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Caesarean birth

Why do I need a caesarean?

There are situations where the safest option for you and/or your baby is to have a caesarean birth. Your obstetrician will explain why a caesarean birth is recommended for you and discuss with you any possible risks and side effects. Do not hesitate to ask questions as it is important to make an informed decision.

A caesarean birth planned in advance is called an elective caesarean birth. An unplanned or emergency caesarean birth may be necessary if complications develop and the birth of your baby needs to happen quickly.

What are the risks?

A caesarean birth is major surgery. Complications are rare but can be serious.

Potential risks associated with a caesarean birth for women include:

  • increased blood loss
  • wound infection and breakdown
  • blood clots in your legs (DVT)
  • pulmonary embolus (a blood clot that moves from your leg to your lungs and is very dangerous)
  • potential damage to organs near the operation site, including your bladder
  • increased likelihood of needing a caesarean with your next baby
  • slower recovery due to having a major operation.
     

Potential risks associated with a caesarean birth for babies include:

  • breathing difficulties – this is significantly reduced if your baby is born after 39 weeks
  • being cut with scalpel during the operation (very rare)
  • bruising to the face or head due to the use of forceps, if required.
     

Potential risks associated with a caesarean birth for future pregnancies include:

  • increased likelihood of needing a caesarean with your next baby
  • placenta being low (praevia) and/or placenta grows into the uterus (accreta); this would require a repeat caesarean section for the next delivery and blood transfusion may be needed.
  • the scar on your uterus may rupture in future pregnancies or in labour. This may require your uterus to be taken out (hysterectomy) as a life saving measure.

What type of anaesthetic will I have?

The anaesthetist will discuss with you the most appropriate anaesthetic for your situation and also discuss the risks and benefits so that you can make an informed decision.

The options are:

  • spinal or epidural anaesthetic – you will be awake for the operation, but should not feel any pain; although you may feel some pressure and pulling or tugging
  • general anaesthetic – you will be asleep during the operation.

Click on this link for some frequently asked questions about these anaesthetics during a caesarean birth.

Can I have a support person with me?

If you are awake during the operation you may have one support person with you in the theatre. Your support person will be required to dress in theatre clothes and will sit next to you during the operation. However, if there is a complication during your surgery it may be appropriate for theatre staff to ask your support person to leave.

If you need a general anaesthetic, your support person can come with you to the operating theatre but will be asked to wait in the recovery room until you arrive there after your surgery.

How long does the caesarean take?

The operation usually takes about 30 to 40 minutes; if you are awake, the doctors and midwives will talk to you and tell you what is happening.

Can my support person take photos during the caesarean birth?

Your support person can take photos, but you must discuss this with your doctor before the surgery and ask permission of the staff that may be included in any of the images. Filming is not generally permitted, therefore; you must have consent from all staff involved prior to the birth.

What happens after my baby is born?

Your baby will be checked by a midwife, paediatrician, or neonatal doctor and if possible you will be able to cuddle your baby and even have skin to skin contact while still in the operating theatre.

Skin-to-skin contact with your baby after a caesarean birth is important and, where possible, the midwife caring for you throughout your caesarean can help you to do this safely. Your baby should be naked against your skin and will have warmed blankets placed over their back and a hat placed on their head. Skin-to-skin contact helps your baby to stabilise their temperature and your baby’s instinctive response to breastfeed is increased in the first two hours after birth. Skin-to-skin contact during this time increases these responses and the likelihood that your baby will attach and feed well at the breast.

Your midwife or doctor may ask you if you wish to have immediate skin to skin contact. This means baby is placed on your chest as soon as baby is born. This is not always possible if baby requires immediate attention at birth or if there are any anaesthetic concerns. If it is suitable, it is your choice whether to have immediate contact with your baby or whether you would prefer baby to be checked, cleaned and dried first.

What can I expect during my recovery

Pain

Your anaesthetist will prescribe pain medication suitable for you. Your pain will be assessed regularly by asking you to score your pain with a number where zero equals no pain and 10 equals the worst pain you can imagine. The aim is to manage your pain so that you are comfortable enough to care for both yourself and your baby with minimal assistance (i.e. pain score of four or less).

