Lengthy answer alert!
Can't speak for the private v NHS part but:
Assuming you choose to have/are medically safe to have an epidural...
- You will come into theatre or the anaesthetic room for your epi (hospitals vary). This is an injection into the spine, done between two vertebrae. Don't worry too much about this, I had MASSIVE needle phobia and handled it fine :)
- You will be laid back on the trolley with a wedge under one side to tilt you over a little - this can feel a little unnerving but it's just to make sure that your arteries aren't being squished by your uterus and so the dr doesn't have to stretch so far...
- The anaesthetist should at some run some tests to check the epi is working. One I used to work with did this by holding cold cans of drink onto the skin to see how far up the block was working, another did it with the tip of a ballpoint, others tended to just stroke or poke with a finger. They will not allow anyone to get further into the op than this until they are happy you are completely without feeling from the point of epi downwards. This being said, people are different and some can take longer for it to work on than others and in some cases it can start to lighten. The anaesthetist (or at very least an ODP/ODA) will be at the 'head end' all through the op and if you start to feel more than you could a few minutes before, TELL HIM. He's not going to tell you you're being silly, he's going to do something about it, or at the very least, monitor it to before doing so if it's necessary. The spinal canula (sp? - also not sure of its correct term) will stay in place and there will be a spot just by your head where it can be injected into. In my case, it was August and HOT and the drugs were very cold going under my back and it was bloody lovely
- Once they are certain you're good to go, the scrub nurse(s) will prep you. This will involve swabbing over your abdomen with sterilising solution (usually Betadine, sometimes Chlorhexidine, can vary by doctor's preference), then draping you to make you a 'sterile field'. You'll be covered in green/blue sheeting which at the head end will be tacked up onto two drip stands so you spend the op staring at about a two foot high wall of sheet, if that makes sense! You can ask for this to be lowered when they get baby out, it just depends how much you want to see! You really can't see much from the head end anyway, sheet up or down - don't worry, you're not going to be looking at your innards! Over your abdomen they'll fix a sticky see-through sheet so they can see where they're cutting. Never did figure out why they bothered though...
- An incision is made (assuming you're having what is called a lower segment caesarian) across the top of your bikini line. They cut down through the layers (could be more explicit here but will only do so if asked) until they get into the uterus. A machine called 'diathermy' is used to help - this is electrical current applied to cauterise and cut at the same time, limits bleeding. It can whiff a little, but it's nothing to be alarmed about. Once they get into the uterus, anyone standing at the foot of the trolley gets soaked in amniotic fluid (I was that soldier - you only stand there once...) and they then dig the baby out. If it can be done by hand, great, but it's quite common to use forceps to get a good grip. All you should feel at any point is pushing and pulling - it's quite peculiar, like all the kicks and somersaults you've felt since 20ish weeks being done by about 100 people, but shouldn't be any sharp pain. Again, anything that's not a dull tugging sensation, tell your anaesthetist.
- Baby should be out, and here's where I can't speak on ELCS. I've seen plenty but in every single case the baby is handed straight to the midwife to take over to a resuscitaire (don't freak on the resus part of that name, it's just a little heated table with resus kit in it) to be checked over, make sure s/he's breathing etc, in case the airways need a little suction to clear them, stuff like that. This is normal, doesn't mean there's anything wrong, and the baby won't cry immediately 100% of the time. That knowledge doesn't stop the few seconds between baby coming out and hearing the first scream being the LONGEST in your life! People on here talk about being able to do skin to skin straight away, but I honestly have never seen it done. I only worked in the one place though, so it may just have been local policy - or no-one ever knew to ask!
- Baby will be handed to you all nicely bundled up in a blanket or two and you will be stitched up (some doctors prefer to use stitches for the top layer, others staples, others glue). Again, here's where I can't speak for ELCS - for my EMCS I was taken down to the postnatal high dependency unit, with baby wheeled down in a hospital crib, while they made sure I was ok - but this may be EMCS only. You will (or should) need three injections over the next few days of anti-coagulant to stop unnecessary clotting. They will want to keep you in a good few days to administer these injections and to make sure there's no post-operative complications.
As far as the catheter goes, I can't remember at what stage of the prep this goes in, but it will be in place before they operate. A tube is inserted into your bladder and a tiny balloon at the top of this is inflated to stop it coming out. It basically means that you don't need to pee while it's in, all urine just goes straight into a bag at the end of it. This serves two purposes: it makes sure the bladder is empty and therefore not in the doctor's way when they're digging around, and it also means that they can check for blood in the urine post-op without asking you for a sample every ten minutes. I can't recall how long mine was in - but my abiding memory of it is 'don't hang the bag off the door of your bedside cabinet and then walk off forgetting you've done that because it bloody well hurts!'
I think that's it all covered. Obviously if you have a GA, all the prep's the same, you're just asleep! Also, I think it varies by hospital, but to the best of my knowledge most will allow your DP/DH/SO/Birth partner in with you if you have an epi - but not if you have a general. Anything else?