Parents often ask questions about Caesarian deliveries and most parents think about the possibility of having a caesarian birth (or surgical birth). The following questions have been developed to help expectant parents educate themselves about Caesarians: how and why they are done and the choices available.
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:
- a consent form is signed
- the abdomen is shaved and scrubbed
- an I.V. (intravenous) is started and I.V. fluids given
- 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
- no food or water prior to surgery
- blood is drawn before the operation
- vital signs are taken (temperature, blood pressure, pulse)
- 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.
What can I expect immediately after surgery?
Encourage your partner to stay with you and comfort you at this time.
Vital signs will be taken frequently by nurses and your incision and the firmness of your uterus will be checked.
A caesarian delivery is major surgery so you can expect to feel discomfort. Medications will be ordered by your physician to help you relax and keep the pain tolerable, so you can get to know your new baby.
What can I expect during the recovery period?
Getting up and moving again after surgery is most difficult the first time. You will probably be asked to get up the evening following surgery, or within 8 hours of your baby's birth. The sooner you start moving, the more quickly your body will recover.
Before standing up, sit at the side of the bed for a few minutes and let your legs dangle, and do some ankle rolling. Take it slowly when getting up and don't be surprised if you are encouraged to take a few steps. From the beginning, you should stand as tall as possible and try to prevent slumping forward to protect your incision. You will likely be able to go home on the 4th or 5th day after your baby's birth.
You should also prepare to do deep breathing and coughing every l-2 hours. This will allow your lungs to re-expand. They may not be fully expanded due to the anesthetic and discomfort you are feeling.
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.
How can I cope with the emotional changes?
A Caesarian birth may bring with it many different emotions, including wonder, delight, joy, anger, frustration and even disappointment. You may feel tremendous love for your baby, while at the same time you may feel disappointed that you had a caesarian birth. All these feelings are normal and it may take time for them to be resolved.
Certain things make the emotional recovery easier:
- If you feel the need to cry, do so, as tears can be very healing.
- Talk with your caregivers and clarify the questions and concerns that you have about your birth experience.
- Take care of your physical needs, including healthy foods, rest and plenty of fluids.
- Write your feelings in a diary or write the story of your birth and what you learned from it.
- Your partner should help you during this time and also speed your recovery by caring for the baby, ensuring that you get enough rest and recognizing your feelings.
- Most of all, acknowledge your achievement: you were willing to have surgery for the birth of your baby.
Can I still breastfeed my baby?
The answer to this question is yes. A caesarian delivery does not affect the production of milk. You may experience some post-surgical pain and weakness, but it does not mean you cannot breastfeed. Instead, you will need help with positioning your baby for breastfeeding. Nurses will be available to help you find a position that will be most suitable for you and your baby. Your partner should learn along with you. It may take some patience, but the effort will be well worth it. Visit the breastfeeding section for more information
Is it true "Once a Caesarian, always a Caesarian"?
A growing number of physicians feel a large percentage of mothers who have had caesarian deliveries should be able to deliver vaginally. Today, women are encouraged to have a VBAC (vaginal birth after caesarian) as long as the reason for the previous caesarian is no longer present.
Plan for the possibility of a Caesarian delivery, as well as a vaginal birth so that no matter what happens, you will be better prepared, have fewer surprises and a greater sense of control and personal choice. Remember, your baby will be born from this experience. Be proud of yourself and the effort you are making.