Wednesday 20 June 2012

Caesarean Birth: Ten things you may not know

This article was first published on The Vegetarian Experience on 2nd November 2011

According to news reports this week, women may soon have the right to choose to have an Elective Caesarean Birth through patient choice, rather than due to medical reasons.

Currently, Nice Guidelines state that “maternal request is not on its own a reason for caesarean" and encourage obstetricians to refer women wanting a caesarean for counselling in the first instance. However, these guidelines could soon be changed to  "For all women requesting a Caesarean section, if after discussion and offer of support, a vaginal birth is still not an acceptable option, offer a planned Caesarean section".

I completely respect the woman's choice to choose what sort of birth she would like, but in most cases, if the mother is healthy mentally and mother and baby are healthy physically, then it is safer and more beneficial for the baby to be born through traditional means than via Caesarean. I suspect that should these guidelines come into effect, many women could choose to have a Caesarean through fear of childbirth, or thinking that it is the 'easy option', or simply because all of their friends are doing it, rather than actually because they have researched the subject thoroughly and have formed the view that a Caesarean birth is best for them.

Of course, Caesarean births save the lives of mothers and babies all over the world and in some circumstances they are the best choice available, but the preconception that Caesareans are the 'easier' option for childbirth can be rather misleading.

So here are ten things you may not know about Caesarean Birth.
  1. From the bean counter's perspective, Caesareans cost more money to the NHS, so money ploughed into them could result in cuts elsewhere.
  2. A Caesarean is an operation and like other surgeries, involves significant recovery time, whilst also trying to care for a new baby. 
  3. A date will most likely be set for an elective Caesarean, but if the hospital is busy and the theatres are in use, the mother could have to wait until the theatre and staff are free which could be the next day or later. Alternatively, she may be sent home.
  4. An elective Caesarean includes agreeing to share your birth experience with at least 10 to 15 other people including consultants, theatre assistants, anaesthetists, scrub nurses, midwives, paediatricians, possibly students and of course a birth partner, so consider how this may affect the birth experience and what you were hoping for.
  5. An all inclusive package comes with the elective Caesarean. This includes an epidural, catheter, intravenous drip and cannula in the arm, blood pressure cuff and possibly other wires and monitoring devices for mother and baby.
  6. Actually getting the baby out only takes about 5 to 10 minutes,but it could take 45 minutes to an hour to stitch the 6 to 9 inch incision back up.
  7. Babies born via elective Caesarean are up to four times more likely to develop respiratory problems. The mothers contractions prepare the baby's lungs for breathing and so a Caesarean birth does not allow the baby to clear the fluid from it's lungs as effectively as it would have if the woman had gone into labour naturally.
  8. After a Caesarean, mother and baby will be taken to a recovery room, where their condition will be monitored before being taken to the postnatal ward. In most hospitals, once mother and baby are transferred to the postnatal ward, the birth partner cannot stay outside of visiting hours and so if staff are busy, the mother may find herself having to care for baby on her own soon after the operation without much help.
  9. Caesarean complications for the baby could include respiratory distress, bruises and cuts to the skin, low Apgar scores, and unfortunately, as with a straightforward birth, a Caesarean birth does not guarantee a live baby.
  10. Caesarean complications for the mother could include   
  • Anaesthetic complications
  • Blood clots and circulatory issues
  • Damage to bladder or bowel
  • Endometritis (inflammation of lining of the uterus)
  • Future obstetric complications (reduced fertility, small increase in stillbirth, emergency     hysterectomy.Haemorrhage (severe bleeding)
  • Infections of abdominal wound
  • Psychological effects
  • Septicaemia (blood poisoning)
  • Pulmonary Embolism
So for women considering the potential choice to have a Caesarean, it can be useful to weigh up the risks and after effects of having the surgery against having a straightforward birth, to allow them to make an informed decision.

The After Effects of Caesarean
  • Can hurt to change position in bed
  • Can hurts to cough or laugh
  • Perennial Pain
  • Bruising on body from drips etc
  • Increased Lochia 
  • Drain for fluid in abdomen
  • Wind
  • Typical stay in hospital is 3-6 days or longer
  • Hard to get up and down the stairs
  • No heavy lifting 
  • Can be hard to carry baby
  • No Heavy Housework, i.e vacuuming, ironing, changing beds- anything that involves bending, lifting, reaching upwards or repetitive tasks
  • Hard to get up out of chair
  • Difficult to carry Moses Basket/Car seat
  • Difficult to go to the toilet
  • Need help with breastfeeding the baby and positioning the baby so it does not hurt the scar
  • Need help for simple tasks such as dressing and bathing yourself and the baby
  • Pain, infection, raised temperature
  • No Driving for 6 weeks (check your insurance)

If after weighing up all of the information, the mother decides that she would like to proceed with a Caesarean, here are some things which can make a Caesarean Birth special

  • The midwife or birth partner could give a running commentary 
  • You could request to have music playing
  • Take photographs/video
  • Use a mirror, or sit up slightly so that you can see baby being born
  • Ask for the baby to be placed straight onto the woman's chest after birth
  • Be the first person to greet your baby
  • Discover what sex the baby is yourself
  • Have the baby resuscitation and weighing station in sight so you can see what is going on
  • Have skin to skin contact
  • Delay having the baby washed, bathed or dressed until you are back on maternity ward and have fed for the first time
  • Start breastfeeding as soon as possible.
  • See the placenta and have it explained- this is the thing that has kept your baby alive for the last 9 months!
  • If coming round from a general anaesthetic,. ask for known midwife, or birth partner to be the first to introduce the baby to you.

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