Elective and Emergency Caesareans - The Facts

Babies born by caesarean (C-section) come out through incisions made in your uterus and abdomen. If you decide to have a caesarean, or more likely, you're advised to have one in advance of labour, it's called an 'elective' caesarean. One that takes place after you've already gone into labour is called an 'emergency' caesarean.

Reasons you might need a caesarean include:

• Your baby's head is too big to fit through your pelvis
• The shape or size of your pelvis makes a vaginal birth difficult
• The placenta is lying low in the uterus (placenta praevia), blocking your baby's exit
• You're expecting twins or triplets (one of whom may be in a difficult position)
• Your baby's lying across the uterus, or is breech (bottom or feet first)
• Once labour has begun, your baby becomes distressed (suffering from a lack of oxygen) and isn't far enough down the birth canal for forceps or ventouse
• You have eclampsia or severe pre-eclampsia
• You're ill, have high blood pressure, or become exhausted in labour

How will it be done?
You'll be given an anaesthetic (if you haven't had one already). The anaesthetic used is almost always given as an epidural, which allows you to stay awake. Occasionally, a general anaesthetic is used.

If you're conscious, you can have someone with you in the operating theatre. In most cases, neither you or your companion will be able to see what's going on, as a screen will be placed across your abdomen.

The surgeon makes an incision in your lower abdomen, just above your pubic hairline, and cuts through the uterus. The baby is then helped out. Most women feel quite a bit of tugging and pulling when this happens.

Once the baby is delivered, the cord is clamped and cut. If everything's OK, your baby will be handed to you. The placenta and the membranes are then delivered and you are stitched up. The whole experience takes about 45 minutes.

What is the recovery like?
It's normal to feel very tired for a few days after a caesarean and you may experience some pain, just as you would with any abdominal operation. You will be given pain relief to help with this. Check with your doctor.

Recovery after a caesarean can take longer than a vaginal birth. There may also be after-effects, such as infection, which is why you'll probably be advised to take antibiotics.

In the first day or so, you may be attached to a tube that collects any blood pooling under the scar. A drip in your arm makes sure you remain hydrated. At the very beginning, you may also need a catheter or bedpan to help you urinate.

The sort of stitches you have may vary too. They may dissolve or need removing later, or you may have clips that will need removing once you've healed.

In most cases you will be advised not to lift heavy objects until you have had your post delivery check up. Always check with your doctor prior to leaving hospital.

How will I feel?
Some women feel disappointed at having an emergency caesarean. If you feel like this, talk to the medical staff about the reasons why a caesarean was necessary. Understanding this can sometimes help you come to terms with it.

You may have no negative feelings at all about your caesarean. This, too, is normal.Caesarean is classed as major surgery, but you may still be surprised by how much it hurts afterwards. You will undoubtedly feel very weak.

Trapped wind is another problem, especially by about day three - tightening the abdominal muscles on an outward breath helps expel the gas. Peppermint water helps, and will be available in the hospital, and you could also try the homeopathic remedy Raphanus 30.

It may hurt to cough or laugh, but less if you support your wound (with your hands or by holding a pillow over your stomach) as you do so.

Wearing knickers that are a size bigger than you really need (or boxer shorts or special knickers made from stretchy gauze and available from the NCT) may make the wound feel more comfortable, and you'll need to use sanitary pads because the lochia, or bleeding from the uterus, is the same as after a vaginal birth.

What will my scar look like?

The vast majority of caesareans are what's called 'lower segment section', which means your scar runs horizontally along your bikini line. At first it may look quite red and sore, but as time goes by it will gradually fade - as with most scars. Some homeopaths suggest taking Arnica for several days after your delivery, to help the healing process.

Will I be able to breastfeed?

There's no reason why you shouldn't breastfeed after a caesarean. Sometimes the pain from your scar may make things a bit more difficult to start. Keep trying different positions until you are comfortable. Lying on your side may be easier than sitting up. If you do sit up to feed him, tuck his legs under one arm and use your other hand to guide his head towards your nipple. Do make sure you move the baby to the breast, not your breast to the baby, or you'll end up with back and shoulder ache as you lean forward. Use plenty of pillows to lift the baby up to the right level.

What happens when I'm home?

You normally stay in hospital for about three days. It may take your body up to six months to recover after a caesarean and many women say they don't feel 'back to normal' for up to a year. You'll probably be advised not to drive for five or six weeks. You will probably be taught to start gentle postnatal exercises soon after your operation. You should not start a more strenuous exercise programme until six to eight weeks after delivery.

Subsequent births
You may be able to have a vaginal birth in the future, depending on the underlying cause of your caesarean.

There's no evidence that 'once a caesarean always a caesarean'. There's a very small risk that the scar on your uterus might start to rupture when you go into labour, but with proper care this can be spotted before it becomes a problem.

Too many caesareans?
There's some controversy about the number of caesarean performed: the total is rising year on year. The climate of 'over-medicalisation' of childbirth and fear of litigation if a vaginal birth goes wrong are thought to be among the reasons for the rising trend.

Statistics from the Department of Health show that one in four babies is born by caesarean in England, with many regional variations. In 1980, the number of caesareans in England was much lower, at nine per cent.

Can I choose to have a caesarean?
You won't automatically be given a caesarean on request, at least not on the NHS. But your doctor should listen to your reasoning. If your doctor and midwife are reluctant to grant your request, it may be because they feel there's no medical reason for it.

visit: www.nhs.uk