Caesarian Birth

It is the birth of your baby through incisions made in your abdomen and uterus. It requires surgical operation and is an alternate method of birth.

Caesarian deliveries are necessary when a vaginal birth is not possible or is unsafe for mother or baby.

Some of the reasons for a caesarian birth are:

• the baby's head is too large to pass safely through the mother's pelvis (cephalopelvic disproportion).
• labour is not progressing or the cervix does not completely open.
• the baby is in trouble (not enough oxygen, not handling labour well or problems with the umbilical cord or placenta).
• multiple pregnancy (twins or triplets where the babies may be in difficult positions).
• the baby is positioned with bottom or feet first (breach) or is sideways (transverse).
• the mother has a serious medical condition.
• the mother has active herpes lesions or genitals that make vaginal delivery unsafe for the baby.
• the mother has had a caesarean birth before.

The pre-operative procedures vary at different hospitals, but usually include the following:

1. a consent form is signed
2. the abdomen is shaved and scrubbed
3. an I.V. (intravenous) is started and I.V. fluids given
4. a urinary catheter is inserted (this is a tube into your bladder to take away the urine). The catheter keeps your bladder empty during surgery and until you are able to go to the bathroom after surgery
5. no food or water prior to surgery
6. blood is drawn before the operation
7. vital signs are taken (temperature, blood pressure, pulse)
8. medications may be given to help you relax

There are 2 types of anesthesia available for caesarian delivery. Both anesthetics have some risks involved and you should discuss these with your health care provider to help you make a decision.

A General Anesthetic is used in emergencies. I.V medications are given or you may breathe in gases. You will be asleep during the delivery and will wake up in the recovery room. The baby also receives the general anesthetic and as a result your baby may be sleepy.

A Regional Anesthetic (epidural or spinal) involves an injection into your back which numbs you from your waist to your feet, but you are fully awake. The baby does not receive this anesthetic, so the baby will be more alert.

A sterile screen is placed between your head and your abdomen, so you do not see the surgery. The delivery room will have a number of people in it - nurses, a physician, an anesthesiologist and your partner or support person. You may hear strange sounds (ie. sucking sounds as amniotic fluid is being suctioned out of the uterus, or clicks as the clips (staples) are closing up the incision). The surgery will not start until there is a good level of numbness, so you should not be able to feel pain. However, there may be a feeling of pressure as the baby is being delivered.

There are two incisions (cuts) made. The first is on the abdomen and the second is through the uterus. The incision into the abdomen may be horizontal or vertical while the uterine incision is almost always horizontal. Many prefer that the incision on the abdomen is made low and horizontal because the incision line is often hidden below the pubic hair line making the skin look better. Generally, the type of incision you will receive is determined by your history and by the position of the baby in your womb and can be discussed with your doctor.

Most hospitals encourage the presence of your support person if you plan to be awake during the delivery. Your partner sits at your head during the procedure and can help you to relax. If you and your partner want to watch the baby being born, you can ask to have the sterile screen lowered at that time.

It will take a while for your digestion to return to normal. Because of the surgery and the effects of the anesthesia, your bowel activity will have temporarily slowed down and food will not move through your system as quickly. Ice chips are offered in the first 24 hours. After this time, fluids will be started and then you will slowly progress to solid foods. A regular diet is usually reached by the 3rd or 4th day following surgery. When you progress to solid foods, it is important to eat a balanced diet with protein and fibre, and drink plenty of fluids.

The catheter will be removed l2-24 hours after the delivery of your baby and your urine output will be measured. This is to ensure that your voiding pattern returns to normal and that no problems arise. You will also experience gas pains around the 2nd or 3rd day postpartum as occurs with any abdominal surgery. Physical activity can help the bowel to function and reduce the gas. Although it may be difficult and uncomfortable, try to move around as much as possible.

The colour and amount of blood flow will change gradually. For the first 3-4 days, your flow will be a bright red. As time progresses, it will become darker and less heavy.  Contact your doctor or local emergency room if you notice any of the following:

• considerable increase in the amount of flow
• large clots (larger than a Loonie or dollar coin)
• foul smell; or
• a fever

Absorbable stitches are used for all layers beneath the skin and may also be used for the outer abdominal incision. These stitches do not need to be removed. If non-absorbable stitches are used for the abdominal incision, they will need to be removed usually on the 5th to 7th day postpartum. Sometimes staples (steel clips) are used and they would also need to be removed. Talk to your doctor ahead of time about the type of closure you will have.