Information regarding your planned Caesarean birth

Information regarding your
planned Caesarean birth
Introduction
This information contains some of the answers to questions you
may want to ask about the birth. It will help you to understand it and
the care that you and your baby will receive. If you would like more
information, please speak to one of the midwives or doctors. They
will be more than happy to help.
1
Contents
What is a planned Caesarean birth and why do I need
one? ……………………………………………………………..
3
What are the benefits of having my baby delivered this
way? …………………………………………………………….
3
What are the risks, consequences and alternatives of
having my baby this way? …………………………………….
3
Preparing for the operation …………………………………...
7
The day of your planned Caesarean birth …………………..
8
During the operation …………………………………………..
10
After the operation ……………………………………………..
14
Going home …………………………………………………….
15
Getting back to normal ………………………………………..
15
Exercises after your Caesarean birth ………………………..
17
The pelvic floor ………………………………………...………
21
2
What is a planned Caesarean birth and why do I need
one?
A birth by planned Caesarean section is an operation on an
arranged date for you to have your baby. We normally recommend
it is not done before 39 weeks of pregnancy as there is an
increased risk of the baby developing respiratory distress
syndrome.
There are various reasons why a woman may need to have a baby
in this way. It may be recommended if labour is considered to be
potentially harmful for you or your baby. The reasons for your
planned Caesarean birth will be fully discussed with you, so please
do not hesitate to ask your consultant or midwife any questions you
may have.
What are the benefits of having my baby delivered
this way?
The decision to advise a Caesarean birth is made using all
information relevant to you and your baby’s needs, and would be
based on any potential problems that could be avoided by having
this operation.
What are the risks, consequences and alternatives of
having my baby delivered this way?
Please be reassured that most Caesarean births are
straightforward and the majority of women have no problems at all.
However, there is a small risk of complications. The degree of risk
can vary depending on the reason for your Caesarean. However, in
general this operation involves a small risk of:

an infection where your operation was performed (6.5% of
women). However, you will be given antibiotics at the time of
the operation to reduce this risk.

excessive bleeding during or after the operation (risk 0.5%).
This may mean that a blood transfusion is recommended. If
you object to this please talk to your obstetrician.
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
the formation of blood clots in the legs or lungs after the
operation (the risk is less than 0.16%). We take measures
during your operation to reduce the risk of this and you may
be given an injection to thin the blood after the operation. Also
you may need to wear special stockings until you are mobile
again.

there is a slight risk of damage to your bowel or bladder,
which may need further surgery (risk 0.5%).

Very rarely a further operation may be required to stop
continuing bleeding. In very exceptional instances a
hysterectomy may be necessary to stop the bleeding.
Risks associated with having an anaesthetic
Every anaesthetic carries a small risk. This depends on many
factors such as the type of surgery and any medical conditions you
may have. Modern anaesthetics are very safe, but risks cannot be
removed completely. The anaesthetist will take some details from
you to plan the most appropriate anaesthetic for you, and to check
for example whether you have any allergies.
You should have received a leaflet ‘Caesarean section, your choice
of anaesthetic’, if not please ask the antenatal clinic staff or your
midwife for a copy.
Spinal/combined spinal-epidural (regional anaesthetic)
Most women are awake when they have their baby by Caesarean.
The anaesthetic is usually a spinal anaesthetic, or sometimes both
a spinal and an epidural together which is called a ‘combined spinal
-epidural’. You will be made numb from above the waist
downwards by putting the local anaesthetic through a needle in
your back. This will be tested thoroughly by the anaesthetist before
the operation begins.
4
At certain times during the operation you may feel tugging and
pressure. Rarely, you may feel discomfort or possibly pain - this is
treated by giving strong painkillers into the drip, or you may wish to
be given a general anaesthetic if you find it too uncomfortable.
A regional anaesthetic (ie. a spinal or a combined spinal-epidural)
can cause low blood pressure leading to dizziness, nausea or
vomiting. This is a temporary problem, which is treated with fluid
and/or a drug to raise the blood pressure.
There is a small risk of headache after a regional anaesthetic
(1 in 100 to 1 in 200).
Sometimes after giving birth, a woman can be left with a temporary
area of tingling or numbness, or a weak leg/foot. Rarely, this same
problem can be caused by a spinal or epidural itself. It can take
several months to get better (1 in 10,000 chance). It is extremely
rare for a permanent nerve injury to occur.
Occasionally it is not possible to use a regional anaesthetic and
then you will need to be given a general anaesthetic.
General anaesthetic (GA)
You will be asleep throughout the operation. The anaesthetic will
be given to you in the operating theatre itself.
You may have a sore throat for a few hours after you wake up.
There is a small risk of damage eg. to teeth or dental crowns, or
bruising of the tongue or lips.
Very occasionally you may be woken up again before the operation
if there are difficulties in passing a breathing tube.
We would like to reassure you that the risk of remembering any
part of the operation afterwards is now extremely rare.
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Deaths caused by anaesthetic are rare and are usually caused by
a combination of complications happening together. There are
about 5 deaths per million anaesthetics in the UK per year. We
encourage women to have a regional anaesthetic rather than a
general anaesthetic, (if it is safe to do so) as the risk is even lower
for regional anaesthetic than it is for general anaesthetic.
If you are concerned about any of these risks, or have any
questions please speak to your hospital doctor or anaesthetist.
Subsequent pregnancies or further surgery

