What is Caesarean Section?

A Caesarean Section is a surgical procedure which may be performed under epidural, spinal or general anaesthetic in which a baby is delivered through
an incision in the lower abdomen.

1. Elective or planned caesarean section: the date for the section is usually planned and discussed in advance at your antenatal visits.
Reasons for a planned caesarean section will be discussed with you by your doctor and midwife.

2. Emergency caesarean section: an emergency caesarean section can occur during pregnancy and /or labour. This is usually performed if there is a concern for the wellbeing of you and /or your baby (or babies).

What pain relief is used?
Elective caesarean sections are usually performed under spinal anaesthetic.
In some cases a general anaesthetic may be necessary, the anaesthetist will decide in discussion with you which option is more beneficial.
An emergency caesarean section is usually performed under epidural or spinal anaesthetic depending on the cause of the emergency. A general anaesthetic may be necessary in some cases. Your birth partner can remain with you unless a general anaesthetic is required

Preparation for Elective Caesarean Section
• You will be asked to come to the admissions department on the morning of your caesarean section. This is located in the Maternity Outpatients Department.
• You will be fasting from 12 midnight the previous night (no food or fluids). However on the morning of surgery at 06.30am you may have 1 cup of clear fluid (diluted cordial, water, black tea or coffee).
• Some women will be already admitted to the hospital prior to the caesarean section due to pregnancy complications.
• You will be seen by a Midwife and a Doctor and bloods will be taken. After the procedure is explained and discussed you will be asked to sign a consent form for this procedure.
• You will be admitted to the ward and a tracing of the baby’s heart rate will be performed. A midwife from the Labour Ward will discuss her role in caring for your baby immediately post delivery.
• You will be asked to change into a theatre gown and measured for anti-embolic stockings. These stockings may help reduce the risk of you developing a blood clot (thrombus).
• You will be given an antacid to neutralise the acid in your stomach. You will then be brought to theatre. Your birth partner will be asked to remain outside the theatre until the section is about to start.
• You will meet the theatre nurses/Anaesthetists and will have a drip (i.v cannuala) inserted in your hand or arm to give you fluids and drugs as required during the procedure.
• You will then have a spinal anaesthetic inserted. This will take approximately 15-20 minutes. A urinary catheter will then be inserted into your bladder to drain the urine as you will have no sensation to pass urine. This is removed the day after your section or as indicated by the doctor
• Once the anaesthetic is effective and the caesarean section is about to commence your birth partner will be brought into theatre to be with you.
The procedure usually takes approximately one hour.

Your care after the Caesarean Section
You will be moved to the recovery area of theatre where you will be closely monitored and given pain relief as required. You can provide skin to skin contact with your baby at this stage and breastfeed if you wish. If you have had a general anaesthetic your partner may provide skin to skin contact or hold the baby as appropriate.

From theatre you will be transferred to the postnatal ward. You will be closely monitored in an area near the midwives station.

Your observations will be monitored frequently and your wound and blood loss will be checked regularly. You will have to remain fasting, however when you can tolerate oral fluids you may have light diet, tea and toast unless otherwise stated by the doctor. You will receive intravenous (I.V) fluids through the drip in your hand/arm. Initially you will have to lie flat after the spinal anaesthetic.

You will be able to get out of bed with help the day after your section or as soon as it is deemed safe to do so.

You will be given a blood thinning injection daily to reduce the risk of developing a blood clot. This will be discussed with you on admission.

You will be given information and advice regarding wound care, hygiene, prevention of infection and recovery at home after your caesarean section.

Discharge
The majority of women go home on day 4 or day 5 after the surgery, this may be earlier or later as decided by your doctor. Your Public Health Nurse will visit you at home.

What are the possibile risks of having a Caesarean Section?
• Wound infection: [Risk of infection: 6 women in every 100] – you will receive antibiotics at the time of the caesarean section to help prevent this.
• Frequent monitoring of your wound will also help to detect any signs of infection.
• Hand hygiene and personal hygiene are also very important in reducing the risk of developing infection.
• Risk of blood clots (thrombus): [4-16 women in every 10,000] – You will be given a blood thinning injection, early mobilisation, deep breathing exercises and wearing anti embolism stockings will all help to prevent you developing a blood clot.
• Longer recovery period.
• Increased risk of caesarean section for next pregnancy. [1 woman in every 4 when a vaginal delivery is attempted]
• Possible breathing problems for baby and your baby may need to be admitted to Neonatal Unit.
• Injury to bladder during the surgery. [1 woman in every 1,000]
• Excessive bleeding, [5 women in every 1,000] which may need further surgery and rarely may require hysterectomy.
• Accidental cut to baby (very rare). [2 in every 100]

Your doctor will discuss management of future pregnancies with you and whether a vaginal birth may be possible. In the case where this is your second (or more) caesarean section, a caesarean section would be indicated for your next pregnancy.

If you have any questions or wish to discuss any of the information in this leaflet, you can talk to you Midwife or doctor at your next antenatal visit.