Caesarean section Delivery
A c-section is a type of surgery used to delivery a baby. The incision is made in the maternal abdomen, and uterus. Medication is given so that pain is reduced, but allows you to be awake when the baby is delivered. Approximately 1 in 3 babies born at VGH are delivered by c-section.
Why do women have c-sections?
There are many reasons that women may have a c-section. These include:
· Previous c-section (other option is a TOLAC – trial of labour after c-section, see: TOLAC section)
· Baby is not coming out head first
· The placenta is blocking the cervix (placenta previa)
· There are concerns that the baby or mother are not going to tolerate the stress of labour
· There are concerns that the baby is too large for a safe vaginal delivery (this is may be determined in labour, when there are signs that the labour is not moving forward)
Some women will request a c-section without clear medical indications. You may request a consultation with the Obstetrician if you would like to consider this option.
For healthy babies and moms, c-sections are booked in the 39thweek of pregnancy (the week before the due date).
What happens during a c-section?
There are a few key steps:
1. Adequate pain control. If you are in labour, you may already have an epidural. Otherwise, a spinal would be recommended in most cases. This offers very good pain control, while allowing mom to experience the delivery. Less than 1% of women need to have a general anaesthetic, which means that mom is asleep for the delivery.
2. You skin is prepared for surgery by cleaning it with a special solution. The drapes for surgery are used to cover the rest of your body.
3. The obstetrician makes a cut in the skin, just above the hairline. The muscles underneath are not routinely cut, but separated and pushed to the sides. The bladder is pushed away from the uterus, and a small incision is made in the uterus.
4. The baby will be delivered through the incisions. Many times, the assistant physician will push on the top of the uterus (fundus) to help deliver the baby. This can be uncomfortable at times.
5. After the baby is delivered, you partner can take pictures of the baby while we wait 60 seconds before clamping the umbilical cord. If you wish, we can lower the surgical drapes so you can see your baby.
6. The baby is passed to the Paediatrician for a quick assessment. Your partner may be asked to join the team in assessing the baby. Once baby is confirmed to be well, they will be brought to you and you partner, while the obstetrician is finishing your surgery. It is possible to have skin-to-skin time in the OR for most women.
7. The placenta will be delivered and the uterus closed. Normally, a two-layer closure will be used to allow for the consideration of labour in another pregnancy. The obstetrician will examine your fallopian tubes and ovaries to ensure that they are normal.
8. The skin will be closed with stitches or staples. A dressing will be placed over the incision.
9. The obstetrician will push on the top of the uterus to ensure that there are no blood clots.
After the surgery, you and your baby will be monitored in the recovery room for at least one hour. You may receive visitors during that time, but the baby should stay with you (unless medical care is needed by the baby, and they are transferred to the NICU).
What are the risks of a c-section?
It is a surgical procedure. There is a risk of bleeding, infection and injury to other organs, such as the bladder. Mothers may be at an increased risk of developing a blood clot in their legs or pelvis, and may be treated with a blood thinning medication for up to six weeks. The initial recover may take a little bit longer. Some moms may also be recovering from a long labour as well. However, by six weeks, most mom report their level of pain similarly, whether they had a c-section or a vaginal delivery
There are risks associated with vaginal deliveries as well. It is a good idea to talk about both types of deliveries with your healthcare provider.
Care after a c-section
· Moms may stay in hospital longer, 3-4 days on average
· It is important to adequately treat pain after a c-section, as under treatment may negatively affect breastfeeding. Medications offered after a c-section are safe for moms planning to breastfeed.
· You will continue to be seen by your maternity provider (Family Physician or Midwife)
· If you have any concerns, the obstetrician in hospital is happy to assess you. The obstetrician who did you surgery is happy to see you in followup in their office for a postpartum check if you would like to discuss your birth and the surgery.
· If you have a fever, your pain increases after discharge from hospital or you have increased bleeding, you should contact you maternity provider. The most common complication is an infection in the skin incision, which may have redness, soreness or leaking fluid. This can be treated with antibiotics.
Hospital information
Currently, due to COVID-19 restrictions, the pre-admission interview will be done by phone. Please note that only one support person is allowed during your labour, delivery and post partum recovery at this time.
If you are scheduled for a c-section at Victoria General Hospital, please see the following information to prepare for your surgery: