The caesarean (C-section) is a major surgical procedure performed when the baby cannot be delivered through the vagina. It is employed if there are health risks to you or your baby.
The procedure involves cutting open the mother’s abdomen and uterus to remove the baby. The incision is usually horizontal, above the pubic hair.
The caesarean is generally done under an epidural or spinal block. The spinal block is similar to the epidural, but the drug is injected into a different region of the spine with only a needle (no catheter) and in a single dose. It allows for a faster anaesthesia. In both cases only the lower body is anaesthetised and the mother remains conscious. In rare cases general anaesthesia is used.
Caesareans may be planned in advance or decided upon during labour if the unexpected occurs. In most cases, the spouse or other person of the mother’s choice may be present during the procedure, which takes place in the hospital.
Reasons to have a caesarean
In Québec, almost one in four women give birth by C-section. There are several reasons that could lead one to a caesarean. These reasons may be related to the mother, the baby, or to labour itself. Below are examples of different situations that may arise.
- When the placenta covers the cervix (placenta prævia)
- In certain cases of breech birth (e.g., the baby presents feet first)
- A previous caesarean combined with obstetric conditions not favourable for vaginal delivery
- The baby is in a position that does not allow for a safe delivery.
- There are concerns about the baby’s health.
- Labour has not moved far enough along.
- The mother has major medical problems.
Possible consequences of a caesarean
Most C-sections go well, but like any surgery caesareans may have consequences.
Short-term effects of a caesarean delivery include the following:
- Abdominal and pelvic pains that may require the use of drugs
- Longer hospital stays, about 3 to 4 days
- Difficulty urinating (use of a catheter)
- The need to have a person present in the hospital room to lend a hand during the first 24 hours • Longer recovery than for vaginal delivery
Since it is a surgical procedure, the caesarean may bring about certain complications: admission to intensive care, infection, bleeding, thrombophlebitis,injury to internal organs, and readmission to the hospital after the birth of the baby.
Over the long term, the caesarean may affect future pregnancies by increasing the risk of a placental disorder (placenta prævia). There is also a small risk of uterine rupture.
Not many significant consequences for the baby are associated with this surgery. Some babies can be injured by the manipulations performed during the caesarean. Likewise, mild respiratory distress is more common among babies born by caesarean. A baby born by C-section may have a lower body temperature. The practice of skin-to-skin contact with the mother or father can help alleviate this situation.
Recovering from a caesarean
At the hospital
You will be able to start breast-feeding and enjoy skin-to-skin contact with your baby right away, or a little later, depending on how you’re doing. It may be more difficult to start breast-feeding after a caesarean due to the pain and discomfort involved in moving. The support of your family and health professionals during this time will help you overcome these difficulties.
At the hospital, you will be encouraged to gradually start walking, drinking, and eating as the effects of the anaesthesia wear off and you feel better. Recovery from a caesarean will be easier if you move about.
You will also have vaginal bleeding (lochia) (see Physical recovery of the mother). While you have lochia you should use sanitary pads rather than tampons.
The pain of the incision and numbness of the skin in the surrounding area may be uncomfortable. The presence and duration of the pain and numbness vary from one woman to another. Your doctor can prescribe drugs for pain relief. The incision will heal in the weeks following childbirth.
Usually a baby born by C-section does not require any special care.
Before you leave the hospital, a health professional will tell you how to care for your wound and will give you advice on dealing with your specific situation. You will also be given tips on how to care for your newborn. Feel free to ask any questions you may have.
You should rest for two weeks following a caesarean but not remain in bed. During this time your activities should be limited to taking care of your baby, your personal care, and moving about as much as possible to ensure a prompt recovery. Having someone around to lend you a hand during this period is helpful.
Once the bleeding and vaginal discharge have subsided you may consider bathing and swimming. It is recommended you give yourself a few weeks before resuming all your activities, such as driving, heavy lifting, certain physical activities and sports, or sexual relations.
Recovery and energy levels vary from one woman to the next and from one day to another. They depend on several factors, such as your baby’s needs, the amount of sleep you get, and available help. The important thing is to be tuned to yourself and not overdo it.
It’s also possible that while recovering from a caesarean you will experience varied, sometimes contradictory emotions. Some women may be relieved to have a healthy baby, but feel disappointed or dissatisfied with their delivery, while others may just be happy they made it through an exhausting and inefficient labour.
Each experience is unique, and the first impressions a woman has after undergoing a caesarean or a difficult delivery can evolve over the years.
When to contact a doctor?
Once back home after a caesarean, contact your doctor right away if:
- You see signs of a possible wound infection (redness, discharge).
- You experience one of the problems discussed in the section Physical recovery of the mother.
Thrombophlebitis : Inflammation of a vein associated with clot formation.