What To Expect During a C-Section
C-sections are one of the most common surgeries performed in the world.
The World Health Organization recommends c-section rates in any country should be 10-15% to provide life saving benefits to mothers and babies (after which point, it no longer saves lives). Yet, in many countries the rate is at least double that. Around 1% of women choose elective c-sections, showing the high numbers of surgery isn’t the result of patient desire.
A c-section section is an operation that enables your baby to be born through an incision made in your abdomen.
A c-section birth might be necessary for the health and safety of you and your baby. This decision does not mean that you can’t have an empowering and positive birth experience. Having a c-section birth plan helps you to communicate what your needs and preferences are with your obstetrician, so that you can work together to ensure your wishes are respected. In this way, you can have an empowering and positive c-section birth, even if a c-section isn’t what you had hoped for.
Knowing what happens during a c-section can help you prepare a c-section birth plan.
Elective And Scheduled Versus Emergency C-Section – What’s the Difference?
Only around 1% of women have an elective c-section, which is a c-section chosen without medical necessity. This is a procedure planned to take place before labour begins. Medically indicated c-sections are also often scheduled to take place before labour begins, this is dependent on the indication for a c-section (e.g. placenta previa, fetal position, etc).
An emergency c-section is the term used for a c-section that occurs after labour has begun. Most of the time, an emergency c-section is not an emergency, rather it’s an unplanned procedure. In some situations there is an urgency to deliver the baby as quickly as possible but this is not always that case.
Regardless of the reason why a c-section is taking place, the procedure is a straightforward one that rarely deviates from a set schedule. The actual surgery takes around 10 to 15 minutes, and another 30 minutes to stitch the incision.
Preparation For A C-Section
You’ll be gowned up and taken into theatre while your partner or support person also gowns up. Most hospitals have a strict policy that only one support person can be present in theatre, though some are more relaxed. If a general anaesthetic is required, no support people will be allowed in the theatre. If you feel strongly about having your doula or birth photographer present, it’s a good idea to find out what the hospital policy is early on so you can make the request.
You’ll have an IV inserted for fluids and drugs to prevent low blood pressure, as well as administer pain relief after the surgery.
Next a form of anaesthesia is administered. This is either an epidural or spinal block. This makes the lower half of your body completely numb but you will still be awake. You will be asked to sit up and lean forward into a curve, so the needle can be inserted into your spine and the anaesthetic administered. When lying down you will notice the operating table is tilted so you are lying on your left slightly. This to prevent the weight of your uterus reducing blood supply to your lungs, causing low blood pressure.
At this point you will have a catheter inserted into your bladder. Because the anaesthetic can prevent your bladder from working properly, the catheter empties it before the surgery begins.
The incision area will be shaved (if necessary) and cleaned with antiseptic solution. You will have electrodes attached to your chest to monitor your heart rate and possibly a finger monitor. A cuff will be placed on your arm to monitor blood pressure. A special sticky plate will be attached to your leg – this acts as an earth for the electrical equipment being used.
Some hospitals routinely put compression stockings onto women having c-sections and administer medications to avoid blood clots from occurring.
A screen will be raised so you are unable to see the surgery, however if you’re really keen, a mirror can be set up so you can watch. As your baby is being born, the screen can be lowered so you can see your baby – ask for this if it’s not offered. Some hospitals are now using clear screens, though this is a newer option that is only now beginning to be used.
The anaesthetist will check if the epidural or spinal block is working and how far up the numbness is. You will have a number of staff in the theatre, including the obstetrician performing the surgery, paediatrician to check the baby once born, nurses, and midwife. It’s not uncommon for staff to chat and if this bothers you, it’s a good time to request discussion focuses on keeping you informed.
Your partner/support person will come into the theatre and will sit next to you near your head.
An incision about the length of your middle finger is made into your lower abdomen, just above your pubic hairline. This might feel like pressure on your skin but you should not feel any pain – if you do let the anaesthetist know immediately.
