Guide to C-Sections

There are only two ways out for baby – out mammy’s vagina (A vaginal / normal delivery) or out via mammy’s abdomen during a c-section.  This guide gives an overview, in lay mans terms, of c-sections.

With around a quarter of births ending in a c-section they are becoming more common place and even if you are not planning a section it is no harm being prepared for what to expect just in case you suddenly find yourself on the way to theatre.  I mean, I don’t buy car insurance expecting to crash and I recommend every mum to be to prepare for a c-section but expect a beautiful normal delivery if that is what you hope for.

The guide is a general guide on what to expect – it is not intended as a medical explanation, offer any replacement for medical advice or represent exactly what will occur as different hospitals may have slightly varying procedure however as someone who has undergone three c-sections for varying reasons I would like to think I know a few things about them and I share my insights here.

What is a c-section?

Why would a c-section be performed?

What happens before the operation?

What happens during a c-section?

Post Surgery

Your Hospital Stay

Breastfeeding after a c-section

Recovery at Home

FAQ

What is a c-section?

A c-section is the birth of a baby through an incision in the abdomen.  The incision is usually made horizontally just below the bikini line however in certain circumstances a vertical incision may be made.

A c-section can be elective i.e. planned in advance or an emergency when it is performed when something arises during labour that necessitates it.

Why would a c-section be performed?

A c-section would normally only be performed when necessitated by a medical reason which makes a vaginal delivery difficult or dangerous to mother or baby.  In very rare cases a c-section is performed “on request” for a mother who does not wish to undergo labour.

A few examples of situations that may necessitate a c-section include (but are definitely not limited to):

Breech baby – when a baby is the wrong way around it can make a vaginal delivery very difficult or indeed dangerous for baby and often, particularly for a first time mother who has had no previous vaginal delivery, it is recommended.

Placenta Praevia – if your placenta is covering the cervix it will block baby from exiting and make a c-section necessary.

Baby’s heart rate drops – if during labour the baby’s heart rate drops and they cannot get it back up this may necessitate an emergency section to ensure baby’s safe arrival.

What happens before the operation?

If you are attending for an elective section you may have had a number of weeks or months to prepare.  Finally D-day arrives!  You will be nervous but no more or less than anyone arriving at a hospital knowing baby is on the way.  You will be admitted to hospital and brought to your hospital bed.  You will have blood tests taken and sign your consent forms.

You will be given a hospital gown, compression socks and shower hat style head wear.  All very attractive!

You can put your dressing gown and slippers on and will be brought to theatre when they are ready for you.

Preparation for c-section

Ready for theatre

Of course if you are thrust into an emergency section the “pre” part is likely to be a matter of minutes and may all happen in a complete blur with a lot of people and action.  At which point the focus will be on getting baby out and less on any questions or queries you might have so all the more reason for knowing in general terms what may happen.

What happens during a c-section?

A c-section is major abdominal surgery so it will take place in an operating theatre with the operating table, lights, sounds and smells of any theatre.  This can be disconcerting but forewarned is forearmed.

When you arrive at theatre you will be brought to the operating table and your partner will be brought to get changed into surgical scrubs.

If you have not already you will be given an antacid before an IV line will be inserted and you will be connected up to heart / pulse / blood pressure monitoring.  You will then have the chosen anaesthetic administered.  The most common is a spinal block.  This involves sitting up on the operating table and leaning forward while they inject into your back.  This is probably the most un-nerving moment but once administered it acts very fast.

In other cases an epidural will be administered or in the event of an emergency section, if you have already had an epidural it will be topped up for surgery.  In some cases a general anaesthetic (where you are completely knocked out) will be performed.

With the standard spinal block you will feel your legs suddenly feel warm and heavy and the theatre staff will have you move pretty quickly into a lying position and pillows will be placed at your sides.

As the spinal block takes hold the theatre staff make their preparations.  One thing that caught me by surprise (don’t ask me why!) was the fact my surgical gown was lifted up to my chest leaving me lying pretty much naked and unable to move.  I guess I just felt a little vulnerable just lying there for all and sundry but the theatre team just got on with business!  They will wash the area around your bump with iodine.  This solution is ice-cold so if you don’t feel this you can be sure the spinal block is working.  They will also shave around the pubic area.  A catheter is inserted but this should be done while you are numb so you shouldn’t feel any of it.  You will be covered with surgical covers including one draped in front of your face so you are blocked off from the action.  I’m sure most people’s fear is that they will feel it all – but don’t worry they will check that you don’t have any sensation before they begin.

C-section

Ready for baby to be born!

