Elective and emergency c-sections
Sometimes, with all the will in the world, a vaginal birth just isn't possible. In this case your baby will be born via caesarean section, or c-section as it's often known. There are two types of c-section: elective caesarean and emergency caesarean.
An elective caeserean is one that takes place before labour begins. In many instances, you will have had time to discuss it with your midwife/ obstetrician beforehand, so you'll know the date when it's scheduled to take place and can plan accordingly.
Reasons for an elective caesarean section include:
- You've previously given birth by caesarian and it's felt that it would be safer for you to do so again.
- Multiple pregnancy - you're expecting twins, triplets or even more.
- Your baby is too big or your pelvis too small for a vaginal birth to be successful.
- Breech presentation - your baby is upside down in the womb, so he or she would be born bottom first rather than head first. While you can give birth vaginally to a breech baby, it makes for a much more difficult birth that may require intervention. Many hospitals have a policy of elective caesarean section at 38 weeks gestation for all breech presentations.
- Transverse presentation - your baby's position means that his or her shoulder will enter the birth canal first. As with breech presentation, this can make giving birth vaginally very difficult.
- Some serious medical conditions - such as diabetes or high blood pressure - can put you at greater risk during a vaginal delivery.
- Placenta praevia - this a condition where the placenta is covering part or all of your cervix and is blocking your baby's exit route.
- Placenta dysfunction - your baby is no longer getting the oxygen and nutrients he or she needs, and so - depending on how far into your pregnancy you are - he or she may be better off out than in.
- Antepartum haemorrhage - you have been bleeding heavily during your pregnancy.
- Previous vaginal tear - if you tore badly during a previous labour it may be decided that it would be safer for you to not undergo another vaginal delivery.
- Infectious disease - some infectious diseases, such as HIV and herpes, make a caesarean the best way to deliver your baby.
- Severe pre-eclampsia - if the condition is so serious that your health and that of your baby is being threatened, the baby may need to be delivered quickly.
And, of course, you may have your own reasons for opting for an elective caesarean, such as a previous injury.
An emergency caesarean is one that takes place during labour because of complications - although this doesn't necessarily mean you'll suddenly be whisked into an operating room with alarms blaring.
Depending on circumstances, you may have adequate time to weigh up the pros and cons of continuing with a vaginal birth, before deciding that having a caesarean is the most sensible route to take.
Reasons for an emergency caesarean include:
- Your baby is in distress and not coping well and needs to be delivered quickly.
- Your labour is failing to progress or progressing incredibly slowly. Sometimes it can take an incredibly long time for your cervix to dilate enough for your baby to be born - this can be completely exhausting for both mum and baby.
- Placenta abruption - the placenta is beginning to peel away from your uterus wall. This is potentially very dangerous because of the risk of haemorrhage (uncontrolled bleeding) and other complications.
- An unsuccessful assisted delivery using forceps or ventouse.
- Your baby has not moved into the birth canal - either the baby's too big or your pelvis is too small to delivery vaginally.
Caesareans take place in an operating theatre. Don't expect this to be a one-on-one affair: there will be a whole host of people including the surgeon (obstetrician), an anaesthetist, various assistants, several nurses and a paediatrician. Providing the operation is being carried out under a spinal or epidural anaesthetic, your partner can usually be present too.
First off you'll be prepped for surgery: this involves the epidural or spinal anaesthetic being sited in your back, a catheter being inserted into your bladder, and a drip being put into your arm or hand so you can have extra pain relief or fluids if necessary.
What can I expect from a caesarean?
Once everything's in place, a screen will be placed across your abdomen so you don't have to watch what's going on. In some hospitals you do have the option of looking up into an overhead mirror so that you can have a bird's eye view of proceedings if you should want to. It's probably not for the squeamish, but it can be an extraordinary experience to watch your baby's birth in this way.
The surgeon makes an incision of about 20cm across your lower abdomen, and then a second cut into your womb. Then your baby is lifted out through the skin. The womb is easily opened and from the first cut to your baby's arrival takes a matter of minutes.
The paediatrician will quickly check your baby to see how he or she is doing and then, providing all's well, hand him over to your partner. But if there are any concerns your baby may need to be moved immediately to the special care baby unit.
While all this is going on your surgeon will deliver the placenta and close the incision, using dissolving stitches or staples.
Providing there are no complications, the whole thing usually takes around half an hour or less. You'll then be moved to a side ward where a midwife will attend to you and your baby. If you plan to breastfeed, now's a good time to have a go if you feel up to it.
In some circumstances, a caesarean takes place under general anaesthetic, so you won't be aware of a thing. But in most instances, you'll have either a spinal or epidural anaesthetic, so you should feel virtually numb from about your chest down.
