Information for people requesting a planned caesarean birth
What is a Caesarean Section
A caesarean section is an operation carried out to deliver the baby through a cut in your lower abdomen and womb.
What are the risks of a Caesarean Section?
Frequent Risks:
- Pain and discomfort: You should expect to experience lower abdominal pain or discomfort following the procedure. Regular painkillers may help you to cope with this. Persistent wound and abdominal discomfort in the first few months after surgery occurs in 9 in 100 women who have a caesarean section.
- Infection: This can affect the operation wound or the womb. You will be given antibiotics at the time of the caesarean to reduce the risk of infection and you will be closely observed after the operation for any signs of infection.
- Haemorrhage (excessive bleeding) requiring blood transfusion occurs 5:1,000 cases. Haemorrhage usually responds to medications that cause the womb to contract.
Rare risks:
- Blood clots: Women are at increased risk of developing blood clots in the legs (deep vein thrombosis or DVT) or the lungs (pulmonary embolus) during pregnancy and following childbirth. This risk is further increased after caesarean birth, 4–16:10,000. VTE is calculated based on risk: both pre-existing and relating to the caesarean section. Compression stockings are given to all birthing people following caesarean, whether that be elective or an emergency. This is due to being immobile for a period of time following surgery. A VTE risk of 2 within the criteria would mean a blood thinning medication, in injection form would be offered and discussed by the midwife caring for you. If your VTE risk is 2, these would be required for 10 days. If your risk factor is 3 or above these would be recommended for 6 weeks. The midwife caring for you will discuss these with you and will teach you how to administer and dispose of these injections safely.
Severe infection – widespread infection in the blood, pelvic abscess (1:1,000 to 1:10,000 women affected)
Uncommon:
- Injury to surrounding organs and structures
• damage to bladder, 1:1,000
• damage to the ureters (tubes carrying urine down from the kidneys to the bladder), 3:10,000
• damage to bowel, 1:10,000 women
Admission to intensive care unit is a very uncommon outcome of the operation. The likelihood of this happening rises for emergency caesarean sections.
Additional unplanned procedures: Very rarely it may be necessary to perform procedures which may become necessary during the procedure.
• Repair of bladder, ureter (the tube connecting the kidney to the bladder) and bowel damage.
There are a lot of ways that we can stop excessive bleeding (haemorrhage) from the womb but if these measures do not work then a hysterectomy (surgical removal of the uterus) may be required. This is extremely rare.
Future pregnancies:
A caesarean section can affect your future pregnancies in the following ways:
- Increased risk of tearing of the womb at the operation scar (called uterine rupture) during subsequent vaginal deliveries affecting up to one woman in every 200.
- Increased risk of the placenta being positioned low and covering the opening of the womb (placenta praevia).
- Increased risk of a placenta which is firmly attached to the wall of the womb that may be difficult to deliver (placenta accreta).
If you wish to have a vaginal birth in the future we will provide an opportunity to discuss your individual history, the risks and benefits of a vaginal delivery compared to a caesarean section and options with an obstetric doctor and a midwife and we will support you in this decision.
Risks to your baby
Injury to your baby: During caesarean section the surgeon takes care to avoid any type of surgical instrument coming into close contact with the baby. When the baby is delivered from the womb, all the surgical instruments are safely removed from the surroundings of the baby. However, there is still a small risk of a minor laceration (cuts to the skin) to the baby during the procedure. This happens in one to two babies for every 100 caesarean sections performed.
What to expect when you have your caesarean section
Deciding to have a caesarean section
You will meet with an obstetric doctor in antenatal clinic to discuss the risk and benefit of having a caesarean section, once you have made a decision to have a planned caesarean section the procedure will be explained to you and you will be asked to sign a consent form. You will not be given the date for your caesarean section at this appointment but the doctor will advise you of the date range they anticipate your having your caesarean section. For most women this will be between 39 weeks and your due date. Depending on your individual circumstances this may be earlier. In the majority of cases, you will be contacted by telephone with a date for your caesarean approximately 1 week prior to your planned operation date. Very occasionally this date may have to be re-arranged, and in such circumstances you will be contacted with an alternative date. Please bear this in mind. We appreciate this can be disappointing, but this is unfortunately unavoidable depending on the needs and demands of the service.