You may have difficulty in becoming pregnant again
(secondary infertility).

There is an increased chance of you having a Caesarean
birth in your next pregnancy although this is not always
necessary. The obstetrician and midwife will discuss the
possibilities of having a vaginal birth after Caesarean (VBAC)
depending on the reasons for your earlier Caesarean.

If you have a Caesarean birth and need a hysterectomy later
in life you are at an increased risk of bladder damage at that
time.
If you are concerned about any of these risks, or have any further
queries, please speak to your hospital doctor.
Alternative option
Your consultant has recommended this procedure as being the
best option.
However, the alternative to a Caesarean section is a vaginal birth.
If you would like to discuss this further, please speak to your
consultant or one of the midwives caring for you.
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Preparing for the operation
The Antenatal Clinic will give you a date for the birth, and whilst
every effort is made to keep to this date, it may occasionally
necessary to change it. We will also give you a provisional time as
this may be affected by how busy the labour ward is. You will have
a blood test to make sure you are not anaemic, and you will be
asked to sign a consent form to say you understand what the
operation involves. We will also take nose swabs for MRSA.
You will be given information about the types of anaesthetic
available. For most women a regional anaesthetic will be
recommended. If you have any questions, please do not hesitate to
raise them with the anaesthetist when you come into hospital.
The day before your planned Caesarean birth
You will be given a tablet called ‘Ranitidine’ to help lower the
amount of acid in your stomach. Take the first tablet between
8.00am and 10.00pm the day before you come in. Take the second
tablet around 7.00am on the morning of the operation.
If your operation is planned for the morning, please do not have
anything to eat after midnight. You should drink small amounts of
water until 6.00am. This is to make sure your stomach is as empty
as possible before the birth.
If your operation is planned for the afternoon, you should have
a light breakfast eg. tea and toast at about 6.00am, you should
drink small amounts of water, black tea or coffee (but not milk) until
11.00am.
Please do not wear lipstick or nail polish/false nails as these items
can make it difficult for the staff to look after you safely and check
on your well being.
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The day of your planned Caesarean birth
Unfortunately, we cannot guarantee a time for the operation.
Sometimes morning operations cannot be carried out until the
afternoon, and rarely planned afternoon operations may not take
place until the next day. This is usually due to emergencies that
need to be dealt with.
In exceptional circumstances you may be contacted 1 or 2 days
before your admission if we need to change the actual day of the
operation.
You will usually be asked to come into hospital on the day of the
operation. Please come to the Labour Ward for 7.30am. You will
see a midwife, a surgeon and an anaesthetic doctor and you are
welcome to ask any questions you may have.
If you are diabetic, the arrangements will be slightly different but
will be discussed with you fully.
If you are having a Caesarean birth because your baby is breech
(bottom first), an ultrasound scan will be done. If baby has turned
and is head first, the way baby is to be born will need to be
discussed as in most cases a vaginal birth is the safest for both
mother and baby.
You may need to have a small area at the top of your pubic area
(bikini line) shaved (you may wish to do this yourself at home). You
will be given a theatre gown to wear.
You will not be able to eat or drink anything until after the
operation. If there is likely to be a delay, you may be offered a drink
of water in the meantime.
Your midwife will walk to the operating theatre with you and your
birth partner.
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A member of the theatre team will meet you and your birth partner.
The ODP (Operating Department Practitioner) will introduce
themselves to you and will then ask you the following questions:

Your name, address and date of birth - the relevant details will
be checked with your wrist band.

