Introduction
This leaflet gives answers to some of the common questions asked by patients about Caesarean births. After reading this, if you have any other questions, your midwife / obstetrician will be happy to answer them.
Do not be afraid to ask questions as the better informed you are about what is happening to you, the more in control you will feel.
What is a Caesarean birth?
A Caesarean birth is a means of delivering your baby through the abdomen (tummy). It is performed by a doctor through a horizontal incision around your pubic hair line (bikini line). The reason for this operation being offered to you will have been discussed with you by your doctor.
Consent
Your doctor will explain the operation, its procedure and risks to you, answer any questions you may have, and ask you to sign a consent form. Most Caesarean births are straightforward and carried out by a senior doctor.
However, it is important that you are aware of any potential risks. These include:
- Thrombosis (blood clot)
- Infection (particularly wound and chest infections)
- Damage to the bladder
- Haemorrhage (which may require a blood transfusion)
What anaesthetic is required?
If your Caesarean birth is planned, in most cases it is safer for you to have a spinal anaesthetic (an injection in your spine which numbs you from the top of your womb down).
Your recovery from this type of anaesthetic is quicker, with fewer side effects than a general anaesthetic (when you are asleep). You will be able to discuss your options with the Anaesthetist just prior to your operation.
Preparation for your Caesarean birth
You will be given an appointment to attend the antenatal day unit 24-48hours prior to your procedure for a pre-operative assessment and to discuss your Caesarean birth.
At this visit any queries you may have will be answered and the following will be undertaken:
- You may sign your consent form for the operation if not already done in clinic
- You will be given medication to take before the operation, to reduce the acid in your stomach / prevent sickness
- You will be asked questions regarding recent hospital admissions if relevant, for the purpose of Infection Control Screening (CPE)
The two antacid tablets will be for you to take home and you will be asked to take one tablet the evening before your operation (approximately 10 pm) and one on the morning of your operation (approximately 7 am):
- A sample of blood will be taken to store in case you require a blood transfusion at or after delivery
- A swab will be taken from your nostril to check if you are a carrier of MRSA bacteria
- A full antenatal check may be carried out, including a blood pressure check, a urine test, measurement of temperature, pulse and weight
What happens on the day of the Caesarean birth?
You will usually be asked to attend the hospital at 8 am on the morning of your operation.
This may vary on occasions, but the midwife will discuss this with you individually and you will be told where to attend:
- Please do not have anything to eat or drink after midnight, this includes chewing gum
- Please bring your maternity notes with you
- Please have a bath or a shower before you come into hospital
- Remove any nail polish on toe nails and fingernails, including gel nails polish and remove false nails
- Please do not wear makeup on the day of admission
- Please leave all jewellery and valuables at home
- You will be asked to remove any body piercing decorations
- Your wedding ring may be taped until after your operation
- Contact lenses will need to be removed
- You will be asked if you have any loose teeth, caps or crowns
If your operation is in the morning:
- You should have nothing to eat or drink after midnight the night before (if you are diabetic a plan of care and management of your diabetes will be discussed with the medical Doctor prior to admission)
- You can take your medication as prescribed (antacid medication) on the morning of your operation with a small sip of water
How long does the operation last?
An elective Caesarean birth usually takes 30-45 minutes to complete (once your anaesthetic is in place).
Can my partner / birth partner be present?
If you have a spinal anaesthetic your partner can be in theatre with you, because you are awake you may be able to hold your baby immediately.
Partners are usually asked to wait outside whilst the epidural or spinal anaesthetic is being put in. This can take up to 45 minutes so do not worry during this time.
Partners will be asked to change into theatre clothing on entry to the theatre. Please note that we cannot be responsible for valuables left in the changing room at this time.
If you are having a general anaesthetic (when you go to sleep) your partner may accompany you to the theatre entrance, but will not be allowed to stay with you throughout the operation and will be shown where to wait.
In this situation any requests regarding the giving of specific information, for example time of birth or sex of baby, must be identified to your midwife prior to your operation.
What happens when I arrive at the hospital on the day of my operation?
Prior to the operation:
- You will have routine observations carried out, which will include temperature, pulse and blood pressure checks
- A name band will be placed on your wrist
- You may need to have your bikini line trimmed
- You will be given a hospital gown and paper hat to wear
- If you are able to walk to theatre please bring a dressing gown and a pair of well-fitting slippers
In theatre:
Equipment will be attached to you to measure your blood pressure, heart rate and the amount of oxygen in your blood. The anaesthetist will set up a drip. This allows us to give you fluid and drugs throughout the operation. You will also be given antibiotics during the operation.
