A caesarean section (CS) is a surgical procedure which allows a baby to be delivered though the mother’s abdomen. Caesarean sections are generally referred to as “elective” (i.e. planned ahead of time, usually for a medical indication) or “emergency” (i.e. performed during labour). A CS is a relatively major operation, involving a “bikini-line” incision in the lower portion of the woman’s abdomen, at approximately the top of the pubic hair line. It is performed in the operating theatre and takes about 40 minutes to complete.
Nowadays, more than 99% of CS are performed under spinal anaesthesia with the patient awake. An injection (similar to an epidural) is placed by an Anaesthetist in the woman’s lower back, which numbs her legs and abdomen entirely. If an emergency CS is performed during labour and the woman already has an epidural in place, this can be used instead. It is better for the woman to be awake, as it allows her partner or support person to be present and they get to see their baby arriving into the world!
Very rarely, CS is performed under general anaesthesia (patient asleep) – this is usually only for serious emergencies or women with a history of bleeding problems or spinal surgery. If you have any concerns regarding your anaesthetic, you can discuss these with your Anaesthetist.
Like any operation, different surgeons perform a CS in different ways. Dr. Colin Walsh has published extensively on the “best” surgical methods at CS and strives to offer women the optimum surgical technique. In general, he prefers to close the surgical incision with absorbable stitches in the skin rather than metal skin clips, as most women prefer this method and it means that there are no stitches or clips to be removed later.
A CS is an operation and all surgical procedures carry the potential for complications. In most cases, the CS is entirely straightforward and the woman recovers quickly. However, in a small number of cases there can be an operative complication.
After a CS, the woman will stay in the Recovery Area for a few hours, until the numbness in her legs wears off and she is able to walk. A bladder catheter is usually inserted at the start of the CS and left in overnight, to prevent the bladder inadvertently overfilling. Studies have shown that women recover quickest by resuming a normal diet straight away after a CS, rather than the old-fashioned idea of drinking clear fluids only for 1-2 days. Many women will be breastfeeding and welcome the chance of a nice meal and cup of tea after the operation!
A CS is a big operation and women should expect to be a bit sore afterwards. It is always better to accept pain medication regularly rather than lying in bed and tolerating the pain. The more comfortable a woman is post-operatively, the quicker she can get up and walk around, which helps to get her bowels working and reduces the chances of a clot in the leg. Because of the risk of clots after a CS, all women will be given tight stockings to wear and most will have a daily blood thinning injection while in hospital.
On average, women can expect to stay in hospital for 5 nights after a CS, although some may prefer to go home sooner, particularly if they have other young children at home.
Although it is felt that an uncomplicated vaginal delivery is the best method for mother and baby, labour is an unpredictable process. The small chance of problems in labour has led some women in recent years to request to deliver their baby by elective CS. Usually, these women and their partners are not planning a large family, prefer the certainty that an elective CS offers and, most importantly, are willing to accept the small risk of surgical complications inherent in any operation.
However, this is a big decision and Dr. Walsh will take the time to discuss all these issues with you in detail. For couples who are fully aware of all the issues involved, we are happy to support the decision they feel is right for them.