Your partner will be allowed in once all is prepared and they will start.  The consultants will talk among themselves and maybe to you too.  There will be someone near your head monitoring you and as you are hooked up to all the monitors – they will be beeping away beside you.  One of the scariest moments of my life was when the alarms went off during my first c-section.  Of course I have obviously watched too many hospital dramas and thought that was it – I was finished.  Turns out it was just an alarm indicating a drop in blood pressure – which makes sense given they had just made a large incision in me!  I really wasn’t prepared for these type of noises.  The surgeon will make an incision in your skin and then in your uterus.  The bag of waters is broken and as the surgery progresses and the birth of your baby nears you will feel a bit of tugging and pressure but no pain.

Once you have given birth they will show baby to you, the cord is cut and baby take it away to be assessed, cleaned and weighed.  This is done in the theatre so you will be able to hear baby crying and moaning away.  You may wish to have skin to skin contact – if so make sure you request this as otherwise baby will be dressed (you will need to have brought a nappy, vest, baby gro and hat to theatre) before been given to you.  If you want skin to skin contact they will pop a nappy on and place baby on your chest.

C-section

Skin to skin contact after c-section

While all this goes on you will be stitched up.  This takes about 20-30 minutes before you are brought to recovery.

Of course if there are any complications baby will be rushed off for attention – maybe even to the neonatal intensive care unit.  This will obviously be a very emotional and fraught time – if you know this may be a possibility beforehand you will get a chance to discuss what will happen and how best to deal with it on a practical level.  Will your partner be there with baby or stay with you? How quickly can you visit baby? How will you handle feeding? Getting these types of queries out-of-the-way in advance will help deal with the scenario when it happens.

Skin to Skin contact

It’s a girl! Skin to skin contact with newborn

Post Surgery

Once the surgery is complete you will be brought to recovery for anywhere from 20/30 minutes up to an hour where they will monitor you.

Each of my sections my recovery room experience was slightly different.  On my first I had my baby with me but was encouraged to wait to feed until they had brought me to a bed back on the ward.  On my second my husband went off with baby and I was left in recovery on my own.  There was some confusion as to where I was going bed wise so I ended up left there for nearly an hour not knowing where my husband and baby were! On my final section I sat in recovery, curtained off in private with my husband – breastfeeding my baby.  That was the most enjoyable.

Be prepared to start itching.  As the spinal starts to wear off your face (and possibly arms) will start to itch.   Let the medical team know and they may give you something to counteract it.  I didn’t get anything and it did go away after a little bit.  It wasn’t like any ordinary itch  – it was stronger and like a tic – I just couldn’t stop myself bringing my hand to my nose to scratch!

If you have time to plan make sure to plan the recovery room also – ask that you can keep baby with you and that you can start breastfeeding immediately if that is your chosen feeding method.

Your Hospital Stay

Once back in ward and in your bed you will still be numb – it will take about 6-8 hours to regain the feeling.  After about 12 hours they will ask you to stand up and move around a little bit but you will still have your catheter in for approx. 24 hours so there will be no need to get up to go to the toilet.

Once the catheter is out you will begin to feel a little human again.  You will continue to get pain relief – and don’t scrimp on it!  Don’t be a martyr when it comes to taking as much as you are allowed.  For the first 48 hours I was given narcotic based pain relief.  Makes you a little bit spaced out – couple that with the fact you have been handed a new born and tiredness will start to set in it makes for an interesting time!

Bowel wise you may be a little off (to put it nicely).  Constipation is not pleasant so make sure you get a laxative or stool softener while still in hospital.  After my first section I still had not gone by the time I left hospital (they will check with you everyday) so was given some Duphalac before I left which helped but then I backed up again so got some Sennakot once home.  By section two I had a bottle of Duphalac at the ready and things were much easier!  Say no more!

You will likely be in hospital for 4-5 days and by the time you are leaving you should be down to more normal pain killers such as Panadol or paracetamol but make sure you leave the hospital with a prescription for further pain relief and take as required.  Don’t let the pain get on top of you because once it does it is difficult to get back on top of it.

By my third section every time the nurses asked did I need any more pain relief I said yes! Whatever you can give me!  On my first I often declined!

If you had staples to close the wound they will likely be removed before you go home.  This will only take a few minutes but may be a little uncomfortable.

Breastfeeding after a c-section

There is no reason you cannot choose to breastfeed your baby – in fact you have every reason you should give it a try!

The key complications and where things get difficult after a c-section is getting a comfortable position for feeding as you will be sore in the abdominal area.

Also, in the case where it is a planned section, that may take place at 37 or 38 weeks your milk may not be ready to come in as easily but this is easily overcome with making sure to put baby on the breast regularly after birth or if you are aware in advance start some expressing in the days before the section and it may stimulate production.

The key being to seek help if you are experiencing problems.  Get as much support as you can and remember “Every feed counts” so no matter how much or how little you will be doing your baby good.  Take it day by day.

Este pecho es mío

 

Recovery at Home

Once you are home just remember you are recovering from major surgery and you are dealing with a new born too.  Get as much help as you need.  Recruit in family and friends and don’t worry about housework or anything that is not related to baby or yourself.  Avoid any heavy lifting, gentle exercise is okay but listen to your body.  To fully recover you need rest which is difficult with a newborn so the old adage sleep when baby sleeps is important.