Simple analgesics such as paracetamol (e.g. Panadol) and anti-inflammatory medicines such as ibuprofen (e.g. Nurofen) or diclofenac (e.g. Voltaren) are used to treat your pain while you are in hospital, if you are able to tolerate them. These medicines are often prescribed together, and if taken regularly this combination works well for mild to moderate pain.

If your method of pain relief is not effective, speak to your midwife, doctor or physiotherapist before your pain becomes severe as pain is harder to treat if it gets out of control. It may not always be possible to completely stop pain or discomfort, but it can be improved.

Occasionally, an oral opioid (e.g. oxycodone) may be needed for a short period of time to manage your pain. Your doctor will talk to you about this and prescribe the medicine if required.

For further information about opioid medicines, refer to Mater’s patient information: Understanding and managing acute pain.

Wound care

  • Your midwife or doctor will tell your how to look after your wound and when to remove the dressing.
  • Report any ooze from your wound to your midwife or doctor immediately.
  • Do not use a hair dryer on the wound, as drying the wound delays the normal healing process.

 

Bladder care

If you have a urinary catheter it will be removed as soon as you can feel and move your legs (usually 4 to 6 hours). This will encourage you to move around which will help to enhance your recovery.

Please let your midwife and physiotherapist know if you are having difficulty passing urine, are only passing small amounts of urine, or are having accidental loss of urine.

Mobility and exercises

While you are recovering in bed, it is important to slowly and gently get your muscles working again. Gentle, but regular, stretches and exercises will help you recover faster, as will getting in and out of bed carefully, and caring for yourself and your baby by using movements and activities that do not cause strain or increased pain.

A midwife/nurse or physiotherapist will help you to get out of bed for the first time after your operation as you may experience some light-headedness. If you had a spinal or epidural anaesthesia, your leg movement and sensation will be assessed prior to getting out of bed to ensure that it is safe to do so.

A physiotherapist can assist with mobility and exercise during your recovery.

The physios have also developed some videos that could help with your recovery including:

  • Moving well after a caesarean birth
  • Getting out of bed after a caesarean birth
  • Resting and recovering well after a caesarean birth
  • Reducing pain and strain after your caesarean birth
  • Looking after yourself while you care for your baby (caesarean birth).

Click on this link to access these videos.

When can I go home from hospital?

You should expect to go home as planned by your midwife and doctor; usually from 48 hours after your surgery.

However, some women choose to go home at 24 hours after their caesarean birth under the Home Recovery Care program. This program has been established for women undergoing routine elective caesarean birth to maximise the opportunity for you to return to your usual lifestyle as quickly as possible.

The benefits of recovering at home include:

  • Resting and sleeping more comfortably in your own bed.
  • Increased privacy with greater opportunity for your partner, family and friends to be near and available to you and your new baby.
  • Fewer interruptions, allowing you to rest quietly. In hospital, there are a large number of activities that occur on a regular basis throughout the day and night. These activities can disturb new mothers who are trying to rest or sleep, especially when two mothers are sharing a room.
  • Reduced risk of infection e.g. wound infection or other types of infection.
  • Reduced risk of blood clots as you are likely to move around more when discharged home.
  • Increased patient satisfaction as you will have greater independence than when you are in a hospital.

Will I be able to care for myself and my baby when I go home?

On the day you go home you will be able to independently care for yourself and your baby and understand how to assist your physical recovery. Please discuss any concerns, regarding you or your baby, with your midwife or doctor prior to discharge.

You will gradually be able to return to your full range of activities, usually between two and six weeks after your operation. You should also avoid any heavy lifting while you recover.

A physiotherapist can also help with mobility issues or pain during movement.

You can drive a car when you can comfortably manage full control of the vehicle. This may take three to four weeks; your insurance provider can advise you about this. Remember, you should not drive if you are taking opioid pain medication.

Mater’s Maternity Homecare Program is available to mothers who are eligible for home recovery care. You will be visited the day following your discharge and, depending on your individual needs, you may continue to receive visits as required. The midwives who visit you at home will discuss how you and your baby are progressing. If you have any concerns, your midwife will be happy to help where possible.

What do I do if I have any concerns at home about my baby or me?

Mother

Problem

Other information

Who to call

Blood loss

increasing in amount and changing colour to red (with or without clots)

Call an Ambulance via 000 and ask to be taken to your nearest hospital or Mater’s Pregnancy Assessment Centre.

