Caesarean section birth

A caesarean section is an operation to help deliver your pēpi. It can be a planned (elective) caesarean section or an emergency caesarean section. An emergency caesarean is done when a vaginal birth is not possible or safe.

Planned (elective) caesarean section

An elective caesarean section is planned before going into labour.

This may be recommended if:

  • the placenta is blocking the cervix (entrance to the womb) so pēpi cannot be delivered vaginally. This is called placenta praevia.
  • there is an active infection in the birth canal such as genital herpes at the start of labour
  • there is a complication during pregnancy, for either yourself or your pēpi, such as preeclampsia or a serious medical condition
  • you have had a previous caesarean section and a vaginal birth is not considered to be safe
  • you have had previous major surgery to the uterus (womb) or have uterine abnormalities
  • your pēpi is premature or not growing well
  • your pēpi is feet first (breech) or lying sideways (transverse).

Emergency caesarean section

An emergency caesarean section is when your operation is done in a hurry, usually when you are already in labour. This can happen when the delivery of your pēpi is needed immediately due to complications that happen during pregnancy or labour.

This may be necessary if:

  • your labour is not progressing as expected
  • your cervix is not dilating (opening up) for pēpi to pass through
  • your pēpi is showing signs of distress from the pattern of its heartbeat
  • your pēpi was not able to be delivered with the help of instruments like forceps or ventouse
  • you develop serious complications of pregnancy-related high blood pressure (preeclampsia)
  • you have excessive bleeding before or during labour
  • the umbilical cord has dropped out through the cervix
  • you have gone into labour before your elective caesarean section date.

Anaesthesia

A caesarean section is usually done with regional anaesthesia. General anaesthesia (where you are put to sleep) is less common.

Your doctor or anaesthetist will meet you before your operation and discuss which option (regional or general) is best for you and your pēpi. In some emergency situations this discussion may not be possible.

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With regional anaesthesia, you will be awake during the operation. Only the lower part of your body is numbed so that you can still talk and respond to your doctor during the operation.

There are 3 types of regional anaesthesia.

  • Spinal — this can be used in a planned or emergency caesarean section. Anaesthetic and pain relief is put inside a bag of fluid and injected into your back using a very fine needle.
  • Epidural — a thin plastic tube or catheter is placed in your back outside the spinal fluids throughout the operation so that anaesthetic can be topped up if it is needed. This is often used for pain relief in labour.
  • Combined spinal epidural (CSE) — both spinal and epidural are combined and given together.

If you have regional anaesthesia for your caesarean section, a support person can stay with you during the operation.

With general anaesthesia, you will be asleep during the operation.

You may need a general anaesthesia if you have any some of these symptoms:

  • there is not enough time for regional anaesthesia to work
  • regional anaesthesia is not suitable or should be avoided. This can be when your blood cannot clot properly or if there is excessive bleeding
  • if you have a curved back or previous back surgery which makes regional anaesthesia difficult or impossible.

Your doctor or anaesthetist will discuss this with you and give you advice if general anaesthesia is needed in your situation.

If you have general anaesthesia for your caesarean section, a support person cannot go into the theatre with you.

Before your caesarean section

If you are having a planned or elective caesarean section, you will have a preoperative assessment.

You will speak to an obstetric anaesthetist and they will explain:

  • the different options for your anaesthetic
  • what will happen on the day of your caesarean
  • when to stop eating and drinking
  • the time you need to come to the hospital
  • other aspects of the surgery.

They will also review your health, pregnancy, medical history and previous anaesthetic.

You will be sent forms for blood tests which you should do the day before your caesarean section.

On the day of your caesarean section

You will be given a time to come to the hospital on the day of your caesarean section. It is important you have a shower and wash your hair on the morning of your operation. This will reduce the chance of a postoperative infection.

It is important to follow the instructions for eating and drinking given to you at your preoperative appointment. Your surgery might be delayed for safety reasons if you do not fast correctly.

If you are having regional anaesthesia, you can bring a partner or support person with you. They will be able to stay with you during the procedure, including the operation. For safety reasons, only one person is allowed to support you in the theatre as the space is limited.

If you are having general anaesthesia, your support person will be asked to wait in the waiting area.

In the operating theatre

Once you are inside the theatre, you will have some equipment attached to you. This will measure your heart rate, blood pressure and the amount of oxygen in your blood.

The anaesthetist (or technician) will put a drip in your hand or arm. This is to give you fluid and medication. A local anaesthetic will be used to numb the skin first.

Your anaesthetist will make sure your details are correct and they will explain the procedure with you before giving anaesthetic.

To reduce the risk of infection afterwards, we give antibiotics through the drip. We also prepare the skin on the abdomen and inside the vagina with an antiseptic solution. A catheter will be placed in the bladder to continuously drain urine during the procedure.

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If you are having regional anaesthesia:

  • You will be asked to sit up on the side of the theatre bed (sometimes you may be asked to lay on your side).
  • You will need to drop your shoulders down to open up the space in your back and the anaesthetist will prepare your back with antiseptic solution.
  • A local anaesthetic injection will be given to numb the skin on your back, then the regional anaesthetic needle is placed in your back.
  • If you are having an epidural or combined spinal epidural anaesthetic, after the injection of the anaesthetic medicines, a catheter (tube) is threaded down the needle. The needle is removed, leaving just the flexible catheter in your back. This will be taped down securely.
  • You will be placed on your back for the operation with a tilt towards the left side. A screen separates you and your whānau support from the operation site. This may be temporarily lowered so you can see your pēpi the moment they are born.
  • After the operation you will be transferred to the Post Anaesthetic Care Unit (PACU). Your whānau support and pēpi will join you there when you are comfortably awake.

If you are having general anaesthesia:

  • You will be positioned on the anaesthetic table lying on your back, with a tilt towards the left.
  • You will be given oxygen to breathe and the anaesthetic is injected into your drip.
  • As you go to sleep, gentle pressure is applied to your neck so you do not vomit.
  • When you are asleep, a tube is placed in your windpipe to allow a machine to breathe for you. This will also prevent stomach contents entering your lungs.
  • While you are asleep, medicines are given to keep you comfortable and stop you feeling sick. You can ask for more of these when you wake up.
  • When you wake up you may feel sleepy and your throat may feel sore from the tube.
  • After the operation you will be transferred to the Post Anaesthetic Care Unit (PACU). Your whānau and pēpi will join you there when you are comfortably awake.

After your caesarean section

Once your pēpi is delivered and checked by a doctor or midwife, you should be able to have skin-to-skin contact. You and your pēpi will be transferred to the recovery area, also known as the Post Anaesthetic Care Unit (PACU). Your support person can usually stay with you.

During this recovery time you will be carefully monitored by the nursing recovery staff. You will be given pain relief. The anaesthetist should have put pain relief into your spinal or epidural which will continue to work after your operation.

In the postnatal ward, there are steps you can take to speed up your recovery. These include:

  • aiming to eat and drink as soon as you can
  • getting out of bed 6 to 8 hours after your caesarean
  • removing your bladder catheter 8 to12 hours after your caesarean
  • keeping your pēpi in skin-to-skin contact with you and feeding your pēpi responsively
  • taking regular pain relievers and laxatives as required.