C-sections: All you need to know

Around 1 in 4 pregnant women have a C-section in the UK and these rates vary globally. As a rule, women spend between one and three days in hospital after birth depending on the clinical situation, how baby is and the reason for the C-section. Some mums are up and out after 24 hours though.

Planned caesarean

The ‘elective’ or planned C-Section is usually carried out at around 39 weeks of pregnancy. If you are considering having a C-Section, you should be given the risks and benefits compared with a vaginal birth so you can make an informed decision about what’s best for you and your family. Never feel like you have to do anything you don’t want to and ask all the questions you need to. Going through the benefits, risks and alternatives, and doing what your gut instinct tells you, can help you decide too.

Listed below are a few reasons this maybe recommended:

• You have a low-lying placenta, often referred to as placenta previa
• Your baby is in a breech position (feet first) and it has not been safe or you have not wanted your doctor to turn the baby – a procedure called ECV (External Cephalic Version)
• You have certain infections, such as untreated HIV or genital herpes (if it’s a first-time infection) occurring in late pregnancy
• There are concerns over the baby’s growth or how they will cope with labour

Some women ask for a C-section as that is their preferred choice. This may be because of an extreme fear of labour or vaginal birth known as tokophobia, for example. Help for tokophobia is offered and sometimes mums feel able to have a vaginal birth after lots of support, but other times a C-section is still preferred, and an agreed date is booked in for the operation to take place.

Remember mamas, you’re the birth boss and you make the final call either way.

If you go ahead with an elective C-section, hopefully you don’t go into labour, but if you do start having contractions or your waters break you need to contact the labour ward. You’ll be admitted for a check-up and the chances are, your C-section will be brought forward.

Before your operation

Around one week before going in for your planned surgery, you’ll have a pre-operative appointment.

Here’s what to expect:

• Everything is explained and you are encouraged to ask questions and share your birth wishes, for example, delayed cord clamping, your partner to cut the cord, music, immediate skin-to-skin etc
• An MRSA (Staphylococcus infection) swab will likely be taken, with your consent. If this comes back positive, you’ll need treatment before your op
• A blood test to check your iron levels and blood group
• Medicines to reduce stomach acid
• You will be asked to sign a consent form. No one can ever do anything to you without your informed consent

The day of your operation

• You will need to be ‘nil by mouth’ (stop eating and drinking) several hours before the operation, but you will be told exactly what time to stop eating/drinking by your midwife or doctor
• You will be welcomed by the specially allocated team on that day and then ‘admitted’ – given a wrist band and have the opportunity to relay your birth wishes
• You will be given a gown to change into
• You will need to have a cannula – an Intra-Venous (drip) put into your hand or arm, so that medicine and fluids can be administered to you
• You will be offered a type of anaesthetic known as a spinal – similar to an epidural. This means you will be awake for the procedure, but you won’t feel any pain as you will be numb in your lower body. The procedure will be carried out by a specialist doctor known as an anaesthetist
• If your birth partner is going to be in theatre with you, they will be given a scrub uniform and hat too.
• A catheter (little tube) will be put in to empty your bladder shortly before the surgery, usually by your midwife

General anaesthetic

If a spinal is not suitable for you, general anaesthesia is used and you will be asleep during the procedure. This is rare though and your birth partner is not usually able to be present.

On rare occasions an elective C-section needs to be pushed back, which is usually due to the unit being really busy. It can be really frustrating if this happens, but as hard as it is, try to stay calm and cherish the extra nights of rest if you can!

The operation

• You will be on an operating table which may be tilted to start to help with blood flow to you and your baby
• A screen will be placed across your tummy and some units are now offering clear drapes or drapes with special sections if you would like to see. This will likely be discussed with you ahead of time so you can relay your preferences
• A cut is made across your bikini line (and into your uterus) where your baby is. Doctors are really good at keeping this cut small and low
• You might feel a bit of tugging and pulling. Some women describe a C-section like someone is doing the washing up in your tummy. Although odd, this bit doesn’t usually last too long
• Your baby will be passed straight to you for skin-to-skin if that’s what you’ve requested, and all is well. It’s important to request early skin-to-skin and delayed cord clamping ahead of time if that is what you would like. Most units encourage this but not always
• You are at an increased risk of bleeding if you have a C-section, so you’ll be given oxytocin to encourage your womb to contract and reduce bleeding. You’ll also be given antibiotics
• Your uterus will be closed with stitches and usually covered with a dressing

Post operation

• You can usually eat and drink in recovery - your midwife or nurse will get you some much needed tea and toast
• Painkillers will be offered to you, but do request to speak to a doctor if you are in a lot of pain or think you need something stronger
• Anti-clotting medication will be prescribed to help prevent any blood clots post-operatively and you’ll be given compression stockings too
• If you have chosen to breastfeed, a midwife or nurse will support you if you want or need help. It’s great to get baby on the breast as soon as possible
• The bladder catheter will be removed between 12 to 24 hours post-op and you’ll likely be asked to take note of your wee time and amount
• It’s normal to have vaginal bleeding – use sanitary pads or the disposable knickers rather than tampons to help prevent infection
• Take things easy for several weeks

Wound care

• Keep your wound clean and dry. Avoid using soap and gently pat the area dry with a clean towel
• Look out for signs or infection (increasing redness, discomfort, oozing pus and lack of healing)
• Wear loose, comfortable clothing, preferably made from cotton
• Removal of stitches/staples if necessary. This will be done by your midwife around day five to seven. If you have any concerns, always call your midwife

Your C-section scar

• The scar tends to appear red for a while, but eventually it will fade. On darker skin, the scar tissue might leave a white or brown mark
• Later, massaging with creams or oils once the skin is fully healed can support further healing and reduce scarring. You can talk to your doctor or midwife about this in more detail

When to seek medical advice

The following symptoms may indicate something’s not quite right, so it’s important for you to report these as soon as possible.

• Feeling tired is normal as a new mum but if you’re really fatigued you could be anaemic, so it’s important to get a blood test and keep taking your antenatal supplements to support your recovery
• Concerns over your milk supply if you are breastfeeding
• Leaking urine
• Replaying your birth, having nightmares or flashbacks. It's important to talk to someone about this as soon as possible so you can get support

The below symptoms need urgent attention:

• Shortness of breath or chest pain
• Swelling or pain/redness in your calf
• Heavy or sudden significant vaginal bleeding
• Pus oozing from your scar and/or offensive in smell
• Feeling feverish, have a high temperature or generally feeling unwell
• Sudden onset of severe headaches

Recovery

Everyone is different but here are some key pointers:

• Whilst you’re recovering, it’s advisable to keep up gentle movement. This helps to prevent clots and can make you feel better as long as you don’t overdo it
• Start pelvic floor exercises as soon as you feel able
• Drink at least 2.5 litres of water per day, this will support recovery but also reduce the chances of blood clots
• It’s advisable not to carry anything heavier than your baby and to avoid driving for 6 weeks –check the guidelines with your insurer too
• Only do what feels right and comfortable for at least 6 weeks (or even more). Listen to your body as much as possible
• Consider seeing a women’s health physiotherapist if you have the budget for it as they can really support your recovery and return to activity
• You will have your six-week postnatal check-up with your GP so be sure to write down any questions or bring up concerns with them then