues under sterile conditions. The baby, once delivered, is handed over to the midwife and usually your baby is placed skin-to-skin on your chest. Sewing up or “closing” the procedure will take around 30 -40 minutes after the delivery is accomplished. Usually the skin is closed with an absorbable skin stitch placed under the skin that does not need to be removed.
After the operation, you will be transferred to the adjacent recovery room where you will be monitored for the next hour. During this time your baby will stay with you and your partner and you will be encouraged to try to feed your baby if you wish. There will also be a catheter that was placed in the bladder prior to surgery, which will continue to drain urine into a bag so that you do not need to get up to pass urine. This is removed the following day.. When the anesthesia wears off after the operation, there will be some pain in the abdomen but this decreases rapidly over the next few days. Painkillers will be offered regularly by the midwives. You will be encouraged to cough, breathe deeply and move about in bed, getting out of bed as soon after surgery as is practical. This helps prevent lung problems such as pneumonia and early mobilisation decreases the risk of clots forming in the legs (deep venous thrombosis).
Eating and drinking
Clear liquids can be taken shortly after surgery and typically you will be eating and drinking freely within 24hrs of the delivery. Under certain conditions, the activity of your intestines may be delayed a day or two before starting to work again. In this case it may be advised to recommence eating and drinking more slowly. It is not uncommon to also have gas pains in the lower abdomen as the bowels start to work once more.
Both in the hospital and the first few days after you go home, you may feel discomfort such that holding or feeding the baby may be more difficult that you would like. Bonding with your baby as well as recovering from the cesarean delivery at the same time is more challenging than after a vaginal birth.
By the time you go home you should be able to increase your activities over the next week or two as you get stronger and more confident in your ability to walk up and down stairs, take longer walks, and provide for your baby. Breastfeeding, if desired, is not affected by a cesarean delivery.