Q&A Series: C-section
Up to 1 in 3 births are c-sections. Whether planning an elective c-section or just wanting to know more before making a decision, there is a lot to consider. We asked Clinical Midwife & Childbirth Educator Lauren Brenton (LB), 10 questions about having a caesarean section.
Q1. Is it better to have a natural birth, rather than having an elective c-section? Caesarean Awareness Month favours vaginal birth, stating that the risks of c-sections are not properly discussed with mothers…
LB > There are many benefits and risks of both caesarean sections and vaginal births however, in my opinion the “better” mode of birth is the one that is best for the birthing parent and their family.
A caesarean section is a major operation and therefore carries increased risks when compared to a vaginal birth. Risks from a Caesarean Section include
- damage to surrounding organs such as the bladder
- increased blood loss at birth
- risk of a wound infection
- increased risk of blood clots due to limited mobility after birth
- longer recovery & longer hospital stays
- risk of becoming dependant on opioid medications as well as future pregnancies becoming higher risk
there are some risks to the baby from a caesarean section which include
- a small risk of being cut during the operation
- risk of needing assistance with breathing after birth
- some bruising to the face due to forceps being used in the operating theatre
However, there are some circumstances where a Caesarean Section is recommended over a vaginal birth. Some of these circumstances include
- your baby being in a position that is not compatible with a vaginal birth (for example footling breech, oblique, transverse)
- a previous classical caesarean section
- you are carrying multiples
- there are concerns for the wellbeing of the mother or the baby
- the mother has a fear of birth
- there are concerns for the mother’s mental health and/or the mother has had a traumatic previous birth
So, as you can see there is no better option for bringing your baby into the world. There are risks and benefits that need to be discussed and weighed up based on each family’s individual circumstances and the birthing parents’ preferences as well.
Q2. Is there a limit to how many C-sections you can have? Are the same scars cut open each time or do the obstetricians prefer a new area?
LB > Back in the day, there used to be an unwritten rule that three was the maximum number of caesareans that you could have. This isn’t necessarily the case anymore.
With advances in modern medicine, there is no hard and fast rule about how many caesareans that you can have. It is important to note that as the number of caesarean sections increases so does the risk of complications. The birthing parent’s individual health, medical history, risk factors and situation all need to be considered when discussing how many caesareans may be recommended for them to have.
When you have a repeat caesarean section the Obstetrician should go through the same scar and some Obstetricians take the old scar out and create a new one. However, if there is a lot of scar tissue from the previous surgery, it may be a little bit more difficult for the Obstetrician to perform the current caesarean section.
This means that you should only have one scar no matter how many caesareans you may have.
Q3. What can I expect in terms of physiological recovery and changes from Day 1 to 6 weeks?
LB > As you can imagine a caesarean section is a major operation where the Obstetrician must cut through 7 layers to get to the baby. I think often women forget that this is a major operation and that they need to plan for their recovery just as they would any other operation and then throw in the fact that you need to care for a newborn baby day and night.
The first day that you have your caesarean section, you can expect to remain in the bed as the feeling in your legs will very slowly return. You should still have some of the pain medications working from the caesarean, with an IV infusion giving you fluids so that you stay hydrated, a catheter in place to help drain your bladder while you are unable to get up and go to the toilet, TEDs stockings (or your own graduated compression socks if you packed them – I packed TheRY Comforter Socks) in place to help reduce your risk of blood clots. You may feel quite sleepy which is due to a mix between your body trying to recover from the operation as well as the pain relief medications. This day is mostly spent focusing on breastfeeding and getting to know your baby; however, you will need help with lifting, changing, and settling your baby because you aren’t able to get out of bed.
Early mobilisation after a caesarean section (Within the first 12 hours) is key to maximising your recovery however, it is important that you have full feeling returned in your legs, are not in pain and do not feel dizzy before you start moving around. Once you feel ready, your midwife will assist you to the shower as well as remove your IV cannula and your catheter. You will be encouraged to try to empty your bladder within 6 hours of your catheter being removed to make sure that your bladder is working again properly.
In the first few days it may be uncomfortable for you to walk, it is important to balance regular movement with rest. Pushing yourself too hard may cause you to be in too much pain and potentially delay healing. It is also important for you to stay on top of your pain medication. Picture your pain medication like a snowball rolling down a hill, if you try to “wait it out”, it is likely that the pain will get worse and not better. This means that it is much harder for your midwife to get your pain under control.
As each day goes on, you will notice that your pain significantly improves and by the end of the first week you are mostly pain free and no longer require opioid pain medication. It is likely that you will not be sent home from the hospital with any pain medication other than Paracetamol and an anti-inflammatory medication and this is to reduce your risk of becoming addicted to opioid medications.
