What is an elective caesarean section?
A caesarean section is an operation to deliver a baby through the lower part of your abdomen (stomach). Elective means it is planned in advance and you do not go into spontaneous labour.
There are many reasons why women have an elective caesarean. These include:
- Maternal medical conditions
- Complications within pregnancy e.g. placenta praevia (when the placenta is low lying)
- Fetal issues – growth restriction, breech presentation (bottom down) or transverse presentation (lying across the tummy instead of head or bottom down)
- Previous caesarean section or traumatic delivery
- Maternal request – occasionally a woman may request a caesarean section without a medical indication, this will require counselling with a senior obstetrician to discuss risks and benefits and likely will require a second opinion consult with another senior obstetrician. This is to ensure that we offer maternal choice for delivery options in line with national guidance
When will the operation be done?
Usually the operation will be booked for a date when you will be 39 weeks pregnant (a week before the due date) as this is when your baby is mature. About one in ten women will go into labour before the operation date. The caesarean section can still be done if this happens. It may be booked earlier than 39 weeks under specific special circumstances, for example, maternal diabetes in pregnancy.
What will happen before the operation?
You will be given an appointment to attend the pregnancy assessment unit several days before the operation for a pre-op assessment. When you attend your appointment the midwife will discuss the procedure with you and answer any questions that you may have. It will also be necessary to take three routine swabs to screen for MRSA (nose, throat and perineum) as well as blood tests to check your iron level and blood group. You will also be reviewed by the anaesthetist to determine the most appropriate anaesthetic for you. The midwife will give you Octenisan antimicrobial body wash for you to use prior to being admitted to the maternity unit for your elective procedure (a separate leaflet regarding its use will be provided), and you will also be given two tablets (antacids) called Ranitidine for you to self administer, one the night before your operation and the other on the morning of your operation.
Is there anything I need to do to prepare?
- Eating and drinking – you must not eat after midnight, the night before your operation. It is good for you to drink water until 7am. Please continue with any normal medication. You may have a small amount of water with your medication
- Antacid – you should take your tablet at 10pm the night before your operation and 7am on the morning of your operation. This reduces the acid in your stomach so that if there are any problems with vomiting you will not inhale acid into your lungs
- Domestic arrangements – you will need to make arrangements for existing children and ensure you have support for your return home as you will be tired and should avoid lifting and domestic chores
What will happen on the day of my operation?
You will be asked to attend the delivery suite (0191 445 2150) at 7am on the day of your caesarean section. Occasionally it may be delayed until the afternoon or another day if the delivery suite is very busy with emergencies. Staff on delivery suite will keep you up to date about events that may affect the timing of your delivery.
You are welcome to bring one birthing partner to support you in theatre and until you are transferred to the ward after the operation. When you are admitted you will be asked to check an identification bracelet and change into a theatre gown. You may prefer to bring along a dressing gown and slippers to wear before being transferred to theatre. Your identified midwife will ask you several questions and do a series of observations on you and your baby. The anaesthetist and the obstetrician who will be doing the operation will come and talk to you and take your consent.
What kind of anaesthetic should I have?
There are two types of anaesthesia; you can be either awake (regional anesthesia) or asleep (general anesthesia). Most caesareans are done under regional anaesthesia, when you are awake but you are numb from your breasts down. It is usually safer for mother and baby and allows you and your birthing partner to experience the delivery.
Regional anaesthetic
Spinal
This is most common method used in pregnancy for both planned and emergency procedures. The nerves that carry messages to your brain regarding pain and sensation are bathed in a local anaesthetic by placing a very fine needle into a bag of fluid inside your backbone. This method is very fast and uses a very small amount of anaesthetic.
