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Know-how: Emergency Caesarian

Even if you plan to have a natural birth, it's good to know all about c-sections in case of emergency

Posted: 2 February 2009
by Laura Lee Davies

About 20 per cent of all births in the UK are carried out by caesarian section (or c-section) and, whilst you may have absolutely no intention of having one, the procedure is there to save lives when and if the time comes, so it's good to at least be aware of what the operation entails in case it happens to you.

When would you need an emergency caesarian section?
An emergency caesarian section may be necessary if you have a medical condition that rapidly deteriorates and threatens either your health or that of your baby, such as pre-eclampsia or placental abruption (where the placental lining comes away from the wall of the uterus).
An emergency section may also be necessary once labour has actually started, common reasons include:

  • If progress in labour is unduly slow and either mother or baby are becoming very tired
  • If the baby becomes distressed in the course of labour and birth is not imminent
  • If the mother's blood pressure becomes high and doesn't respond to drugs
  • If there is abnormal bleeding
  • If the umbilical cord becomes wrapped around the baby's neck and there is a risk of strangulation at birth
  • If the umbilical cord emerges through the cervix and so risks being constrained as the baby comes out, so cutting off the baby's oxygen supply

If the labour ward team believe that such an emergency has arisen and that a caesarian is now the safest way to deliver your baby they will discuss this with you and your birth partner and seek your permission to carry out the operation.

Tip Even if you are not aiming to have a caesarian, ask your midwife team during an antenatal appointment or at antenatal classes about what procedures and permissions they will seek should the need for an operation arise. You will feel better prepared if you are a little more familiar with your hospital's or clinic's arrangements for such emergencies.

What happens during an emergency caesarian?
A caesarian section is a procedure where small horizontal incisions are made which cut through your abdomen and the wall of the uterus (womb), allowing the surgeon to remove your baby directly rather than your baby passing through the birth canal and being born vaginally.
Your midwife will probably accompany you into the operation to provide support and talk you through what's happening. Even if you are not under general anaesthetic, you probably won't be able to see the operation yourself because a screen is put up across your abdomen.

After disinfecting the area, the surgeon makes an incision in the abdomen, just above your pubic bone, to reach the uterus. This cut is commonly known as the bikini cut. The surgeon then cuts through the uterine wall in the lower section, where the uterus is stronger for more effective post-operative healing, and exposes the sac of fluids protecting the baby. After carefully cutting through the bag of waters, the baby is lifted out before the umbilical cord is clamped and cut. The whole thing will probably take only about ten minutes.

Once delivered your baby is given a quick health check before being handed to you or your partner for holding while your placenta is delivered and you are stitched up. You may even be able to attempt breastfeeding your baby now if you feel up to it, although you may equally want to wait until you are out of theatre. Unsurprisingly the stitching up part takes quite a bit longer than the cutting open, not only are there several layers to be stitched, but doing a really good job is important for future pregnancies.

When the procedure has been planned in advance, the woman is usually given either an epidural or spinal block. Sometimes this is possible during an emergency caesarian, or in some cases the woman has already had an epidural as part of her labour. However, depending on the condition of the woman and/or unborn baby, it may be necessary to give a general anaesthetic. This will require your advanced permission should the need to admiminister a GA arise.

If you have your baby by epidural your partner will be allowed to be present but in most cases when a general anaesthetic is given, your partner will have to leave the operating theatre. If you are concerned about this, feel free to talk to your midwife team about it. Such medication is only given if the operating surgeon feels it is the safest option for you and your baby.
In an emergency a general anaesthetic is usually the favoured option, in which case you won't be awake for the operation and it will usually be about half an hour before you come around afterwards, and another half-hour until you can hold your baby.

Don't feel that having a caesarian means you have 'failed'
It's not all 'too posh to push'. Caesarian sections tend to get a bad press in the UK because they are seen as a form of 'giving in' or of not even trying to go through the rigours of childbirth.

It is certainly true that some women choose to have a caesarian for personal reasons, but even these 'elective caesarians' aren't always purely for the vanity or convenience of the mother. Many women have valid reasons for either needing to know when they are going to have their baby, or have emotional reasons why the experience of vaginal childbirth is not something they feel they can face.

There are also those women who discover they have a physical condition during pregnancy which makes a caesarian the safer option. These are called planned caesarians.

If you end up having an emergency caesarian, don't worry that losing out on the traditional birth experience makes you less of a mother. Instead, concentrate on the positives – you and the labour ward team pulled off a safe birth in a tricky situation, plus you now have a beautiful baby to enjoy! And believe us when we say that having a caesarian is not the easy option – you will have weeks of recovering from the operation on top of the regular demands on any new mum. So you have definitely not 'cheated'!

For more, go to Top Tips for Recovering from a Caesarian.

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