What happens during a Caesarean birth when you are awake?
The anaesthetic is given with a spinal injection and you will be asked to sit or lie on your side curling your back. Your back will be sprayed with some very cold antiseptic.
The anaesthetist will examine your back to find the best place to give you your injection. Local anaesthetic is given so that you do not feel the injection. This sometimes stings for a moment.
The spinal anaesthetic works very quickly. First you may notice a warm feeling in your bottom and very soon your legs will begin to feel heavy and warm and may start to tingle. Numbness will spread gradually up your body. You will be helped to lie down on the operating table by clinical staff, but may notice that the table is tilted sideways slightly, but do not worry as this is to help maintain your blood pressure.
The anaesthetist will check how far the anaesthetic has spread, by using something cold or a light touch on your tummy. This is to make sure you are ready for the operation.
If you do not already have a catheter (a plastic tube into your bladder), one will be inserted at this stage to ensure that your bladder remains empty during the operation. The catheter will usually be removed after 12-24hrs.
There will be a screen between you and your tummy so you may not be able to see what is going on, if you wish to see, what is happening, please discuss this with the team caring for you during your birth. During the operation it is normal to feel some strange sensations such as pushing and pulling, but there should be no pain. Your blood pressure may drop and this can make you feel light headed and sick. If this happens you can be given medication through your drip to help you feel better.
The anaesthetist will assess you throughout the operation and give you pain relief if required.
From the start of the operation it will take about 10 minutes before the delivery of your baby. Immediately after the birth the midwife will dry and examine your baby. A paediatrician may also be present. After this you and your partner will be able to hold your baby and have your baby skin to skin.
After the birth of your baby a drug called Syntocinon may be put into your drip to help deliver your placenta. The remainder of the operation takes about 30 minutes. At the end of the operation you will be given a wash and offered a suppository in your back passage to relieve pain for after your anaesthetic has worn off.
After the birth and the end of the operation you will be transferred onto a bed and helped to sit up slightly. You will then be taken to recovery area at Scunthorpe, or your room at Grimsby, where you will be under observation for a while and this will include checking your pulse, blood pressure and wound. Your partner and baby can usually be with you.
Are there any risks or side effects?
If the spinal anaesthetic is not successful in making you numb then the injection can be repeated. However this is rare. If this still does not work adequately then you will be offered a general anaesthetic instead.
Numbness from the spinal anaesthetic usually lasts 2-3 hours.
As well as local anaesthetic, the spinal injection contains a painkiller which will keep you comfortable after the numbness has worn off. A side effect of the pain killing injection is that it can make you itch. If the itching becomes a problem you will be offered something to help relieve this.
What happens during a Caesarean birth when you are asleep?
Once shown to the theatre where your delivery will take place, you will be asked to lie down on the theatre table, which is tilted. In theatre equipment will be attached to you to measure your blood pressure, heart rate and the amount of oxygen in your blood.
The anaesthetist will set up a drip. This allows us to give you fluid and drugs throughout the operation. You will also be given an antibiotic throughout the operation. Before the operation you will be given a small drink of antacid medicine.
The anaesthetist will give you oxygen to breathe through a face mask for a few minutes and the anaesthetic will be given to you into your drip to send you to sleep. The anaesthetic works very quickly. As you are given your anaesthetic, the anaesthetist’s assistant will press on the front of your neck. This is normal and is to stop anything from your stomach coming up and interfering with the anaesthetic.
Whilst you are asleep you will have a tube inserted in your mouth which goes into your windpipe. This is attached to a breathing machine to breathe for you. Your heartbeat, blood pressure and pulse are measured at intervals whilst you are asleep. When you wake up your throat may feel a little uncomfortable and sore.
You will be given a strong painkilling injection into your drip and a suppository to make you comfortable when you wake up. It is also common to still feel drowsy and sick for a few hours afterwards, but medication can be given for the sickness.
You will be taken to the recovery area where you will meet up with your partner and baby. At Grimsby you will return to your room.
Are there any risks or side effects?
There is a small risk of acid from your stomach finding its way into your lungs during your anaesthetic and every effort is made to minimise this happening by having nothing to eat prior to the operation and taking the antacid tablets as prescribed. Acid from the stomach in the lungs can result in a severe form of pneumonia, but this is very rare.
You may have a sore throat if you have had a general anaesthetic and a drink of water may help ease this. You can drink water to quench your thirst as soon as you like, or possibly have a cup of tea if you have not had a spinal anaesthetic.
