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All your pregnancy questions answered

What is a caesarean section?

In this procedure, a doctor makes an incision in a woman's abdomen and uterus and removes her baby through it.

Why might I need a caesarean delivery?

Doctors often don't decide to perform a c-section until labour has begun, but that doesn't mean it's an emergency procedure. Most commonly it's something the medical staff simply couldn't anticipate until labour was underway.

A woman may have an unplanned surgical delivery for several reasons, including:

• The cervix stops dilating (arrest of dilation) or the baby stops progressing down the birth canal (arrest of descent in labour) and appropriate attempts to stimulate uterine contractions to get things moving again have failed.

• The baby's heart rate becomes irregular and the doctor determines (if she is unable to correct the situation) that the baby may not be able to withstand continued labour and a subsequent vaginal delivery.

• The umbilical cord prolapses, or slips through the cervix, where it becomes compressed, thus decreasing the baby's oxygen supply.

• If there are signs that the placenta is starting to separate from the uterine wall, a c-section is done because the baby will be in danger, as well as there being bleeding from the mother.

Under what conditions would I have a planned c-section?

Sometimes it's clear that a woman will need a cesarean even before she goes into labour. Some of the conditions that may necessitate a planned c-section include:

• There is a maternal history of invasive uterine surgery such as having had a fibroid removed [myomectomy]

• The baby is in a breech (bottom first) or transverse (sideways) position. (In some cases, a breech baby may still be delivered vaginally.)

• There are three or more fetuses.

• The mother has a low lying placenta or a placenta praevia (when the placenta is implanted so low in the uterus that it blocks the baby's exit through the cervix).

• At the time of labour, the mother is having an outbreak of genital herpes, which could be passed along to a baby delivered vaginally.

• A mother's hypertension is rapidly worsening, making it dangerous for her to delay delivery.

• The baby has a known fetal illness or abnormality that would make a vaginal birth risky.

• The baby is expected to be very large, especially in the case of a diabetic mother or if the mother had a previous fetus of the same size or smaller who suffered serious trauma during delivery.  

What should I expect during a c-section?

If the c-section is unplanned but not an emergency, your doctor will explain why she has decided to do one, and you will be asked to sign a consent form. The next thing to expect is a visit from an anaesthetist, who reviews with you various pain-killing options. It's rare these days to be given general anesthesia, which would knock you out completely, except in emergency situations. More likely, you'll be given an epidural or spinal block, which numb the lower half of your body.

A catheter is inserted to drain urine during the procedure, and an IV started. Anesthesia is administered and the staff raises a screen so you won't have to see the incision being made. If you'd like to witness the moment of birth, ask them to lower it — slightly, so you see all but the most explicit details.

Once the anesthesia takes effect, the doctor usually makes a small horizontal incision in your skin above your pubic bone (called a bikini cut), and then makes a second cut in the lower section of your uterus. Then, it's time for your baby to make his entrance. The doctor eases him out, lifting him so you get a glimpse of him before he's handed off to be cared for by a pediatrician or nurse. While the staff is examining your baby, the doctor delivers the placenta. You will be awake [if you are not given GA] and could talk to your doctor as well as the anaesthetist.

 After this your wounds will be closed. Then, finally, while being wheeled into the recovery room, you can hold your baby. Once there, you should try to breastfeed, if possible. You may find it more comfortable if you both lie on your side and face each other.

Why a spinal anaesthesia and not general anaesthesia?

This is one of the most common questions that we face just before a caesarean section. lot of patients are apprehensive that a spinal anaesthesia [SA] could give rise to back pain later. This is untrue and there are a number of benefits of SA.

• If you are given general anaesthesia [GA] then it also affects your baby and it may take some time for your baby to cry after the delivery

• GA is more risky for you in case you have vomiting during the procedure

• With SA you are awake and can see your baby as soon as the paediatrician has finished his examination

• You will have a better recovery and less nausea and vomiting with SA

• SA does not cause any long standing back pain

In fact most patients who were initially reluctant to have SA find after the procedure that they were very comfortable with the SA and really have no regrets

How will I recover after a C-section?

• At this hospital you will receive  intravenous fluids for about 24 hrs after the surgery. However if all is well you will be allowed to drink clear fluids within 6-8 hours after surgery.

• You will be helped to walk the day after your surgery

• You will have your urinary catheter as well as the IV line disconnected 24 hrs after surgery

• You will be fit for discharge between the 3rd and 4th day after surgery if your baby has been discharged by the paediatrician

• You will usually have no externally visible stitches and would not routinely need a stitch removal

• You will have your dressing removed between the 5th and 7th day and you may bathe normally after that

This all applies to a routine and uncomplicated case of course.

Your next delivery

Will your next delivery have to be by caesarian section? Not necessarily- if your c-section was for a "non recurrent" indication you may try for a VBAC [vaginal birth after caesarian section]. By non recurrent I mean a reason such as fetal distress where your baby's heart rate had dropped and that was what made you require a c-section. This is a reason that need not HAVE to happen the next time. However if your caesarian was done because your baby was not fitting into your pelvis then it is very likely that you will have a repeat c-section a your next delivery. This is because second babies are usually larger and if the first baby was not fitting then it is highly unlikely that a larger second baby would.