Your ‘Pre-Op’
An appointment will be made for you to visit the antenatal clinic or Pannal ward for a pre-operative assessment. This will be no more than three days before the caesarean section.
You will be seen by a maternity support worker or midwife.
This is a mandatory appointment as we require a recent sample of blood which is valid for your caesarean section date in case of an emergency where blood products may be required. You will be weighed and your legs will be measured for compression stockings. They will explain the admission procedure including fasting times. You will then be seen by an anaesthetist to discuss the anaesthesia for this operation and the benefits and risks that are related to this.
Enhanced recovery
Enhanced recovery is an evidence-based approach designed to help people recover more quickly from surgery, including caesarean section. The advantages of an enhanced recovery programme are:
- It focuses on the elements of care women have told us are important to them
- Good information prior to admission
- Reduced time fasting before caesarean
- Effective pain control afterwards
- Helping you get up and about so that you can look after your baby more easily
- Quicker return to normal after surgery
- Shorter stay in hospital
The information below outlines when you can and can’t eat before your surgery. Please check the time of your surgery as this will make a difference to your fasting times.
MORNING CAESAREAN SECTION
Day Before Your Surgery
We recommend that you eat a carbohydrate-rich supper (such as rice, pasta or pizza)
You can eat light snacks such as toast or cereal and have dairy products until 2am
The Morning of Your Surgery
NO MORE FOOD AFTER 2pm
You can continue to drink WATER ONLY until 6am and can continue to sip water until transfer for surgery
At 6am on the morning of your caesarean drink ONE of the following to enhance your recovery:
• TEA/COFFEE (max 400mls) +2 SUGARS + A SMALL AMOUNT OF MILK ONLY (15mls)
• SMALL CARTON OF RIBENA (max 400mls)
• SMALL CARTON OF CLEAR APPLE JUICE (max 400mls)
Please make your way to Pannal ward for 7am
AFTERNOON CAESAREAN SECTION
Day Before Your Surgery
We recommend that you eat a carbohydrate-rich supper (such as rice, pasta or pizza
The Morning of Your Surgery
7am BREAKFAST to be COMPLETED by 7.30am
No solid food for 6 hours prior to surgery
You can continue to drink WATER ONLY until 11.30 and can continue to sip water until transfer for surgery
At 11.30 on the morning of your caesarean drink ONE of the following to enhance your recovery:
• TEA/COFFEE (max 400mls) +2 SUGARS+ A SMALL AMOUNT OF MILK ONLY (15mls)
• SMALL CARTON OF RIBENA (max 400mls)
• SMALL CARTON OF CLEAR APPLE JUICE (max 400mls)
Please make your way to Pannal ward for 12.00pm
What happens on the day of the Caesarean Section?
Unless otherwise informed by staff you will need to arrive at Pannal Ward at 7am on the day of the operation for a morning caesarean section, or 12pm for an afternoon caesarean section.
You will meet a midwife on the ward who will accompany you to theatre and monitor you and your baby’s well-being throughout. You will also meet the obstetric doctor who will be performing the caesarean section. At this time you will have an opportunity to ask any further questions or voice any concerns you might have.
You will walk to our main theatre accompanied by your birth partner (if you wish) and a midwife.
Please remove all jewellery and body piercings prior to your surgery day. Glasses can be taken to theatre and if necessary, if they need to be removed, they will be given to your birth partner for safe keeping or the midwife caring for you.
The anaesthetic
After a few checks you will be seen by the anaesthetic doctor in the anaesthetic room next to the operating theatre. The anaesthetist will insert a plastic tube called a cannula, into a vein in your hand or arm. This is needed for giving fluids and medication during and after the operation.
The majority of women having a planned caesarean section have a spinal anaesthetic which takes around 20 minutes to site and typically lasts for 2 to 4 hours, sufficient time to complete the procedure. You will be awake, but you will be numb from the level of your nipples to your toes.
