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- Caesarian birth facts
- Elective caesarian birth
- Complications of birth leading to caesarian birth
- Emergency caesarian birth
- Caesarian birth: step-by-step
- Advantages of caesarian birth
- Disadvantages of caesarian birth
Today, having a baby by caesarian is very common - around 30% of all births in Australia are performed as caesarian birth.
While caesarian birth is a very common surgery in Australia, it is important to know that it is major abdominal surgery, which requires at least six weeks for the pregnant woman to recover fully. The caesarian requires an incision (or cut) to be made in the mother's abdomen, as well as another incision (or cut) in the uterus, so the baby can be lifted out.
Caesarian can be performed either with general anaesthetic (the pregnant woman is not awake) or, if the pregnant woman has already had an epidural, she can remain conscious throughout the actual operation, as her lower spine (and associated organs) have been anaesthetised by the epidural.
Caesarian is also known as caesarian section, or c-section.
Some women may elect to have a caesarian prior to the birth, for one or a combination of any of the reasons below:
- low lying placenta (placenta praevia)
- the baby is in an abnormal position and natural birth is not possible
- an active genital herpes infection
- the baby's head is too big to go through the birth canal (pelvis), which is called a "known cephalopelvic disproportion"
- problems with a previous birth
- breech presentation
- poor placental function
- multiple babies
The advantages of having an elective caesarian procedure is that it can be scheduled for a particular day and planning for the birth can be easier.
Today, more and more women are electing to have a caesarian which does not have anything to do with any of the reasons above and there is some concern about this procedure being performed unnecessarily.
There are some situations during birth, which require a caesarian to be performed, otherwise the life of the mother or baby could be at risk:
- Cord prolapse - if the umbilical cord slips down the cervix before the baby has come through, this could mean that when the baby does descend through the cervix, the umbilical cord could get squashed or compressed and this will cut off the baby's oxygen supply; in some cases, the umbilical cord can be freed, but in general, a caesarian will be performed, usually as an emergency procedure
- Foetal distress - if the mother's water breaks and in the clear liquid, there is some greenish-coloured substance (called meconium, it is baby's first poo), this is a warning that the baby is in distress; or if during monitoring of the baby's heart beat, a change is detected that indicates possible distress of the baby. If distress of the baby is suspected and the mother is not close to delivering the baby naturally, then caesarian will be performed
- Excessive bleeding - if there is an excessive amount of bleeding during birth, for any reason, a caesarian will be performed, and it will be an emergency procedure as both mother and baby's lives could be in danger
- Breech birth - if the baby's head is not descending correctly or if the baby's feet are trying to come through the birth canal first, then caesarian birth will be performed
- Lack of progress - if the birthing process is slow or the contractions are not dilating (opening up) the cervix enough, the doctor or midwife will either relax or stimulate the mother (through getting the mother to sleep, take a walk, change positions or even give the mother oxytocin or helping the mother's waters to break); if both the mother and baby doing well and not distressed by the extended labour, it will be allowed to continue, but if it continues for over 24 hours, the doctor or midwife will recommend caesarian
If caesarian is recommended during birth, it is advisable to go ahead with it (even if a natural birth was the goal of the birth), as it could mean saving the life of the mother and child.
Emergency caesarian surgery is performed when something goes seriously wrong in labour and either the mother or the baby's lives (or both) are in serious danger.
In Australia, the mother will be asked to sign the consent form for the caesarian before it is performed and her partner will not be able to stay while the surgery goes ahead, due to the seriousness of the situation. The mother will be given a general anaesthetic for the caesarian surgery.
The caesarian surgery, in detail and step-by-step:
- Drip inserted - a drip will be inserted into your arm for the medications (pain relief and anti-nausea) and fluids
- Anaesthetics given - a local anaesthetic will be administered to the area where the spinal block and epidural will be given; the spinal block will numb you from the chest down and the epidural will numb you from the waist down (both require stillness when they are given, as they are both injected into the spine)
- Catheter inserted and abdomen screened - a catheter will be inserted into your bladder and your abdomen will be swabbed for the incision; your stomach area will be screened so that you do have to view your insides
- Incisions - the surgeon will make a cut in your abdomen and once through it, will make another cut in your uterus
- Baby pulled out - your baby will be pulled out of your uterus and you may feel a slight tugging sensation, or just some pressure as the baby comes out (but you should not feel any pain)
- Umbilical cord is cut - the umbilical cord will be cut, the baby will be checked for any obvious health issues and then you will be able to hold your baby
- Medications given - you could be given some antibiotics to prevent infection and some oxytocin to shrink your uterus
- Placenta is removed - the placenta will be removed from the uterus, after which your uterus and abdomen will be stitched up; your partner will also be able to hold the baby if it has been given the ok for health
- Back to your room - after all checks have been completed on you and your baby, you will be able to go back to your room, where you will rest at first, but within a few hours of going back to your room, you will be encouraged to take some steps to help aid your recovery
- Painkillers given - you will be given painkillers to take in the first few days after the caesarian, as you will be in pain from the major surgery; the stitches in your uterus will be dissolvable ones and will have dissolved after a few days, while the ones in your abdomen will need to be removed after about five days
Full recovery from the caesarian surgery will take approximately six weeks, due to the seriousness of the surgery. You should not lift anything heavy nor should you do any heavy manual work or exercise. Moderate, very low impact exercise such as walking, swimming, some types of yoga and pilates are recommended.
There are a few advantages of having a caesarian birth, some of which are below:
- the baby is born in a safe and controlled environment
- the mother's perineum remains intact
- the baby's birth can be scheduled and the mother can plan accordingly
- the mother does not have to feel the pain of labour and can enjoy the birth (as long as there are no complications and it is not an emergency caesarian birth)
There are a few advantages of having a caesarian birth, some of which are below:
- it is major abdominal surgery which carries risk - damage to the mother's organs and infection
- there is a higher risk that the baby may suffer respiratory distress (doesn't immediately breath) as it did not go through the birth canal
- the mother is immobile for a few hours, as the drugs used to numb the body take a while to wear off, plus the mother will still have a drip and catheter in place during this time
- mother's recovery time is much longer (around six weeks) than for a natural birth, so certain activities are restricted during this time so recovery is not compromised
- bonding with the baby may be delayed, as some mothers will not be able to hold the baby immediately after the caesarian birth (especially so if there were any complications, which need further care and monitoring of the baby)
- some women feel disappointed or guilty, as they were not able to have a natural birth
- Osieki H. The Physicians Handbook of Clinical Nutrition, 2nd edition. BiConcepts 2002
- Stoppard M. New Pregnancy and Birth: A Practical Guide for All Parents To Be. Dorling Kindersely, UK, 2007