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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, or c-section.
There are two types: elective caesarean and emergency caesarean.
What is an elective caesarean?
A c-section 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.
You may have one if:
You've previously given birth by caesarian and it's felt that it would be safer for you to do so again
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
Your baby is breech, so would be born bottom first rather than head first
Your baby's position means that his or her shoulder will enter the birth canal first (transverse presentation)
You have a serious medical condition which could put you at greater risk during a vaginal delivery
You have severe pre-eclampsia and your health and that of your baby is being threatened
You have an infectious disease, such as HIV or herpes
You have been bleeding heavily during your pregnancy
You have placenta praevia - a condition where the placenta is blocking your baby's exit route
You have placenta dysfunction - when your baby is no longer getting the oxygen and nutrients they need
You tore badly during a previous labour and it's been decided that it would be safer for you to not undergo another vaginal delivery
What is an emergency caesarean?
A c-section 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.
You may have one if:
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, which can be exhausting for mum and baby
You have a placenta abruption - where the placenta is beginning to peel away from your uterus wall - with the risk of haemorrhage and other complications.
You've had 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 deliver vaginally
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What happens during a caesarean?
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 present 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 there too.
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.
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.
While you won't feel pain, you will certainly feel some pressure as the operation takes place and your baby is delivered.
The paediatrician will quickly check your baby to see how he or she is doing. If there are any concerns your baby may need to be moved immediately to the special care baby unit. If all is well, they'll be handed over to your partner.
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.
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