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What is a Caesarean Birth?
A Caesarean is an operation to allow your baby to be born through a cut along the “bikini line” on your tummy. A decision to have a Caesarean has to be made carefully as it involves major surgery with some risks attached.

Having a Caesarean Birth
We include everyone having an elective Caesarean birth in the Enhanced Recovery Programme. This is a care programme that aims to help you recover from your operation and regain your independence as quickly as possible. There is a focus on eating, drinking, and moving around soon after your operation, good pain relief and importantly help you help yourself recover quicker.

The Antenatal Clinic

What happens once the decision has been made?
Once you and your consultant have agreed that you will have a Caesarean, you will be asked to sign a consent form. MRSA screening needs to be done by a simple swab in the nostril and skin crease at the top of your leg. MRSA is a normal bacteria that can be carried on the skin of some people. It does not usually cause any problems, but if you have an operation it may cause an infection that is very resistant to antibiotic treatment. So if we find that you happen to be a carrier of MRSA before your operation we will offer you some treatment to eradicate it and reduce the chance of this particular infection.

The Pre-Caesarean Clinic

When should I go to this clinic?
At 11 am on the weekday before your planned birth The clinic is based in the Day Assessment Unit (DAU) on the 4th Floor, Lanesborough Wing. Around bank holidays this may alter but we will let you know if this happens.

What happens when I come to the Pre-Caesarean clinic?
This is a clinic designed to check that everything is in order for the birth, answer any further questions you may have and to check you understand everything about your operation and recovery. When you arrive at the clinic you will be seen by a midwife. The midwife will go through a checklist to ensure that everything necessary has been done for your operation date. You will have some routine blood tests. You will also be seen an anaesthetist who will discuss the anaesthetic with you. This visit may take 1-2 hours. The midwife will give you tablets (pre-medication) to take home with instructions. It is important to take the tablets at the instructed time. Please ensure you bring your hospital notes.

When do I need to come to the hospital?
You will usually be asked to come to the hospital early in the morning (from 7.00am) of your Caesarean birth.

Arriving at the hospital

What should I do on the morning of my operation?
When you arrive you should report to the reception area on Gwillim Ward, our postnatal ward, on the 4th floor of Lanesborough Wing. Most of our bays have 4 beds, but we also have 4 single amenity rooms available. If you would like to know more about our amenity rooms, including costs, please ask your midwife in clinic or on Gwillim Ward for information and whether one is available. More information about Gwillim ward will be given to you upon arrival.

Once on Gwillim Ward, the midwife responsible for you will meet you and make final preparations before going to the operating theatre.

This involves: changing into a hospital gown; having a bikini shave if necessary; removing all nail varnish, contact lenses and jewellery (apart from wedding ring); and putting a name-band on your wrist. You will also need to take a nappy and hat for your baby. It is not necessary to take other baby clothes to theatre as we encourage skin to skin soon after the delivery of the baby if all is well, to encourage breastfeeding and bonding.

One midwife will take you and your birth partner to the theatre and will stay with you. If you are going to be awake during your Caesarean, your partner can be with you and he or she will be given special theatre clothes to change into.

In rare circumstances, your planned caesarean birth may have to be delayed due to emergency work. We will keep you informed if this is the case.

The operation itself

Are there any choices I can make for myself?
Although a Caesarean involves surgery in an operating theatre, it is the birth of your baby. You will be able to say how you prefer some things to be done. For further information see the GRAPES checklist in Appendix A.

How long does the procedure take?
The operation on average takes about thirty minutes, although your total time in theatre will be nearer 60-80 mins as it will include time to give you your anaesthetic. Your baby will be born within the first five minutes, quickly followed by the placenta, and the remaining time is spent stitching your wound. The operation may be longer if there is scar tissue, e.g from a previous operation.

Who else will be there?
It can be a bit surprising to see how many people are in the operating theatre with you. It is normal for the whole team to include 10 people, sometimes more when we count you and your partner!

The medical staff will include; a midwife, the doctor who operates and an assistant, a theatre nurse and an assistant, and anaesthetist and their assistant; and possibly a paediatrician. St George’s is a teaching hospital and students may also observe if you have no objections and give your consent.

