C-section: emergency or whatever’s best for you

Whether it is planned or carried out in an emergency, a C-section is a major operation which requires a team of medics in the operating theatre. Here Polly Ferguson, consultant midwife at Betsi Cadwaladr University Health Board, guides parents through the

Why do we get so exercised about the rights and wrongs of having a caesarean section? After all, it’s a procedure that has saved the lives of many mothers and babies.

From a clinical point of view, having a caesarean is serious abdominal surgery. Why would any woman with a healthy pregnancy choose this if there is no medical reason?

The argument often goes something like “If you want an experience, go to Disneyland. If you want a healthy baby, do whatever works.”

The most important thing is that you have a healthy baby, but it is very possible to have a healthy baby and a good birth experience, whether that’s through having a caesarean or a normal birth.

What’s really important is that you are as well informed as possible, and to ask your midwife and obstetrician any questions you need to make the right choice for you. labour progressing too slowly, your baby showing signs of distress, or a placental abruption where the placenta comes away from the wall of the uterus. How you prepare for a caesarean section depends on whether you’re having an elective or emergency procedure.

Obviously with an elective, there’s a much greater opportunity to make plans in advance and fully prepare, both physically and mentally, for what is a major operation.

You will meet with an anaesthetist to discuss your anaesthetic options. Most caesareans are now carried out with a spinal anaesthetic – a one-off injection in the lower spine that works quickly and provides enough relief for the whole operation.

Some caesareans, around one in 10, are performed under general anaesthetic.

General anaesthetics provide additional challenges compared to a spinal or epidural, and are not recommended unless you do not want to be awake during the operation, or you have a medical problem that prevents you having a spinal or epidural.

A day or two before surgery, routine blood tests will normally be provided with medicine to reduce the acidity in your stomach to take at home the night before.

Your anaesthetist will explain exactly what will happen on the day and ask you to sign a consent form.

You will then be asked to go into hospital early on the morning of the operation.

Just before your operation, you will be helped to change into a hospital gown and a midwife or healthcare assistant will check that you are not wearing nail varnish, contact lenses or jewellery.

A midwife will usually take you to the operating theatre where the anaesthetist will put in your spinal or epidural anaesthetic.

An intravenous drip will be inserted prior to the spinal or epidural injection. If you’re planning on having another baby, it’s important to know 75% of women who have had a caesarean section

Your birth partner will be able to stay with you and will be asked to change into theatre clothes, though if you have a general anaesthetic they will usually be asked to stay outside the operating theatre.

A midwife will also be present, whose role is to support you and monitor the baby’s heartbeat.

There’s no change in procedure if you have an emergency caesarean – the only difference is that it all happens much quicker, and there will be more people involved to ensure you’re prepared safely for surgery. Both emergency and planned caesareans are done in a similar way.

In the room with you and your partner are usually a midwife, two obstetricians, a theatre nurse and assistant, an anaesthetist and assistant and, once the baby is about to be

born, a paediatrician.

If you are awake, a screen will be placed near your head so you can’t see the actual operation, and your anaesthetist will be by your side to make sure don’t feel pain during the operation.

If you have had a general anaesthetic, you won’t be aware of anything until you wake up.

The obstetrician will carry out the surgery and your baby will be born very quickly, within about five minutes. It will take about half an hour to stitch your wound.

If you have had a spinal or epidural, the midwife will hand you your baby straight away, unless your baby needs any help with breathing or has other problems.

In this case a paediatrician may need to take the baby to the special care baby unit.

Your baby can have skin-to-skin

contact with either you, or your birth partner, as soon as they are born, and it is also possible to breastfeed your baby while still in theatre.

If you have had a general anaesthetic, your baby can be given to your birth partner in a room outside the operating theatre. Normally, you will be taken to another room where your midwife will stay with you to make sure there are no problems and you will be taken to the postnatal ward after about two hours, if you are well recovered. Your birth partner can stay with you and your baby.

You will be given painkillers and recommended to wear tight stockings to reduce the risk of blood clots.

If all is well, most women are ready to

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