When you last ate or drank anything.

What, if any, allergies you have eg. antibiotics, drugs, latex
etc.

If you have any caps or crowns on your teeth.

If you have signed a consent form for the procedure - the
theatre staff will also check that it is your signature on the
consent form.
Although someone else may have already asked you this
information, it is important that the theatre staff recheck it.
When my anaesthetic is carried out where does my birth
partner go?
If you are having a general anaesthetic, your birth partner will not
be able to come with you into theatre; however they will be able to
wait outside.
If you are having a regional anaesthetic, your birth partner can
normally come into theatre with you. He/she will be asked to
change into theatre clothes (the same as the doctors and midwife).
The midwife will show your birth partner where to get changed.
Information for your birth partner - it is important that you
remove all outer clothing leaving just your underwear, and then put
on theatre trousers and a top, as it is very warm in the operating
theatre! Please take any valuables into the theatre with you or lock
them away.
Once your birth partner has changed, they will be able to join you in
theatre. Occasionally for medical reasons this is not possible but
that will be discussed with you both in full.
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During the operation
Once inside the theatre you will be helped up on to the operating
table. A small amount of local anaesthetic will be injected into the
back of your hand to numb it before a cannula is inserted. This is
so we can give you fluids and drugs through a drip directly into a
vein (IV).
We will need to monitor your blood pressure, heart rate and oxygen
levels. This will mean having a blood pressure cuff placed around
your arm, some leads on your chest and a clip on your finger.
What happens if I am having a regional anaesthetic?
The anaesthetist will put on a sterile gown and gloves. When he/
she is ready the preparations for the anaesthetic will begin:

Your lower back will be cleaned with a very cold solution.

The anaesthetist may then feel your lower back to find the
exact place where they will site the spinal anaesthetic.

A small amount of local anaesthetic will be injected into your
back, this may sting a little. Once it has worked the area will
feel numb.

The spinal needle will then be sited, you should only feel
pushing or pressure.

Once the needle is in the correct position, the anaesthetic
solution will be injected and the needle will be removed.
Your midwife will stay with you during this time.
We will then lie you down on the operating table. A guard rail may
be put in place on the left side of the operating table and then the
table will be tilted to the left so that you are not lying completely flat.
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What happens next?
Once the anaesthetic is effective, the midwife will place a small
tube (catheter) into your bladder to ensure that it remains empty
during surgery.
The midwife will listen to the baby’s heartbeat.
The anaesthetist will then check that the anaesthetic is working
correctly.
Fabric boots will be placed onto your legs and feet to massage
them during the operation. This is to ensure that there is constant
flow of blood in your legs to reduce the risk of blood clots.
Your abdomen will then be washed with a skin cleansing liquid and
sterile sheets will be placed on your body (below your chest area).
A screen will be put up around the chest area so that neither you
nor your birth partner sees the surgery.
The sensation of the regional anaesthetic is very strange; during
the operation you will be able to feel touch and possibly pulling or
tugging, but you should not feel pain.
Music!
There is often a CD player available in theatre and you are
welcome to bring your own CD to be played during your operation
(this is at the discretion of the surgeon and anaesthetist).
What happens when my baby is born?
When your baby is born, he/she will be shown to you and then
checked by your midwife and paediatrician (if one is present). You
or your birth partner will be able to hold your baby soon after that.
When the obstetrician has finished the operation, you will be
transferred to a bed, and moved into the recovery room where your
birth partner will be able to stay with you. Now is your chance to
have a cuddle and ‘skin to skin’ with your baby. You will stay in this
room until you are moved - usually to Ward 314 and usually within
the hour.
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Can I take a camera into theatre?
Yes you can take a camera to theatre, to enable your birth partner
(or midwife) to take photographs of your baby once he/she has
been born. We do ask that you do not take photographs of the
operation. Staff are usually happy to take photographs of you, your
baby, and birth partner if you would like. It is not a suitable
environment for taking videos.
What happens if I have a general anaesthetic?
If you have a general anaesthetic, your birth partner will not be able
to accompany you into theatre, however they will be able to wait
nearby. You will be taken into theatre and an intravenous drip will
be placed in your hand/wrist. You will then be asked to lie down,
there will be a guard rail at your side, and the operating table will
be tilted to the left.
A mask will be placed over your face to give you oxygen and then
the anaesthetic will be given into your drip. You will be asleep
throughout the operation.
Once the anaesthetic is effective, the midwife will place a small
tube (catheter) into your bladder to ensure that it remains empty
during surgery.