In addition to the physical recovery there is the emotional side also.  While most mothers will feel elation at meeting their new baby, the first days and weeks can be a rollercoaster of emotion.  Hormones will be racing and many under-estimate the emotional side of recovering from birth.  For those undergoing a c-section the emotional side can be heightened by a feeling of disappointment, a sense of failure or regret in the birth experience especially for those who really wanted a normal delivery.

It is important for new mums to speak about their feelings and not bottle them up.  Ignore unwanted comments about being “too posh to push” or being lucky not to have to endured labour pain.  Give yourself time to come to terms with your feelings.  Where necessary treat your feelings like a bereavement and work through each stage until you can come to terms with the loss of the birth you wanted.

If you are finding it difficult emotionally after the initial number of weeks seek professional help. Don’t let it get on top of you.  There are trained counsellors able to deal with birth trauma or post natal depression.

FAQ

Can I wear contact lenses during surgery?

I was wearing contact lenses on my second section.  It wasn’t a planned section and it just happened that I was wearing continuous wear lenses when my waters broke.  Of course I didn’t think to take them out before I headed to hospital and then I ended up in theatre and never mentioned I had them in – they didn’t ask either.  So I guess it’s not a problem but if you are worried about leaving them in check with your hospital as varying policy and practice is likely.

Do I need a labour bag?

You don’t need a labour bag if you are going for an elective section however you will still need your hospital bag though – there is very little difference in requirements as you still need all the PJ’s/nightdress and dressing gowns, slippers, toiletries etc for yourself after the birth – whatever way baby emerges.

You will still need your disposable / comfy knickers and maternity pads as you will still experience the post birth bleeding (lochia).

In fact you might need an extra PJ’s / supplies as your stay will likely be a bit longer (usually up to 5 nights).

You will need all the same stuff for baby – nappies, vests, sleep suits etc.

Can I wear my jewellery during surgery?

I did take off my jewellery for the surgery.  On my first they asked me give anything valuable to my husband so I gave him my rings but I think that it was only out of security rather than the actual procedure.  Again this is something that you can check with your local hospital policy. There was a section in my notes to record whether or not jewellery was off.

Can I wear nail varnish?

Always a nice treat for a mum to be before baby arrives is to go and get a manicure or pedicure.  However you don’t want to have your new talons ruined if you end up with a section.  Generally it is a no, no to have any makeup or nail polish on and they will remove it so maybe save the treat for after baby arrives.

Will it hurt?

The actual procedure does not hurt due to the anaesthesia but there is no point in lying – the post birth experience is not pleasant but provided you keep your pain relief up it is totally bearable.  It can be uncomfortable for example going from a lying to sitting position or don’t have people make you laugh too much in the first few days as this can hurt a little – as can coughing.    Just hold onto scar if laughing or coughing to give some support – don’t worry you shouldn’t burst open. I have seen it recommended to use a skipping rope for when at home to pull yourself up and out of bed but only really useful in my view if you have something to tie it on – one of those frame beds. Best way to get in and out of bed is just to roll on side, hang legs out of bed and then get up to a sitting on side of bed position.

When can I drive after a c-section?

A lot of people say no driving for 6 weeks – my obstetrician was a little more relaxed and said to drive when I felt comfortable doing so and initially keep it to just local driving.  After all three of my c-sections I drove around the 3 week mark.  Just locally and I felt ready.  If you don’t feel ready until week ten then don’t drive until week 10.  There are no hard and fast rules but take the advice of your GP or consultant – only they will know how you are recovering.

What about the Scar?

No one wants to be scarred for life but a c-section scar marks the entrance point for your baby so try to be positive about it.  In the early days it will be red, raised and probably a little tender but given time the scar really does settle down and after 6 months to a year you will hardly notice it.  If you had a low bikini cut there will be no issues wearing slinky underwear or bikinis.  The scar will not be noticeable.

What you may notice is a lack of feeling around the scar.  This is where nerves have been damaged and it may take many years for feeling to return and in some cases it may never fully return.

When can I have sex again?

Of course sex is probably the last thing on your mind immediately after having your baby but if you have undergone a c-section you may wonder when is it safe to start having sex again. The general indication would be approximately 6 weeks but of course wait until you feel comfortable.  This may mean having open and honest conversations with your other half to ensure you are both on the same page.  Make sure this is a topic of discussion at your 6 week check up.

Big thanks to my fellow Irish Parenting Bloggers who provided great feedback and reminded me of the things I had blocked out!

I have now gone on to set up a full website dedicated to C-section Mums.  If you have an upcoming C-section, are an existing C-section Mum or just want to be as prepared as possible for the birth of your child then pop over to C-section Mums

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