By the end of the first week, your external scar may appear to have scabbed or healed over. However, the internal scar is still in the process of healing and your abdominal muscles are also in the process of healing. It is important to wear your TheRY postpartum compression tights to gently support your abdominal muscles and help them heal as well as helping to reduce your pain over the following weeks.
By 6 weeks, your internal scar is most likely healed, your abdominal muscles should be close to being healed, your postpartum bleeding should have stopped as your uterus is now back down below the pubic bone and if you have chosen to breastfeed your milk supply should now be a bit more regulated. You should have a 6-week postpartum check up with your midwife or Obstetrician to discuss any concerns and to make sure that the wound has healed well. This means that, you can now gradually go back to normal activities such as exercise, driving, sexual intercourse, lifting things heavier than your baby and this may give you a new sense of freedom.
Q4. What other complications can there be from a C-section – what is normal recovery time or when is a medical check-up needed?
LB >The most common complications from caesarean sections are the risk of a wound infection and the risk of a postpartum haemorrhage, which is a blood loss greater than 500ml after birth.
A wound infection can occur after a caesarean section and presents with
- increased pain
- redness & swelling
- a temperature
- generally feeling unwell
- an ooze or a smell that is coming from the wound.
To reduce your risk of a wound infection it is recommended to keep the wound clean and dry, making sure that no soaps or products are put onto the wound and that good hand hygiene is used prior to touching the wound. It can be common for you to receive IV antibiotics in the operating theatre to try and minimise the risk of infection as well. If you were to have any of these signs or symptoms it is important to call your maternity unit immediately and go in for assessment. Depending on your specific circumstances you may be sent home with oral antibiotics, or you may need to be readmitted to the maternity ward for IV antibiotics.
A postpartum haemorrhage occurs when you lose more than 500ml of blood after birth. This is most common in the first 24 hours after birth however, it can occur anytime up until 6 weeks postpartum. It is normal for your blood loss after birth to be like a heavy period and you may have more when you’ve been sitting down for a long period of time and then get up or when you are breastfeeding. If you are soaking more than one maternity pad every hour, you need to be checked by your health professional. In addition, blood clots are normal after birth however if you have a blood clot greater than a 50c piece it is important that this gets checked by your healthcare professional. Similarly, an increase in bright red blood loss along with any feelings of being weak, dizzy, racy heart or feeling unwell you should get checked by a health professional immediately.
Remember, even though you have been discharged from your maternity unit, anytime that you are concerned or have any questions you are able to call up for advice or to get checked.
Q5. Why can c-section wounds open up?
LB > A caesarean wound, like any surgical wound relies on the two layers of skin being pulled together and then those two layers healing together. Sometimes, the two layers of the wound, that had been closed together come apart and this is also known as a wound dehiscence. A wound can dehisce with or without leading to the exposure of underlying tissues and organs. Wound dehiscence after a caesarean section is rare and occurs in around 3-4% of caesarean births worldwide. It is commonly caused by history of a previous lower segment caesarean section or the presence of a wound infection.
Q6. Am I less likely to experience prolapse with a c-section compared to vaginal birth?
LB > Pelvic organs prolapse is often described as the feeling of “something coming down” and a discomfort in the vagina. Prolapse can dramatically impact a woman’s quality of life as well as cause complications with the bladder, bowel, and sexual function.
In some cases, a caesarean section can protect against a prolapse when compared to a vaginal birth. The largest risk factor for a prolapse is the use of forceps during vaginal birth. This is because the forceps go into the vagina and cradle the baby’s head, thus further stretching and potentially causing damage to surrounding muscles and ligaments of the pelvic floor.
During pregnancy, the weight of the pregnancy and growing uterus puts pressure on the pelvic floor and can cause damage. Therefore, it is essential to do pelvic floor exercises during pregnancy and the postpartum period regardless of if you have a vaginal birth or a caesarean birth.
Q7. What is a maternal assisted c-section. What are the pros & cons?
LB > A maternal assisted caesarean is one that is close to my heart as I birthed my fourth baby this way. A maternal assisted caesarean (MAC) is where the mother is surgically scrubbed, wears a surgical gown and surgical gloves, and assists in the birth of her baby.
So, you’re thinking how can the mother help birth her baby via caesarean? It’s actually simpler than you may think! The obstetrician births the baby’s head and shoulders and then guides your hands underneath the baby’s shoulders so that you can lift the rest of your baby out and directly onto your chest. Amazing right?!
Pros of a maternal assisted caesarean are that the mother feels empowered, in control and involved in the birth of her baby. Therefore, leading to increased satisfaction with the birth experience and increased bonding with the baby. Furthermore, the immediate skin to skin and reduction in time away from the baby helps to regulate their heart rate, respiratory rate and temperature as well as encourage early initiation of breastfeeding which can help improve the overall success of the breastfeeding journey.
