Caesarean Section

What is a caesarean section?

A caesarean section (CS) is a major operation where the baby is delivered through the mother’s abdomen.  It involves a “bikini-line” cut in your abdominal wall.  The CS is performed in an operating theatre and takes about 40 minutes.

Some CS are planned ahead of time and usually scheduled for 39 weeks.  Common reasons for planned CS include a breech baby, previous CS, twins or triplets, fetal growth problems, maternal medical problems and maternal request.

Emergency CS are performed when an unexpected problem occurs before or during labour.  Reasons can include heavy bleeding, very high blood pressure, a mother who is unwell, fetal distress or a labour that has stopped progressing.

What is caesarean section - dr colin walsh

Will I be asleep or awake during the procedure?

These days, 99% of CS are performed under spinal anaesthesia.  The Anaesthetist places an injection into your lower back, which numbs you from the chest down.  You’ll be awake throughout the operation, which means your partner or support person can be present and you get to see your baby arriving into the world!

CS under general anaesthesia (with the mother asleep) is only performed for serious emergencies, or women with bleeding problems or spinal issues.

 

Are there any risks with a caesarean section?

All operations carry the potential for complications.  In most cases, the CS is entirely straight-forward and the woman recovers quickly.  Operative complications are rare and include [5]:

  • Increased risk of blood loss (although only 1% risk of needing a blood transfusion)
  • Wound infection (2-3%) – antibiotics are given during the operation to minimise this risk
  • Damage to the bladder or bowel (risk 1-in-500 in women with minimal previous surgery)
  • Risk of a blood clot in the leg or lung

 

Are there different types of caesarean section?

Different surgeons perform a CS in different ways.  Having said that, the majority of CS are fairly similar.  I have a special interest in surgical technique at CS and have published scientific articles on the “best” surgical methods – you can find the references at the bottom of the page.

Occasionally we have to use a special kind of caesarean, for example in very premature births or women with very large fibroids.  Your OB will advise if your CS was a special type, as this has implications for future births.

I prefer to close the surgical wound with absorbable skin stitches rather than staples, as most women prefer this method.

 

What should I expect after my caesarean section?

  • You will stay in the Recovery Area for a few hours, until the numbness in your legs wears off
  • A catheter is usually inserted into your bladder at the start of the surgery and removed the following day
  • You can eat and drink immediately afterwards (sensibly!)
  • You should expect to be sore afterwards – a CS is a big operation. It’s always better to take pain medication regularly so that you’re able to get up and move around.
  • The stitch in the skin is very fine and it takes approximately 2 weeks for the wound to strengthen – take care to protect the area when drying your tummy or bending down.
  • You’ll be given tight stockings and a daily blood-thinning injection to reduce risk of leg clots
  • Women usually stay in hospital for 5 nights after a caesarean section
  • I’m generally happy for you to start driving 4 weeks after CS, as long as you are fully recovered. However, many car insurance companies specify 6 weeks – don’t forget to check.

 

Do you offer elective caesarean sections on maternal request?

In an ideal world, an uncomplicated vaginal delivery is the preferred option for mother and baby.  However labour is an unpredictable process.

Some women request a planned CS because of the small chance of problems in labour, as well as the risk of pelvic floor damage from a difficult vaginal birth.  Usually, these couples are not planning a large family, prefer the certainty that elective CS offers and, most importantly, are willing to accept the small risk of surgical complications.

This is an important decision and I will take the time to discuss these issues with you in detail.  I’m happy to support your choice for an elective CS once you’re aware of the pros and cons.

References

  • Walsh CA. Evidence-based cesarean technique. Curr Opin Obstet Gynecol 2010 22: 110-5.
  • Walsh CA, Walsh SR. Extra-abdominal vs intra-abdominal uterine repair at cesarean delivery: a meta analysis. Am  J Obstet Gynecol 2009 200: 625.e1-8.
  • Clay FS, Walsh CA et al. Staples versus sub-cuticular sutures for skin closure at cesarean delivery: a meta-analysis of randomized controlled trials. Am J Obstet Gynecol 2011 204: 378-383.