Once your baby is born and has been checked by the midwife
and paediatrician he/she will be taken out to your birth partner
until the operation is finished.

When you have woken up from your anaesthetic you will be
taken into the recovery room for up to 1 hour where you may
be able to cuddle and ‘skin to skin’ with your baby before
being taken back to Ward 314.
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What happens during the Caesarean birth?
The baby will be born within a few minutes of the operation starting;
however you may be in theatre for up to 1½ hours.
The wound is closed either with dissolving stitches, stitches or
clips/staples that require removal after 5 - 7 days.
The wound will then be covered with a dressing.
You may have a tube (drain) into the cut to drain away excess fluid.
This is usually removed within 24 hours of the operation.
An antibiotic will be given into your drip during the operation to help
prevent infection later - remember to let the midwife or doctor know
if you have any allergies.
Where will the scar be?
A Caesarean birth will always leave a scar as the operation
involves making a horizontal cut about 15 - 22cm long (usually just
below your bikini line). Rarely it is necessary to make a vertical cut
from below the tummy button down towards the pubic hair.
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After the operation
Pain relief
To help with pain relief a suppository (special tablet) may be placed
into your back passage after the operation, but only if you give
permission for this. The pain relieving effects can last for several
hours.
The painkiller given with the regional anaesthetic (into your back)
lasts for about 12 - 24 hours after the operation. It can cause
sickness and itchy skin in some people. It is very effective so you
may only need additional tablets by mouth afterwards.
If you have had a general anaesthetic you may be given PCA patient controlled analgesia. You control the amount of the
painkiller you receive by pressing a button when you need it. You
cannot give yourself an overdose as there is a built in time lock.
All these methods will be discussed with you before the operation.
You may feel pain and discomfort for a few days. Painkillers are
always available, so please tell your midwife if you need something
to help relieve the pain.
Nausea and vomiting
You may experience nausea and/or vomiting, but the anaesthetist
or midwife will be able to give you something for this.
Mobilising
It is important to move around as soon as possible to help prevent
blood clots forming in your legs. The staff will ensure you receive
help to get up within a few hours of the birth, but if you need
painkillers first, please ask.
The staff will help you find a comfortable position for yourself and
for when you feed your baby.
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Bladder care
Your catheter can be removed once you are mobilising,
approximately 12 - 18 hours after the operation.
Eating and drinking
Once you are able to tolerate fluids and have passed urine, the drip
in your arm/hand will be removed. This is usually within a few hours
of the birth. Many women do not feel like eating the same day, but
you can have something light to eat depending on how you feel.
This is usually offered in the evening if you had your baby in the
morning or breakfast the next day if your baby was born in the
afternoon.
Wound care
The dressing on your wound will be taken off the day after your
operation. It is important to try to keep the wound clean and dry,
but you can still have a bath or shower. Your midwife will usually
remove the stitches or clips around 5 days after the operation,
unless you have a dissolving stitch.
Going home
You will normally be able to go home 2 - 3 days after the birth of
your baby, if all is well with you both. Please do not hesitate to
discuss any queries or concerns you may have before you go
home. Occasionally you may go home earlier if all is well with you
and your baby, you can discuss this with the obstetrician, but it is
important to ensure you have support at home.
Getting back to normal
You should continue gentle exercises at home (see below).
It is advisable not to have intercourse (sex) until your vaginal
discharge has stopped (usually 2 - 3 weeks after the birth) and you
feel more comfortable. Your wound may be tender for some time
after the birth. It is important to consider contraception, please
discuss this with your GP.
Please make an appointment with your GP for your postnatal
check-up approximately 6 weeks after the birth.
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Posture and lifting
After your Caesarean it is important that you stand tall and walk
tall! There will be a tendency to walk bent forward but this will put
extra strain on your back.
Ensure that you maintain a good sitting or lying posture when you
are feeding. A towel or pillow in the small of your back will help to
support you and may help to alleviate backache. Placing a pillow
on your knees will bring your baby up towards you preventing you
from slumping forwards to feed and providing a more comfortable
feeding position.
For the next 6 weeks you should avoid lifting anything heavier than
your baby. You should avoid all heavy lifting for 3 months.
When you do lift make sure that you bend with your knees and not
with your back!
Sports and exercise
Walking is a particularly good exercise after your Caesarean. Begin
with a short 10 minute walk and then gradually build up your
exercise tolerance as able.
Swimming is also very good and can be started once you have had
your 6 week check-up (to ensure that your wound has healed).
Pregnancy hormones can still affect your joints for up to 6 months
(or for as long as you are breast feeding) after the birth so
competitive and high impact sports should be avoided during this
period. Strong tummy exercises should be avoided for 3 months.
Driving
The usual recommended time for you to start driving again is 6
weeks. This will depend on your rate of recovery and how well you
feel. As a guide, you should not drive until you can comfortably
wear a seatbelt, can comfortably look over your shoulder and turn
the wheel and perform an emergency stop without undue pain.
If you wish to drive, we suggest that you check with your car
insurance company to see if they have any restrictions for people
following major surgery (they may refuse to meet a claim if they
feel you have driven too soon).
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Exercises after your Caesarean birth
You will have been given a leaflet during your pregnancy called
‘Safe exercising in pregnancy and early motherhood’ which also
has information on postnatal exercises after a Caesarean.
Your midwife/physiotherapist will advise you to continue them once
you go home.
Breathing exercises
After your Caesarean it is important to take regular deep breaths,
especially if you have had a general anaesthetic. Deep breathing
exercises are a good way to expand the bottom parts of your lungs
and will also help to loosen any phlegm.