Layers of muscle will be separated and tissue opened so the surgeon can reach your uterus. Your bladder will be moved out of the way so an incision can be made into your uterus. The amniotic fluid will be suctioned out.
You may feel quite a lot of tugging and prodding as the baby is moved into position. The surgeon will lift the baby out through the incision. If the baby’s head is stuck in the pelvis, forceps may be needed to pull the baby out.
In many cases the cord will be clamped immediately, though delayed cord clamping during a c-section is becoming an option in some cases. After the cord is cut you’ll be able to see the baby briefly before the paediatrician takes the baby to a table for observation. The paediatric team will check baby’s vital signs, and possibly use suction to clear airways of mucus.
While baby is under observation, the obstetrician will remove the placenta and suction out the uterus, removing blood clots etc, as well as check your reproductive organs. Your baby can be brought to you for a cuddle and then the midwife will take the baby to the nursery with your partner or support person.
Continuous skin to skin in the theatre and during recovery is another option that is growing in popularity. When mother and baby are in good health and they have stable vital signs, this may be a safe and gentle option to improve the birth experience for both. Discuss this option with your provider prenatally, as well as before the c-section occurs.
The closing of the incision can take around 30 minutes. Absorbent stitches are used on the uterus incision and either stitches or surgical staples will be used on the external incision. You may be given antibiotics to reduce the risk of infection and artificial oxytocin to contract your uterus and minimise the risk of haemorrhage.
You’ll be taken to recovery and depending on your hospital may be able to bond with your baby. If your hospital doesn’t have a maternity recovery ward you may have to wait 1-2 hours until you’re given the all clear to go to your room, where you can have your baby brought to you if all is well.
The Different Types of Incisions Used for C-section Sections
Transverse Incision (LUSCS)
The most common type of incision used is made on the lower part of your stomach, just above your bikini-line, and is referred to as a transverse incision or LUSCS as it cuts through the lower fibrous part of your uterus to deliver your baby. This part of your uterus heals very well, and involves less blood loss, so it’s the preferred incision site.
It’s rare to need a classical incision during a c-section. This type of incision runs vertically (up and down) your uterus. It’s normally done either because your baby is premature, the uterus has not stretched enough to allow a LUSCS to be performed, because the baby is lying crossways in the uterus, or the placenta is in the way. A classical c-section is only used in these specific circumstances because this approach is associated with a greater blood loss, and may not heal as strongly as a LUSCS, leading to an increased risk of uterine rupture during future births.
‘T’ or ‘J’ Incision
There are other rarely used incisions, entitled ‘T’ or ‘J’ incisions because of the shape of the incision. These are the result of a LUSCS incision unexpectedly being inadequate to deliver the baby. The obstetrician extends the uterus incision in a ‘T’ or ‘J’ shape to increase its size and allow delivery. Usually the baby is in an unusual position, such as a transverse lie (sideways across your belly). The increased risk of uterine rupture involved in birthing vaginally after a previous classical, T or J c-section need to be thoroughly discussed with the professional caregivers involved, and acknowledged by the mother.
The type of incision used on your skin ‘usually’ indicates the type used on your uterus, but not always. A classical incision on your uterus may have been done after a ‘sideways’ incision was done on your belly, and vice versa. The only way you can be sure what type of internal incision you have is to check with your doctor.
What Sort of Anaesthetic is Used During a C-section Section?
The dose of anaesthetic used during a c-section is very finely tuned. This is to reduce the amount of drug that may be passed through the placenta to the baby. So, although the mother should feel no pain during the surgery, it’s common to feel tugging or pulling sensations as your baby is being removed from your uterus.
The most common type of anaesthetic used during a c-section is a spinal. This involves injecting an anaesthetic drug into the actual spinal fluid, which surrounds the spinal nerves and cord. This method of anaesthesia is faster acting than an epidural, and is given in a single injection, whereas an epidural dose can be adjusted.
The other type of anaesthetic commonly used during a c-section birth is an epidural. In this case the local anaesthetic drug is injected into the epidural space, which contains the spinal nerves and their blood vessels.