The anaesthetic doctor will perform some checks to ensure that the spinal is working effectively and will keep observing and monitoring your condition to ensure you are completely safe and comfortable throughout your operation.
The midwife will have another listen in to your baby’s heartbeat to ensure no concerns following the administration of the spinal anaesthetic.
After the spinal is sited the midwife will insert a flexible tube called a catheter into your bladder to ensure it is empty before and during the operation.
Please see the following website, for further information regarding anaesthetic for your elective caesarean section.
During the operation
From the anaesthetic room you will be moved to the operating theatre next door. Your birth partner will sit with you and the doctor will cover your tummy with protective drapes and a low screen will be put up so you do not see the operation. If you would like this to be dropped at the point of delivery so you can watch your baby being delivered, please speak to your Midwife caring for you. During the procedure you will feel some stretching, pulling and pressure on your tummy. This is normal; you should not feel any pain. Your baby will usually be born around 5 -10 minutes after the operation has started. You can discuss with your midwife and doctor before your operation the details of the birth. We practise delayed cord clamping where it is safe to do so and your baby can come straight to you after birth/ initial check and once we are happy baby is clinically well for skin to skin and to initiate breastfeeding. Babies can become cold very quickly so your midwife will dry your baby to help ensure s/he keeps warm whilst in your arms. If you do not feel able to hold your baby whilst still in the theatre, then your birth partner may wish to do this. We actively encourage skin-to-skin contact with you and your baby as soon as you are able. For some women this is not until you reach the recovery area.
After your baby is born the obstetrician will deliver the placenta. You will be given medication to help the womb contract and to avoid heavy bleeding. It normally takes up to 45 minutes to complete the operation.
After the operation is complete you will be offered a suppository (a rectal dose of medication) which will provide additional pain relief when the anaesthetic starts to wear off.
If you wish to take photos of your baby at delivery please ensure you DO NOT get any of the medical staff in these, unless you have prior permission.
What happens after the caesarean?
Following the operation you will spend a short period (20-30 minutes) in the recovery bay of the operating theatre. You will be supported to have skin to skin and offer a first breast feed to your baby if you wish. Once the staff caring for you are happy that you are recovering well and your observations are stable you will be transferred back to Pannal Ward. A midwife will continue to monitor your pain level, blood pressure, pulse and vaginal bleeding every 30 minutes for the next two hours.
You should usually be able to drink and eat straightaway.
Your catheter will be removed approximately 6 hours after the caesarean section or when you are able to mobilise. We actively encourage you to mobilise as soon as you are able after your caesarean as this aids your recovery and reduces the risks of complications.
The midwives and support workers on Pannal Ward will assist you as required throughout the day and night following your operation.
Regular painkillers will be offered, and it is recommended that these are taken at the prescribed intervals even if there is no discomfort at that time. If you feel it is not sufficient tell your midwife so they can give you something stronger and more effective.
Feeding support will be offered during your admission. Please also seek additional support if you require-use your call bell when your birth partner is not present or ask them to attend the desk for support. The postnatal period is a really important and special time to bond with your baby. Although we do have visiting 11am – 9pm (only 2 visitors at a time, and no children under the age of 16, other than siblings) we strongly recommend these are kept to a minimum so that cares, checks, feeding and recovery is not disturbed. Your designated birth partner can stay overnight to offer you support, but please note that this will be in a reclining chair.
Unfortunately we do not offer private rooms. Side rooms are utilised to control infection risks, for service users who have a clinical need, or those who have a baby on special care baby unit.
The majority of women who have a planned caesarean section do not need to see a doctor before they go home, however if you have any questions about the operation please ask the midwife looking after you and they can ensure you are appropriately reviewed.
You will be seen by a physiotherapist who will give you advice on recovery from your surgery and discuss exercises which will help your recovery.
Going home after your Caesarean Section
Most mothers and babies are able to be discharged the day after their operation. In the first 24 hours we closely observe your blood loss (lochia), ensure you are able to mobilise independently, ensure your pain is well managed and you are clinically fit for discharge. This is individual to you and varies from patient to patient.