What does it feel like?
Most Caesarean operations are performed using an anaesthetic injected into your back, either an epidural or a spinal. A spinal is a one-off injection that lasts for around 4 hours, whereas an epidural is anaesthetic that you may have had in labour that can be topped up. These types of anaesthetic are recommended because they are safer. Both of these types of anaesthetic mean that you are awake when your baby is being born and that your birth partner can be with you in the operating theatre to support you. If have a general anaesthetic your partner will be asked to stay outside the operating theatre.

You should not feel any pain during the operation. Some women have described the feeling as if “ someone is doing the washing up in your tummy” but the anaesthetist will give you extra painkillers into your drip if you need them at any time. Occasionally you may have to have a general anaesthetic instead which means you will be asleep when your baby is born. Before you leave the theatre you may be given an anti inflammatory painkiller, if this is suitable for you, that lasts for a long time until you are taking painkiller tablets again.

Your birth partner and baby stay with you for the rest of the operation, as long as you and the baby are well. You and your birth partner will usually be able to hold and cuddle the baby during this time. If your baby is unwell, he or she may need to be looked after in the Neonatal Unit soon after the birth. Every attempt will be made to give you some contact with your baby as soon as it is safe.

After the Birth

Will I have stitches?
Yes. After a Caesarean there are several layers of tissues which need stitching. The underneath layers have stitches that will dissolve by themselves. On your skin you will most likely have:
– One stitch under the skin which will dissolve on its own
– or sometimes there is a stitch / stitches
– One continuous stitch* with beads, or skin staples

*If you have non dissolvable sutures or staples, this will be explained to you and will be re-moved by the midwife 5-7 days after your Caesarean

You will have a dressing over the wound. You will be advised when this can be removed.

What happens after the birth?
You will be moved to the Recovery room until you and your baby are well enough to be taken to the postnatal ward, usually within one hour. During this time the nurse will be taking your blood pressure and pulse, looking at your wound and checking your blood loss.

You will have a drip in your arm to give you extra fluid, and a catheter in your bladder to keep it empty. You are encouraged to drink in recovery and have something to eat as soon as you get to the ward.

We encourage all babies to have skin-to-skin contact with their mothers; this has been shown to benefit babies and encourage early breastfeeding. You can do this at any time after the baby is born. We advise you to breastfeed the baby in Recovery if possible. Before you are taken to the postnatal ward your baby will be weighed and examined by a midwife. The baby will also be given name-bands for identification and security.

On the Postnatal Ward

What medical care will I receive?
Care will be provided by the midwifery team. Your care will include monitoring of your blood pres-sure, pulse and temperature at different times, and also checking your wound and bleeding. You will continue to have a drip in your arm until you can drink a normal amount. Often this drip can be removed later the same day. You may have a blood test later the same day or the following day to check whether you need to have iron tablets to help your recovery

We encourage you to get out of bed the evening of your Caesarean to sit in a chair have a meal . The catheter will be removed at around 6am the following day unless the doctor requests otherwise.

You should try and pass urine by 3-4 hours after the catheter has been removed. We ask women to get dressed into their normal daytime clothes on the first morning as this has been shown to help with your recovery.

Most women will be advised to receive daily injections of a blood thinner to reduce the risk of blood clots. This is completely safe for breast feeding and you will be shown how to do it yourself so you can continue for 10 days or 6 weeks as instructed.

Will I be in pain after the birth?
Pain relief will be given at regular intervals. However it is important for you to let us know if you are in any pain so that we can make your recovery as pain-free as possible.
At first your wound may cause some pain when you cough, sneeze, laugh or change position suddenly. To help reduce the pain, you may try bending your knees towards you and supporting the wound with your hands or a pillow. Don’t be afraid to hold over the wound firmly, you cannot damage it in this way.
Most people notice the pain lessening day by day.

Will I be able to care for my baby?
Yes. Caring for your baby may be difficult for the first day but our staff and your partner will be able to help you with your baby’s needs.
A call bell will be next to you if you need help for yourself or your baby. Your baby will be checked by a specially trained midwife or paediatrician to ensure that all is well.

Will I be able to breastfeed after my Caesarean?
Yes. Having a Caesarean birth does not stop you breastfeeding. Staff, including out Infant Feeding Advisor on Gwillim Ward, will be able to help you find comfortable positions to feed your baby.