Take a deep breath in through your nose and hold for
3 seconds.

Slowly sigh the breath out.

Repeat this exercise 3 - 4 times every hour until you are up
and walking about.
If you feel the need to cough, support your stitches and bend your
knees up towards your chest. If you are sitting then support your
stitches and lean forwards.
Circulatory exercises
In order to maintain circulation and reduce ankle swelling we
advise you do regular leg exercises.

Pull your feet up towards you and then point them away
briskly.

Circle your feet around in one direction, then the other.

Repeat for 30 seconds every hour.
Avoid crossing your legs.
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Getting in and out of bed (see diagrams in the ‘Safe exercising
in pregnancy and early motherhood’ booklet)
We advise you to get in and out of bed through ‘side lying’ for the
next 6 weeks to prevent pulling on your abdominal muscles.
To do this:

Bend your knees one at a time - keep your feet flat on the
bed.

Gently roll onto one side.

With your upper hand push your top half up off the mattress
whilst gently allowing your feet to drop to the floor.
Abdominal exercises
The following exercises can be started the day after your
Caesarean.
They are gentle exercises that will help to relieve any backache or
wind pain and will also help you to regain your body shape.
Your abdominal muscles form a corset, which support your back
and pelvis. During pregnancy these muscles have been stretched
and weakened and are further weakened during your Caesarean.
Exercising these muscles as soon as possible will help to
strengthen them.
If any of the exercises cause pain, discomfort, your wound to
leak or become red and inflamed, stop the exercises
immediately and seek professional help from your midwife in
the first 10 days or your GP.
The following exercises have the same starting position - lying as
flat as possible, knees bent up and feet flat on the surface. Ensure
that they are done slowly and with control, keeping your back as
flat as possible throughout.
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1.
Pelvic tilting
Pelvic tilting can be done in lying or standing:
a. Lying
Pull the lower part of your
tummy upwards and
inwards. Feel the hollow in
the small of your back and
try to flatten it out onto the
bed. Hold this position for
a few seconds then relax.
Keep your breathing steady as you do this exercise.
b. Standing
Standing against a wall with your knees slightly bent and your
feet apart, tighten your bottom and tip your pelvis up so that
your lower back is flat against the wall. Make sure that the
movement is coming from your pelvis and that you are not
simply tilting your shoulders backwards and forwards.
2.
Knee rolling
Push the small of your
back firmly into the bed
and slowly roll both
knees over to the right,
bring them back to the
middle and relax. Repeat
to the left. Keep your
back flat against the
surface and breathe steadily as you do this exercise.
Begin by doing 3 - 4 of these exercises twice a day, gradually
building up to 10 of each.
Exercises 3 and 4 can be started 7 - 10 days after your Caesarean
or when your clips/stitches are removed. Do not do them if you
have neck pain.
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3.
