Caesareans are one of the most common modern medical procedures, with very low mortality rates.
What is a caesarean section?
A caesarean section is a surgical procedure that involves incisions being made in a pregnant woman’s abdomen and uterus to deliver a baby, as an alternative to vaginal birth.
Because a caesarean section is major surgery, it poses the same risks with regards to complications, infection and side effects of anaesthesia, as with any other operation, and it also increases the chance of needing to have a caesarean for a subsequent pregnancy and the susceptibility for ectopic pregnancy due to scarring. So when a doctor suggests a Caesarean should be performed, it is important to be aware of these things and also to understand the reason why it is required.
However Caesareans are frequently performed (recent reports by the National Institute of Health and Welfare found that approximately one in three women in Australia give birth by C-section) making it one of the most common modern medical procedures, with very low mortality rates.
This increase in Caesarean sections is said to be partly due to number of women getting pregnant later in life and the rise of certain chronic illnesses such as diabetes, which can both make a pregnancy more risky.
Who needs a c-section?
There are several types of caesareans:
- Elective caesarean: This is when a caesarean is chosen by the mother, and not out of medical necessity. This can be an option to alleviate anxiety and to give a mother a sense of self-control, especially if previous pregnancies have resulted in a traumatic experience with vaginal delivery (such as an episiotomy) or other emotional reasons.
- Planned caesarean: This is recommended prior to the start of labour where it is deemed to be safer than a vaginal delivery for the mother or the baby due to pre-existing medical conditions such as some infectious sexually transmitted diseases, or medical conditions that develop because of pregnancy such as gestational hypertension or diabetes, pre-eclampsia or an unusually large baby (cephalopelvic disproportion). Having a caesarean in an earlier pregnancy is also a reason a doctor might recommend having a caesarean section.
Generally, planned caesareans are performed when it is very likely that a mother will need to give birth by Caesarean section anyway and it can be scheduled and undertaken as a day procedure, rather than as an emergency caesarean.
- Emergency caesarean: An emergency caesarean is performed after labour has commenced and there are complications, such as haemorrhage, prolonged labour or failure to progress known as dystocia, any sign of foetal distress, cord prolapsed, uterine rupture or increased blood pressure or heart rate due to amniotic rupture, placental problems, abnormal presentation such as breech or tranverse positions, an unsuccessful induction of labour or umbilical cord issues.
Any mother who undergoes a planned caesarean or emergency caesarean for any of the reasons above, to protect her health or the health of her unborn baby, would be considered as someone who needs a Caesarean.
What happens during a caesarean section?
Before a caesarean a mother’s iron levels are checked and a drip is inserted as well as a catheter, once the anaesthesia has set in. Regional or general anaesthesia is administered in the spine and blood-thinning medications may also be given to prevent blood clots from developing in the legs which can lead to Deep Vein Thrombosis. A mother’s blood pressure will be monitored throughout the procedure and electrodes will be applied to the chest or a finger pulse monitor may need to be worn to monitor heart rate. Mothers may also be offered oxygen during an emergency Caesarean if there is foetal distress.
During a caesarean birth it is common for the mother to feel a tugging sensation because although the anaesthesia acts as pain relief, it also enables the mother to remain awake and is managed so that as little medication as possible passes through the placenta and to the baby.
A screen is put up and lowered slightly once a baby is delivered. Generally the incisions that are made are small and below the bikini line unless you have a low lying placenta or are having a premature baby. The umbilical cord and placenta are then removed before the doctors begin to close the incision. A caesarean scar can be stitched up using internal stitches which dissolve away or with major surgical staples, depending on the size of the incision.
After the caesarean is completed in an operating theatre, some time will be spent in a post-operative recovery room before going back to your normal hospital room and antibiotics are administered to help guard against infection. Blood-thinning medications may be continued and oxytocin will be given through a drip to help your uterus contract which diminishes blood loss. You may have a surge or drop in temperature due to the anaesthetic.
What are my options during and after a caesarean section?
During a caesarean you are able to decide the following things:
- Who you take into the theatre with you
- Whether or not you want to be told about the events as they are happening
- Whether or not you want your support person to cut the umbilical cord
- How soon you decide to breastfeed, provided there are no medical complications that require you or your baby to be monitored.
Some mothers can be disappointed when they are required to give birth by caesarean section and may want to attempt vaginal birth in a future pregnancy.
Vaginal birth after caesarean is possible but many people in the medical community are wary of it, as there is a small chance of uterine rupture. Individual obstetricians have varying opinions about it. But repeat Caesareans also increase scar tissue inside the body so both have disadvantages. Double stitching in a caesarean has been said to hold a scar together more strongly but you should speak to your obstetrician about this if you are considering a vaginal delivery. Certainly a vaginal birth after a Caesarean should always be performed in a medical facility where there is access to emergency care.