Caesarean section

More information Obstetric interventions Induction Augmentation Active management Prostaglandins Artificial membrane rupture Fetal monitoring Forceps delivery Ventouse Episiotomy Cascade of Intervention Reference Material A Guide to Effective Care in Pregnancy and Birth Pursuing the Birth Machine Obstetric Myths versus Research Realities Care in Normal Birth The Thinking Woman’s Guide to a Better Birth Other Resources Useful Websites

This is the delivery of the baby through a surgical incision made in the abdominal wall and the lowest part of the uterus.

When is it necessary?

• Pre-eclampsia (hypertensive disorder)
• Fetal distress
• Failure to progress in labour - often the result of a failed induction
• Malpresentations, such as shoulder or brow
• Prolapse of the umbilical cord
• Antepartum haemorrhage, due to the placenta separating early
• Placenta praevia - the placenta is located over the cervix
• Disproportion - the baby is too big to fit through the pelvis
• Severe intrauterine growth retardation - the baby is growing poorly
• Multiple pregnancy - more than 2 babies
• Very large baby
• Fetal abnormality

Caesarean operations are also sometimes suggested for the following conditions, although research supports vaginal births in these cases. The risks from the Caesarean have to be weighed against any potential gains for the baby.

• Breech
• Previous Caesarean section
• Twins
• History of infertility
• Previous neonatal death
• Maternal age

How is it done?
There are two types of Caesarean births:

• Elective - a complication occurs during the pregnancy which indicates a vaginal birth is inadvisable.

• Emergency - a complication arises during labour, which requires immediate action.

Types of anaesthesia:

• Epidural: the most commonly used anaesthesia unless there is a real emergency. The mother will be awake during the operation and can see and hold her baby straight away, unless the baby's condition requires urgent treatment. With an epidural, suction noises and changing internal pressures and tugging (but no pain) may be felt as the baby emerges. See epidural section for details on how this is administered.

• Spinal anaesthetic: similar to an epidural, but faster acting and of shorter duration. Used in emergency situations as an alternative to an epidural. Further details below.

• General anaesthetic: used if an emergency develops requiring immediate operation. The mother will be completely unconscious.

• The pubic hair is shaved and the area cleansed.

• A catheter is passed into the bladder to keep it empty.

• An intravenous drip line will be set up into the back of a hand.

• A blood pressure cuff is attached to give a continuous reading.

• The area will be surrounded with sterile drapes, and a drape will be erected as a screen so the operating area is out of sight of the mother.

• If the anaesthetic is to be an epidural or spinal time, is taken to ensure that it is completely effective.

• If a general anaesthetic is being used the mother will become unconscious very quickly.

• When anaesthesia is complete, an incision is made through the lower abdominal wall usually on the bikini line.

• The bladder is lifted back, and the uterus is opened.

• The amniotic fluid is sucked from around the baby after the membranes have been opened.

• The baby is lifted from within, sometimes using forceps if the head is tightly wedged in the pelvic cavity.

• If an epidural or spinal has been used, at this stage the baby can be seen emerging and the first cries will be heard. It may be possible to hold the baby.

• As the baby is being born, an injection of Syntometrine is given to help the placenta to separate. This is then lifted out, and the wound stitched.

• Following the surgery the mother is taken to the recovery area and the baby may be taken to the nursery for observation. Support people can go with the baby to make initial contact.

Effects on the mother
Advantages:

	1.	A Caesarean may be necessary to save the life of the mother, or to get the baby born.
	2.	A lower segment Caesarean is less prone to complications later, heals well and the scar becomes invisible. The caesarian operation itself does not preclude a later vaginal birth.
	3.	The use of epidural or spinal anaesthetics make it possible for mothers to be awake and aware during the birth to see and hear the baby born. This greatly facilitates bonding and post-operative recovery.

Disadvantages:

	1.	A Caesarean section doubles the risk of maternal mortality.
	2.	Since a Caesarean is abdominal surgery there are risks of damage to other internal organs and blood vessels.
	3.	Caesarean section carries a risk of infection, which may prolong the hospital stay, interfere with the establishment of breastfeeding and delay post operative recovery.
	4.	Side effects of the anaesthetic used must be considered. See separate entries for details of epidural and spinal anaesthetics.
	5.	Women have been shown to have lower fertility rates following Caesarean section.
	6.	The mother who has been unable to deliver vaginally can feel very disappointed. Even though she is no less a mother, she will need comfort and support from those around her if she is to be able to accept this unexpected outcome to her pregnancy.
	7.	Separation of mother and baby may be the usual practice after a Caesarean, although the time involved may vary according to hospital routine and the health of mother and baby. If the baby must stay in the nursery, the mother can be taken to the nursery in a wheelchair, to see and touch her newborn.

Effects on the baby
Advantages:

	1.	On occasion, a Caesarean may be life-saving for the baby.
	2.	A Caesarean may be less traumatic for the baby than a difficult vaginal delivery, especially if the baby's health is at all in question.

Disadvantages:

	1.	Depending on the reason for the Caesarean, the baby may already be at risk, and therefore extra treatment and observation may be necessary.
	2.	The baby may be adversely affected by the anaesthetic used.
	3.	The baby may be accidentally cut as the incision is made.
	4.	The baby born after an elective Caesarean may be premature, and is more likely to have difficulties with breathing because of the absence of the stress hormones produced by the baby during a normal labour.
	5.	Early separation of the mother and baby may interfere with bonding.
	6.	The baby is less likely to be breastfed during this period of separation.