What other discomforts might I have?
One of the things that some women have experienced is “wind pain”. This is where your bowel is trying to start working again, because you did not have anything to eat for quite a long time before your operation. Sipping hot peppermint water, massaging your tummy and moving around usually helps this.

In common with all women who have given birth, you will experience bleeding which is like a heavy period. You will need to use absorbent sanitary towels or maternity pads held in place with comfortable underwear that covers your wound. Please ensure the pad does not come up and touch your Caesarean wound.

Should I rest after the birth?
It is best to start moving as early as you are able. This will help healing by improving your circulation. To get out of bed, you will find it easier if you roll onto your side first before pushing yourself up into sitting. This is also the best way to get out of bed during pregnancy.

When can I go home?
We encourage women to talk to their midwife about when they feel ready to go home. This will depend on you and your baby. Over half of women stay one night and go home the following day when the midwife is happy with all the checks, the baby is feeding well and you have good support at home. If needed, you may stay in hospital longer than this.

Please arrange to have your own painkillers, usually paracetamol and ibuprofen, at home. You may be given iron tablets and the blood thinning injections (enoxaparin/ dalteparin) to go home with and a midwife will instruct you how to give these to yourself once a day.

Recovering from a Caesarean

Is there anything I shouldn’t do after having a Caesarean?
It usually takes 6 weeks for your wound to heal. In this time it is best to avoid lifting anything too heavy, which may cause strain on your wound and your back. If possible ask a partner/friend or family member to do the lifting of shopping, the vacuum cleaning, hanging out the wet washing and the ironing. It is safe for you to lift your baby, but this should be the limit of your lifting.

It is also advisable not to drive for this 6 week period as an emergency stop may hurt your tummy and make you unsafe. Check with your insurance company before returning to driving. If you are a passenger in a car, make sure that someone else lifts your baby in his or her car sear, as these can be very heavy. You may find it comfortable to place a small folded towel over your wound, before putting the seatbelt on.

It is very important to return slowly to normal activity, so movement and walking are essential. It is safe to go up and down the stairs, and going out for daily walks is a good way to recover.

You will need to make an appointment to see your GP six weeks after your baby is born. This is to check that you are recovering well from the birth.

If all is well, you will then be able to return to low impact exercise, e.g. pilates, yoga, swimming. We would advise you to wait until a minimum of twelve weeks after your baby is born before returning to higher impact exercise, e.g. jogging, aerobics.

How will I feel?
As well as giving your body time to recover from your operation, and looking after a new baby, you may have some strong feelings to cope with and you might need some extra support from family friend or health professionals.

If you had a planned caesarean birth, you may have had time to accept it and feel glad that your baby was born in this way. But you may still be left with some questions about why is was necessary, or worries about how it will affect future births.

Some women can feel disappointed or even angry that a caesarean birth was necessary even if it was planned.They may have feelings of failure, depression, grief or a loss of confidence. Any of these feelings are quite normal but can be hard to cope with, especially when recovering from major sur-gery.

If you have any of these feelings, it helps to talk to someone about them. It could be a midwife, health visitor or GP that you know well, an NCT antenatal teacher, or you could contact a support organisation such as AIMS to talk about your experience or feelings.

Wound recovery

The scar will change colour during recovery depending on your skin colour
Often on white skin it changes from red to pink to silver over weeks to months.
On darker skin it can be red to dark brown or black.

A few women develop a raised scar – called keloid- this is usually due to your own skin healing ability – not the suture used at the time of closure of the wound.

The feeling or sensation of the skin around the scar recovers in a different way in everyone- it is very common to have a slightly odd sensation of numbness “ like cotton wool” in particular above the scar which can last for weeks or months. A few women the sensation ( recovery of the nerves) of the skin in this area never completely returns to normal.

If you notice any fluid coming from an area in the wound, especially if this is smelly then please ask your midwife or doctor to review you as you may have an infection in the skin. All women having a Caesarean birth are given a dose of antibiotics at the time of the operation but 1 in 10 women can still get an infection following their birth and the skin is one of the most likely places for it to develop. Antibiotics given to you should be safe to continue to breastfeed.

Video content about Caesarean births