Caesarean section

What is Caesarean section?

This is operation to remove baby from the womb through cut in a belly.

Why do I need caesarean section?

Some of the reasons for caesarean delivery of the baby are:

• Labour not progressing well
• Foetal heart rate abnormalities that suggest baby does not tolerate labour
• Baby is not in a position for safe delivery (eg lying with bottom first of crossway position)
• Certain placental abnormalities (eg placenta previa)
• Previous surgery to womb (previous c/s or removal of fibroids)
• Heavy vaginal bleeding suggesting placenta may be peeling away from uterine walls)
• Other medical emergencies that may threaten mother’s or baby’s life
• Elective caesarean delivery

Can I choose an elective caesarean delivery even if there are no medical reasons for that?

Yes, you can elect to have caesarean section. Your doctor will counsel you about all benefits and risks of caesarean section. If you would like to proceed, then caesarean section will be scheduled between 39 and 40 weeks of pregnancy.

How is caesarean section preformed?

A night prior to caesarean section you will be given medicine to reduce stomach acidity. You will be asked not to eat and drink for 8 hours leading to operation. This will decrease risk of inhaling any stomach secretions during operation.

Your anaesthetist will discuss types of anaesthesia with you, but generally spinal anaesthesia (injection of anaesthetic injected near spine) is recommended as is safest in pregnant women. Sometimes it is not possible to place spinal anaesthesia, and you may need to undergo general anaesthesia where a woman is put to sleep with medications and then tube placed in wind pipe to help with breathing.

A tube is also placed in a bladder to help with operation and voiding as anaesthesia interferes with awareness of bladder fullness. The tube is usually removed 24 hours after surgery.

A skin cut is made at “bikini line”, and then extended into the womb. Womb is closed after baby and placenta are both removed. Cut is closed in several layers.

What are the complications of operation?

Caesarean section is very common and usually safe procedure, but sometimes complications do occur.

Most common complications are:

• Infection at operation site treated with antibiotics
• Bleeding, sometimes necessitate blood transfusion or return to theatre to stop ongoing bleeding and drain any blood collections in belly
• If uterus does not contract properly and is causing ongoing bleeding not responding to medications hysterectomy (removal of womb) may be performed. This would be done as a last resort to save your life. It would however prevent you from having any more pregnancies
• Adhesion (scarring)
• Lung collapse or infections, treated with antibiotics and respiratory physiotherapy (breathing exercises)
• Injury to surrounding organs such as bladder, bowel and ureter, sometimes needing additional surgery to correct problems
• Blood clots in legs and lungs
• Recovery will take up to 6 weeks, during this time you will not be able to drive a car, and any heavy lifting will be not recommended.

What are the implications for future deliveries?

Two main risks are abnormal placentation in future pregnancies and rupture of scar on womb.

Both of those risks are rare, and vaginal birth after caesarean section (VBAC) is possible in certain circumstances. You will need to discuss this with your doctor.