Caesarean Section

A caesarean section (c-section) is a common surgical procedure in which an incision is made in the mother’s abdominal wall and the wall of the uterus and the baby is gently pulled through. A caesarean section is usually performed when it is safer for the mother or the baby than a vaginal birth. Your doctor may advise that it is best that you have an elective caesarean. An elective caesarean section is when the surgery is planned (because there is a risk of complications) before labour starts. An emergency caesarean is when a decision is made to perform the operation after labour has started, because of complications which occurred during labour or birth.

There are lots of complications that may lead to a caesarean section, they include

Breech birth (feet first) or the baby is lying sideways (transverse) and is not able to be turned.

The cervix is blocked by the placenta (placenta previa).

The baby is becoming stressed during labour

There are multiple babies.

The baby’s head is too large for the mother’s pelvic opening.
The mother has a health condition, for example high blood pressure, that means the mother or baby will not be able to tolerate the stress of labour.
Labour is not progressing.

Anaesthetic and operation procedures

You may be given spinal or epidural anaesthesia for the procedure or you may have a general anaesthetic. Spinal anaesthesia is similar to an epidural, where a needle is inserted into the fluid that surrounds the spinal cord so that there is no sensation from the chest down. You will still be conscious and will be able to breathe normally. Some women may require general anaesthesia during the caesarean, which means they are not conscious during the birth. This is sometimes necessary when the baby must be born quickly.

Types of incisions

There are two types of incisions (cuts) in the uterus that can be used to deliver the baby. These include:

Classic incision – a vertical cut made through the front wall of the uterus. The cut on the abdomen may be either horizontal or vertical. Classical type incisions are sometimes used for women with placenta previa or whose babies are lying sideways, or when the baby is very small.
Lower segment incision – wherever possible, a horizontal cut is made through the abdomen into the lower end of the uterus, across your ‘bikini line’. These incisions heal better and are less likely to be associated with complications in future pregnancies.

How your baby is delivered

If you have a caesarean section, your baby is born through the incision head first. Forceps might be used to help lift out your baby’s head. Amniotic fluid will be wiped from your baby’s nose and mouth before its body is lifted free from your uterus. The placenta is then removed. You will be given an injection of oxytocin to make your uterus contract and minimise blood loss. The uterus, tissue layers and overlying skin are then stapled or stitched together.

Let staff know if you have problems

Tell your midwife or doctor if you are having any problems, including:

Increased pain
Pain passing urine
Leaking urine
Increased vaginal blood loss
Coughing or shortness of breath
Swelling or pain in your calf (lower leg).

Possible complications

A caesarean section is generally a very safe procedure but, since it is an invasive type of surgery, there are risks for both the mother and her baby that you need to be aware of. Some of these risks and possible complications include:

Infection of the mother’s wounds
Damage to the mother’s bladder and other internal organs
Damage to the mother’s blood vessels
Damage to the baby inflicted by surgical instruments
Increased risk of the baby experiencing respiratory distress
Increased time in hospital
Increased abdominal pain
Increased risk of having a caesarean section in the future.

Taking care of yourself at home

Be guided by your doctor, but general self-care suggestions include:

Get as much rest as you can for the first few days. Ask family or friends to help, or organise paid help if possible.
Take a gentle walk every day to reduce the risk of blood clots.
Eat a healthy diet and drink plenty of water every day to prevent constipation.
Take pain killers as long as you need them.
Wear loose cotton clothing and keep the wound clean and dry. Look for signs of infection (such as redness, pain and swelling) every day.

Driving and travel

If you had a caesarean birth, do not drive for three to six weeks. Otherwise, there are no reasons to specifically avoid local travel except the possibility of overexertion and fatigue. On long road trips, get out of the car every hour or so and walk for several minutes to help your circulation. If you are planning a long-distance trip in the first six weeks, first speak with your midwife or G.P.

Long-term outlook

After a caesarean you will not be able to do some activities straight away, such as driving a car, carrying heavy things, exercise or having sex. You should only do those things once you feel you are able to do so and they do not cause pain. Once you have had one caesarean, it can be more likely that you will require a caesarean for your next birth. If you want to have a vaginal birth after a caesarean, you will need careful monitoring by an obstetrician. Having repeated caesarean sections may limit the number of children you are safely able to have.

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