Curl-ups I
Push the small of your back firmly into the bed. Place your
hands on your thighs, reach towards your knees and, as you
do so, lift your head and shoulders to look at your knees.
Lower your head slowly. Ensure that your back is kept firmly
pressed down. Breathe steadily.
4.
Curl-ups II
When you have mastered Curl-ups I, start by reaching your
right hand towards your left knee as you curl up across your
body. Repeat with left hand to right knee.
Begin by doing 2 - 3 of these exercises twice a day, gradually
building up to 10 of each. Continue all 4 exercises for a
minimum of 6 weeks.
If during exercises 3 and 4 you notice any ‘bulging’ of your
tummy then inform your GP. If this is the case you may
require further physiotherapy to help bring your tummy
muscles back together to prevent backache in the future.
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The pelvic floor
The pelvic floor muscles act like a ‘hammock’, stretching from the
pubic bone at the front of the pelvis to the base of the spine at the
back.
Pelvic floor exercises can be started once your catheter is
removed and you have passed urine for the first time.
Spine
Uterus
(womb)
Bladder
Bowel
Pubic bone
Cervix
Coccyx
(tail bone)
Urethra
(bladder opening)
Vagina
Anus (back
passage)
Pelvic floor
Pelvic floor muscles can become weak and sag due to pregnancy.
Weakness of the pelvic floor may result in:

Leakage of urine when you cough, sneeze or laugh.

A ‘prolapse’ of the uterus or bladder through the weakened
vaginal walls.
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
Lack of bowel control.

Back or pelvis pain.
Pelvic floor exercises help to strengthen the muscle. The more
you exercise the stronger they get.
Pelvic floor exercises can be done lying, sitting or standing with
legs slightly apart.
1.
Imagine that you are trying to stop yourself from passing wind
and passing water. Squeeze and lift your pelvic floor. Try to
hold this contraction for 5 seconds then relax. Repeat 5 times.
Gradually build up to holding for 10 seconds and repeating 10
times. These are called slow pull ups.
2.
Try to pull these muscles up quickly and tightly then relax.
Repeat 5 times and build up to 10 times. These are called
fast pull ups.
Do these exercises 6 times a day. Try working these exercises into
your day eg. every time you put your hands in water, after every
time you have been to the toilet or every time you are feeding your
baby. Do these exercises for the rest of your life!
References
Caesarean section. National Institute of Clinical Excellence (NICE) 2011
Your anaesthetic for Caesarean section, OAA October 2012
If you have any queries, or require further information
about your planned Caesarean please telephone
Ward 314 (Maternity) on 01332 785620.
For more information regarding anaesthesia or Caesarean birth
visit www.rcoa.ac.uk or www.nice.org.uk or
www.labourpains.com/ui/content/content.aspx?id=46
If you have any queries, or require further information
about physiotherapy exercises please telephone 01332 789632.
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www.derbyhospitals.nhs.uk
Trust Minicom 01332 785566
Reference Code: P1874/0669/07.2015/VERSION8
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