Please ensure that you have a supply of Paracetamol & Ibuprofen at home for when you are discharged as we do not routinely provide these to take home.
You should inform your GP if you develop any of the following symptoms. If you are unable to contact your GP and aren’t seeing the midwife the same day please ring the single point of contact.
• painful or increased vaginal bleeding (that could indicate infection of the womb)
• worsening pain in your wound or abdomen (that could indicate infection of the womb)
• foul smelling discharge from your vagina or wound (that could indicate infection of the womb)
• coughing, breathlessness or calf pain (that could indicate a possible blood clot)
• any pain on passing urine (possible urine infection)
Minimal lifting is recommended for 6 weeks (anything heavier than your baby) and heavy lifting should be avoided for 2-3 months. Gentle exercises are safe to start after 8-10 weeks depending on the degree of post-operative pain. High impact exercise is not recommended until after 12 weeks. If activities are resumed too early it can increase the risk of wounds re-opening.
Sexual intercourse can be resumed when you are comfortable to do so and your lochia (vaginal bleeding) has stopped. Please be aware that you can conceive 3 weeks after birth, before your regular periods return so consider contraception options prior to resuming sex.
Driving may be resumed once you are able to turn without restriction to look over your shoulder, able to operate the gearstick and wear a seatbelt appropriately without discomfort and safely perform an emergency stop. You may wish to check with your insurance company to confirm.
Pain Relief After Discharge
You are likely to experience some pain or discomfort in the wound area, following your caesarean birth. It is important to take your pain relief as needed to help you stay comfortable, move around more easily, and support your recovery.
Please take your pain medication in accordance with the instructions provided on your prescription. Do not exceed the recommended dose.
As your body heals, you should gradually find that you need less pain relief. This reduction will vary from person to person, but most mothers notice a steady improvement over time. If your pain is not improving, becomes worse, or you feel you need more pain relief than expected, please use the Single Point of Contact (SPOC) telephone number (01423 557531), to seek further advice.
Caring for your wound after your Caesarean
After your operation a waterproof dressing is applied to your wound. We advise that you should remove this after 24 hours, after which your wound does not need to be covered. The easiest way to do this is in the shower to enable the dressing to be wet. We advise that you wear loose comfortable clothing and cotton underwear over the wound. This will help minimise discomfort and provide the best environment for your wound to heal.
The stitches that are usually used in the operation are absorbed by your body and do not need to be removed. If, however, sutures do need to be removed then this is usually done at home by your community midwife on the 5th day following surgery.
You are encouraged to shower/bathe after the surgery, but it is recommended to avoid using products along the wound under fully healed. It is advisable to rinse off any soap suds from the wound site and pat dry following showers/baths. Once the wound is fully healed you are able to use toiletries as normal.
Your wound will be monitored for any signs of infection as this can slow or breakdown the wound healing process. In rare cases this may lead to the wound opening (wound dehiscence) or to sepsis.
The main signs of a wound infection are:
• Fever
• Feeling generally unwell
• Increasing pain in or around the wound
• Wound becomes red and warm
• Discharge from the wound
• The wound has begun to separate, or has completely opened up
If you have any of these signs you must contact your GP urgently. If you cannot gain urgent access to your GP telephone the single point of contact where we are available 24 hours a day. If a wound infection is suspected, you will be advised to start a course of antibiotics.
What if my waters break or contractions start before my planned elective caesarean date?
In the first instance, please phone our Single Point of contact number, available 24 hours a day (01423 557531). After a telephone assessment you may be asked to come into the maternity unit so we can determine if your waters have broken or if labour could be starting. If this is the case please do not worry. You will have a discussion with the doctor on duty about the options available to you and a plan of care made for the safe arrival of your baby.
If you have any difficulties, concerns or queries you can contact your midwife who can give you advice and support.
This page is intended to give you additional information following your discussion with the doctor or midwife. If, after reading this, you have any questions, please ask these at your next antenatal appointment or at your pre-operative assessment visit.