Cons of a maternal assisted caesarean are that there may be a slight increased risk of infection, however if the mother has been surgically scrubbed, gowned, and gloved correctly this risk is very minuscule.
Although this option is life changing for some families, it may not be the right option for you if you are fainthearted or not good with blood. It’s important to consider that maternal assisted caesareans are still a relatively new option, and this means that not all health professionals and hospitals are supportive of this option. You may need to swap hospitals, care providers, or utilise a hospital that is not close to where you live to be able to access this as an option.
8. What are differences between a planned caesarean and emergency caesarean? What advice for do you have for an anxious mum being told she needs an emergency caesarean?
LB > There are a few differences between a planned caesarean and an emergency caesarean with the main one being the mental load of having an emergency caesarean. Some common reasons for needing an emergency caesarean include the birthing parent is not progressing in labour or if there are concerns for the wellbeing of the baby or birthing parent. With the physical exhaustion of the time you have already spent in labour, and then add the surprise of going into the emergency caesarean, some anxiety and stress is normal.
There may even be some nervousness going into a planned caesarean. In this circumstance though, there is usually less concern for the baby and the atmosphere in the room is usually quite light-hearted and fun. This can really help you ease your nerves by seeing how relaxed and excited your Obstetrician and birth team are.
The operation itself remains similar, however depending on the circumstances an emergency caesarean may be performed a lot faster if there is concern for the baby. Furthermore, if the baby is born needing a little bit of extra help you may be separated from your baby while it goes to a special care nursery (SCN).
My advice for an anxious mum who is being told she may need an emergency caesarean is to remember that there is absolutely nothing that you could have done to have changed this outcome. No matter how prepared you were, how active and upright you were… sometimes things just don’t go to plan and there is a safer way for your baby to be born.
It is important to make sure that you ask your midwife what their procedure is for a caesarean section so that you can mentally prepare and know if your partner is allowed to come with you or not. Additionally, it is important to ask your midwife if you can still have skin to skin in theatre with your baby if there are no further concerns for the baby when he or she is born. Another great way to calm any nerves before a caesarean section is to talk to the anaesthetist. Their primary job is to talk to you, calm you and to make sure that you are okay while the operation is being performed. Most anaesthetists are happy to talk you through what is happening or just talk to you about other things to distract you.
Finally, try not to focus on “how bad you may think a caesarean is going to be” – you are completely numb during the operation so can’t feel anything. Instead, try to distance yourself with what is happening and focus on what it’s going to be like the moment you meet your baby and the moment that you have those first cuddles.
Q9. How will I feel in the delivery room? Will I feel close to my baby or more removed as I’m being stitched back up?
LB > In the operating theatre, there are lots of people, lights and there is a very heavy focus on keeping the surgery sterile (to reduce any risks of infection). This can mean that you may feel a little removed from what is happening around you. It can be helpful to have constant skin to skin with baby with limited interruptions to help distract you from what is going on around you and to help you feel more connected to the baby. Then once you and your baby are taken back to the maternity ward, you may feel a little more relaxed and it may feel more real that your baby is here!!
Q10. What are your recommended “must haves” for c-section recovery for the hospital or at home?
My absolute must have items for caesarean recovery are ones that focus on rest and healing.
This is my top item because they help support your abdominal muscles with healing, help protect your pelvic floor through supporting your abdominal muscles and they help with reducing your pain after birth - this is because there is reduced weight sitting on the caesarean wound along with the low seams so that they aren’t sitting and rubbing on the wound.
- Ice Packs
Using an ice pack over the wound to reduce any swelling and discomfort in the first 48 hours. Once the skin layer has healed, you may find that a heat pack is more comfortable for easing discomfort.
- Big grannie undies
These sit around your belly button and therefore don’t sit and rub on your wound. Additionally, adding a maternity pad into the top of your undies across your wound can help you feel more comfortable rather than having the fabric rubbing on the wound.
- A Bunnie Caddie
Keep one of these next to the bed and/or the lounge to keep all your baby essentials close by. This can help you rest by reducing the number of times that you need to get in and out of bed or walk upstairs. Therefore, allowing your muscles to rest and heal.
- Water bottle
This may seem simple, but it is so underrated. Increasing your fluid intake can help reduce your swelling as well as helping your body recover.
- Help after birth from partner, family, or friends.
Whether this is help with household tasks (like cleaning or washing), helping with minding older children or helping by dropping over meals so that you don’t have to worry about cooking – any way that you can lean on your greater support network for help, the better. This may even mean outsourcing a cleaner to do your housework for the first 6 weeks so that you aren’t straining yourself.
One Mama Midwife - Lauren Brenton
Clinical Midwifery Specialist | Childbirth Educator | Mama of 4
Helping to educate, inspire & empower