While you won't feel pain, you will certainly feel some pressure as the operation takes place and your baby is delivered.
A c-section is considered a safe operation for you and your baby, but it's major surgery and there are risks involved. The main ones are that you might bleed heavily at the time or surgery or - following delivery - that your wound will become infected or you will develop a blood clot (thrombosis) in your leg veins.
According to the National Instititute for Health and Clinical Excellence (NICE) compared with a vaginal birth, a caesarean increases the risk of the following:
Pain in the abdomen • Bladder injury • Injury to the ureter (the tube connecting your bladder to your kidney) • Needing further surgery • Hysterectomy • Admission to an intensive care unit • Developing a blood clot • Longer hospital stay • Readmission to hospital • Having no more children • Death of the mother
This all sounds pretty terrifying. But every birth is different and these risks don't apply to everyone; they're dependent on you and your circumstances. Your obstetrician and midwife will discuss all this with you - providing time allows - and take all the appropriate measures to reduce your risk of complications.
However, according to NICE findings, compared with a vaginal birth, you are no more or less likely to suffer:
- Infection of the wound or lining of the womb
- Injuries to the womb or genital organs
- Bowel incontinence
- Postnatal depression
- Back pain
- Pain during sexual intercourse (obviously, this is after you've left hospital)
And you're less likely to experience:
- Pain in the perineum
- Bladder incontinence three months after the birth
- Womb prolapse
As far as your baby's health is concerned, there's no increased or decreased risk (compared with a vaginal birth) of rare complications such as injury to the nerves in the neck and arms; bleeding inside the skull, cerebral palsy or death.
However a c-section does increase the chance of your baby experiencing breathing difficulties at birth: about 35 of every 1,000 babies born by c-section experience this, compared with five out of every 1,000 babies born by vaginal birth.
There's a very useful thread of Mumsnetters' tips and advice if you're having a caesarean (or have had one when you weren't expecting to), covering everything from shaving off your pubic hair beforehand to doing a poo afterwards.
Caesareans come in for a lot of critical press and there's genuine concern among many midwives (and mums) that one in four births in the UK is by caesarean. This is reflected in Talk, where there's a lot of (heated) debate about vaginal vs caesarean births.
Trouble is, if you've spent nine months planning a water birth at home (or a hospital delivery) and end up having major abdominal surgery instead, you've got enough complex emotions to handle without feeling that, in some obscure way, you've failed.
As one mum puts it: "Being a mum is difficult enough without being made to feel like you have to justify your birthing method."
If you end up having a non-elective caesarean and don't really understand why, make sure you get someone to explain. There's no point feeling you didn't push hard enough, or somehow didn't make the grade, if actually it would have been a physical impossibility for you to give birth vaginally.
There are plenty of occasions for maternal guilt, but this isn't one of them. You gave birth. Congratulations.
What Mumsnetters say about having a caesarean
- My first caesarean was an emergency after a failed induction, three days of absolute misery with vaginal examination after vaginal examination, pessaries, waters broken, drips running and only getting to 4cm before my baby decided he had had enough and so his heartbeat first dipped and then raced so they had to rush me off for an emergency section. It took me more than two weeks to be fully mobile afterwards. Whereas my second son was breech and so I had an elective section, had him at 8.50am, up to ward by lunchtime and moving around by my bed demanding that my catheter be removed by mid-afternon, a wholly more positive experience. lvickiyumyu
- In theatre there will suddenly be a LOT of people who you didn't know existed. Also as the drugs wear off you shake a lot, which I found scary and thought I was going to die! But it is apparently normal and if I had known that I would shake (a LOT!) then that would have helped. My tip in case you end up with a section is to be as fit as possible beforehand - I was - by doing a lot of swimming - and it really helped with the muscle recovery. SingingBear
- It's absolutely bizarre that while they anaesthetise the area to numb pain, it doesn't actually numb sensation, so you can actually feel them rummaging around inside you! It didn't hurt, it was just strange, like someone pulling washing out of the washing machine! mrsbabookaloo
- I had a back operation 10 years ago. I wasn't too posh to push, more like too scared to push, so they agreed to the section. Elesbells
- Turns out the little wotsit had the cord wrapped round him so could have been there a month of Sundays and not got him out. Was desperately upset about not pushing him out until my midwife pointed out that in previous times, babies with the cord round them were the ones they lost. This brought me swiftly to my senses and made me realise that as long as we were both OK it didn't matter how he arrived. Then, to really cheer me up, she looked at me, smiled naughtily and stage whispered 'remember - you'll always be honeymoon fresh down there because of it' and gave me a wink. Love that woman. tokentotty