Catheter
A catheter will have been inserted into your bladder prior to the operation. This is usually left in place for a day following your operation so there is no need to worry about having to get up to go to the toilet.
Vaginal bleeding
Even though you have had a Caesarean birth the extra lining of your uterus (womb) still needs to be shed, so expect a fairly heavy period-type loss for the first few days.
Chestiness
Sometimes after a Caesarean birth you may feel ‘chesty’, especially if you have a general anaesthetic or are a smoker. A physiotherapist will be called if the doctor considers this necessary, but it is important that you breathe deeply and support your wound when coughing (either with hands or a cushion).
Feeding and care of your baby
You and your partner will be given support with caring for your baby. You will be given help to find a comfortable position in which to feed your baby. Further information is available online www.unicef.org.uk, www.tommys.org
Pain relief after the operation
There are several ways to give you pain relief after a Caesarean birth:
- Suppositories are often given at the end of the operation
- A Morphine, or similar painkiller injection into a muscle.
- Morphine or a similar drug, is fed into a drip -which you can control yourself. This is called patient controlled analgesia (PCA). This is used occasionally at Scunthorpe, usually after a general anaesthetic
- By mouth – a midwife can give you tablets such as Voltarol or Paracetamol, given regularly as needed
- Once home you can take Paracetamol and / or ibuprofen. These will have no effect on breast feeding. If you require stronger pain relief please discuss this with your midwife as some drugs cannot be used if you are breast feeding
Day of birth
Your midwife will examine you to ensure that you are progressing normally. If all is well your intravenous infusion can be discontinued and you can have something to eat:
- Your catheter can be removed. We will need to know when you pass urine to measure your first void
- You can sit out of bed and walk to the toilet
- The wound dressing will be removed and any wound drains removed when no longer required
Hygiene Shower
You will be offered a bed bath usually 8 hours following your caesarean birth. After 24 hours, if you feel you would like a shower or bath the staff will assist you. The wound dressing is removed at this time. Try and walk as upright as you can.
Wound care
The wound area should be kept clean and dry with normal healing taking place within a few days of the birth. Your wound can either be sutured with stiches or closed with staples. Some stitches are dissolvable while others will need removing, your midwife will discuss this with you and put a plan in place for their removal. The midwife will also check your wound at each post- natal visit to ensure that healing is taking place.
Wind
A lot of women suffer from post-operative wind pains. By mobilising as much as you can and walking upright, you may relieve this a little. Ask the midwife for medication if you cannot get relief.
Observations
Your blood pressure, temperature, pulse and fluid balance will be monitored for at least 48 hours to ensure all is progressing normally.
Elasticated stockings
These are worn for six weeks after your operation to reduce the risk of thrombosis (a blood clot). You may also be given a small injection daily for at least ten days which helps prevent blood clots developing. At Diana Princess of Wales Hospital, Grimsby (DPoW) you will also wear compression boots for the first 24 hours to further reduce the risks of clots forming in your legs.
Discharge home
You can be discharged home 24 – 48 hours after the birth of your baby depending on how you feeling.
We are also offering enhanced recovery
If you meet certain criteria you can have an enhanced recovery following your birth and go home after 24 hours, if you wish. Please discuss this with your midwife. To prepare you for this you will be encouraged to make sure that you drink plenty of clear fluids and eat a carbohydrate rich supper no later than 8 hours prior to the birth. After the birth you will be encouraged to drink and have a light meal within the hour after birth. Regular pain killers should be taken to help you to with walking and feeding your baby.
Recovery
Recovery does take time and you should take things easy at first and gradually build up activities as your body allows.
Q When can I start to do housework?
As soon as you feel able. Avoid hoovering and ironing for 4-6 weeks. Avoid lifting or carrying anything heavier than your baby for at least 12 weeks.
Q How much rest should I take?
It is advisable to rest on your bed at least once during the day to avoid getting over tired. Remember you tire very easily caring for yourself and your baby. Accept all the offers of help, but only you will know when you are ready to do all the work yourself again.
Q When can I start driving again?
We advise you wait 4-6 weeks following the birth of your baby. Check with your insurance company before starting to drive again.
Any Comments, Compliments, Concerns or Complaints
If you have any other concerns please talk to your nurse, therapist or doctor. Our Patient Advice and Liaison Service (PALS) are available on 03033 306518 (Grimsby, Scunthorpe and Goole). You can also contact nlg-tr.PALS@nhs.net
As a Trust we value equality of access to our information and services, therefore alternative formats available on request at nlg-tr.interpreters@nhs.net
Review information
Date of issue: May 2019
Review period: May 2022