Both a spinal and an epidural enable the mother to remain awake during the surgery, and therefore be aware of the birth of her child, participating in this important life experience.
The epidural catheter, which is a fine plastic hollow tube through which the anaesthetic is administered, is often left in place for the first day after the c-section. This enables immediate pain relief to be given, directly into the epidural space, when requested by the mother.
Some anaesthetists will use a spinal/epidural technique, which gives fast action and allows for postoperative pain relief.
Using one of these types of anaesthesia, rather than a general anaesthetic has other benefits than being awake to welcome your child. It also avoids the risk of vomiting under general anaesthesia and breathing this into your lungs.
The drugs used for epidurals/spinals also have the side-effect of relaxing the blood vessels in your lower body, below the spot on your spine that they were injected into, which may cause your blood pressure to drop, but it also contributes to less blood loss during the surgery.
Once the spinal/epidural has taken effect, the urine catheter is inserted, and your bladder emptied. This reduces it in size and thus helps protect it during the surgery. This may remain in place until the morning after your c-section, when you will be able to walk to the toilet and take care of this need yourself.
Spinals and epidurals do in themselves carry some risk. Between 1 to 10% of women experience severe headaches after the spinal/epidural. Some women have suffered injury to the spinal cord and other severe effects but these are very rare (between 1 in 3000 and 1 in 2 million). Your anaesthetist can further discuss these risks with you.
General anaesthesia, where you are actually ‘put to sleep’ during the c-section, is usually only used when an extreme emergency occurs (i.e., cord prolapse, uterine rupture). It’s avoided, where possible, due to the drug’s ability to pass through to the baby and make him/her drowsy.
If it should be necessary, this is what may happen. A drip is inserted in your arm, heart monitor dots are placed on your chest and you are tilted onto your left side to remove the weight of your uterus from your major blood vessels, which supply vital oxygen to your baby. Then a mask, flowing oxygen, is placed over your mouth and nose to boost your oxygen levels before proceeding with the surgery. A rapid-acting anaesthetic is injected via the drip, in your arm. You may get a metallic taste in your mouth depending on the drug used.
As you lose consciousness you may feel the nurse pressing on your neck, just below your Adam’s apple. This blocks your oesophagus, to prevent the risk of your vomiting. Another drug is then given to relax your muscles and a breathing-tube is placed in your throat, through which anaesthetic gases are given to keep you asleep. A longer-acting muscle relaxant is also administered.
After your baby has been born, a narcotic is often given to aid your after-surgery pain relief, and at the end of the operation a drug is given to reverse the muscle relaxation. The anaesthetic gases wear off quickly, and the tube is removed when you start to awaken, and begin to swallow or cough.
You may be given antibiotics, to avoid infections, and a drug that thins your blood, to help prevent the possibility of blood clots forming in your legs.
Even after a general anaesthetic your baby will often be able to stay with you and your partner in recovery with your midwife whilst you wake up fully. This may not always be possible, however, and if your little one does have to go to the nursery, you should be able to meet her/him very soon. Staff will make every effort to make sure of this, and you can remind them if they seem to have overlooked the importance of this monumental meeting!
Some women report difficulty in bonding following a c-section, especially when general anesthesia is used. This may happen due to separation during recovery, not feeling their baby be born, or especially when the mother is unable to witness the birth due to general anaesthesia. Not all women will report this feeling, but for those that do it can be troubling. Fortunately, healing can occur with lots of skin to skin, breastfeeding and taking time to process the experience.
Suture Materials Used in Your Skin Wound
Your obstetrician will probably have a preference for the method of stitching the skin wound. It could be a dozen or so individual stitches or metal clips across the wound (they look like staples), or a single, continuous stitch running just under the skin. This latter type of stitch may be of absorbable material so that it dissolves over a few weeks, or be non-absorbable and need removal – usually on about the fifth post-operative day. If you have your own preference for the type of skin suture, discuss it with your doctor beforehand, so that it can be negotiated.