Difficulty passing urine or regular bowel movements

 

Call 13 HEALTH, your GP, nearest hospital or come to Mater Mothers' Pregnancy Assessment Centre.

 

Possible urinary tract infection

 

Fever or flu-like symptoms

 

Offensive vaginal discharge

 

Signs and symptoms of wound infection

e.g. redness, oozing, increased pain

Spinal/epidural site infection/complications

e.g. redness, swelling and/or increasing back pain at the insertion site, changes in sensation of your legs, changes to bowel or bladder control, headache made worse by standing up

Call 13 HEALTH, your GP, nearest hospital or come to Mater Mothers' Pregnancy Assessment Centre or call the Acute Pain Service at Mater on 07 3163 8111

 

 

Baby

Call 13 HEALTH, your GP, Queensland Children’s Hospital or Mater Mothers’ Parenting Support Centre if any of the following occur:     

  • Baby will not wake for regular feeds.
  • Small number / concentrated wet nappies or irregular bowel movements. 
  • Baby’s skin colour is very yellow.
  • Redness around umbilical cord area.
  • Fever. 

Remember, take a copy of the Matrix Discharge Summary given to you when you left Mater as this will help let other healthcare professionals know what occurred before, during and in the immediate postnatal period after your caesarean birth.

Emergency caesarean birth

It is not uncommon to feel disappointed that you gave birth by caesarean and it is important to remember that there is nothing you can do that causes, or prevents, the need for a caesarean birth. Babies sometimes become distressed in labour and contractions are sometimes not strong enough—but these are not things that you have control over.

Why did I need an emergency caesarean birth

Many women plan a vaginal birth for their baby and end up having an emergency caesarean birth, for a variety of reasons. Your doctor would have explained to you the specific reason for your needing a caesarean birth at the time, but with all that was happening around you, the details may now seem a little unclear and you may have some further questions.

There are two common reasons for an emergency caesarean birth:

  1. Your baby’s condition indicates that they need to be born as soon as possible.
  2. Your progress in labour stopped, even after attempting other treatments (if possible) to see if labour would continue.

There are two reasons why the progress of labour can stop:

  1. The position of the part of the baby trying to come out first is preventing progress because of a poor fit; this situation is specific to this labour and this baby.
  2. Despite the baby being in a good position and contractions being strong your labour does not progress; this situation may recur in future pregnancies.

Other reasons for an emergency caesarean birth are less common and may include complications of mother’s health or concerns about baby’s growth which make it safer to avoid labour and vaginal birth, or you went into labour before your date for a planned elective caesarean birth.

If it is an emergency why doesn’t the caesarean always happen straight away?

When an emergency caesarean birth is required there are guidelines about how quickly this may need to happen which are based on the reason for the caesarean. Sometimes staff will prioritise emergency caesarean births if several women need one at the same time. Usually, the woman and her baby most at risk will go first.

What happens with my next birth?

Most women who have had one emergency caesarean birth can have a vaginal birth in their next pregnancy. In general, it is safe to deliver vaginally after a caesarean and your obstetrician will advise if this is appropriate for you, in your next pregnancy.

There are some factors which can arise in future pregnancies which mean this may have to be reconsidered. In your next pregnancy an obstetrician will discuss your specific circumstances considering both the reason for your emergency caesarean birth, as well as what is happening in your subsequent pregnancy, before you make a final decision as to what you would plan to do.

Women who have had more than one caesarean birth, or those women who have had a classical (different type of incision in the uterus) caesarean birth, would be encouraged to consider an elective caesarean birth next time, without waiting for labour to begin first. This is because in these circumstances the risks of labour and vaginal birth are believed to be greater than those of an elective repeat caesarean birth.

If you have any further questions about what happened this time or what you would be recommended to do in any future pregnancies please ask to speak to your doctors again before going home.

 

Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: PI-CLN-430042
Last modified 04/12/2020.
Consumers were consulted in the development of this patient information.
Last consumer engagement date: 01/9/2020
For further translated health information, you can visit healthtranslations.vic.gov.au/ supported by the Victorian Department of Health and Human Services that offers a range of patient information in multiple languages.
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