Epidural
This is very similar to a spinal but the anaesthetic is not placed directly into the fluid filled bag but infused by a plastic tube / catheter outside the bag and is then absorbed. This is often used during labour and is a weaker solution, but can be sometimes topped up with a stronger solution for an emergency caesarean section
General anaesthetic
If you have this anaesthetic you will be asleep for the procedure. This is less common however is still sometimes necessary in emergency situations or if the anaesthetist is unable to site a spinal or epidural. If you have this type of anaesthetic your birthing partner will be unable to go into theatre with youbecause you will need to have a tube passed into your airway during the anaesthetic and this may be distressing for your birth partner to witness
Advantages of regional compared to general anaesthetic
- Spinals and epidurals are usually safer for you and your baby
- You and your birthing partner can witness the delivery
- You will not be sleepy afterwards
- You can start skin-to-skin contact and breastfeeding as early as possible even whilst still in theatre
- Your baby may be more alert
Disadvantages of regional compared with general anaesthetic
- Spinals and epidurals can lower blood pressure which can result in dizziness and sickness but this is easily treated
- Often this may take longer to set up than a general anaesthetic
- Occasionally you may feel shaky
- Rarely, they do not work perfectly and a general anaesthetic may still be necessary
- You may feel slight tingling in one/both legs
- You may experience itching
- One in hundred women experience a severe headache, however this can be treated
- Nerve damage is possible, but is very rare
Spinals and epidurals do not cause chronic backache. Unfortunately backache is very common after childbirth, but there is no direct relationship with regional anaesthesia (OAA.)
What will happen during the operation?
You will receive a drip (via a cannula) into your hand or arm then your anaesthetic in the theatre. When you are completely numb the staff will insert a catheter into your bladder to ensure it remains empty throughout the operation and initially in the post operative period until you are walking around again. If you are going to be awake during the operation a screen will be placed over your chest so you cannot see the procedure. The delivery of your baby usually takes about five to ten minutes after this and the rest of the operation will last approximately forty to sixty minutes in total.
One minute after the birth of baby the cord will be cut to allow a build up of baby’s iron stores, provided you and baby are both well. Baby will be dried and wrapped and assessed by either a paediatrician or a midwife. As long as everything is normal the baby will be handed to you or your birthing partner to cuddle and start skin-to-skin contact and breastfeeding if you wish. If you are asleep for the operation the same will happen to your baby and the theatre staff will look after the baby until you are transferred to recovery at which point the baby will come with you and be introduced to you and your birthing partner.
How long will I be in recovery?
You will be in the recovery area of the delivery suite for up to four hours and at this point there will not be any visiting other then your birthing partner.
Your baby will receive a full examination and will be weighed at this point.
You will be transferred to the postnatal ward directly from this area.
How long will I stay in the hospital?
Following an uncomplicated caesarean section you can be discharged home the next day. However your individual needs will be planned with the midwifery staff.
Following your discharge you will be cared for in the community by the community midwifery staff and health care assistants.
Are there any risks to my baby?
The process of normal birth helps to clear the baby’s lungs of fluid. In a caesarean this process is missed and a very small number of babies (1-2%) may have breathing problems and may need extra help initially with oxygen. If you have a general anaesthetic, your baby may also need some support with breathing as the baby may also be slightly sleepy. Very rarely the baby may suffer a minor injury/cut (2%) from the operation on the part of the baby below the cut of the womb. This may leave a little scar but should heal quickly.
Are there any risks to me?
- The main risk is of bleeding; approximately between five and ten in one hundred women need a blood transfusion
- Eight in one hundred women develop an infection after a caesarean section, which is why antibiotics are given as a preventive measure during the operation
- One in three hundred women may get clots in their legs (deep vein thrombosis / DVT) or a lung (pulmonary embolism) which is why you will have leggings on during the operation that inflate up and down in theatre and recovery. You will also be prescribed a daily injection of Tinzaparin (a drug to reduce the chance of developing clots) until you are fully mobile and this will help prevent a DVT from developing. In addition you may be asked to wear support stockings immediately after your operation
- There are risks of damage to any of the surrounding organs such as the bladder and the bowel (this happens one in three hundred caesarean sections)
- The risk of death with a caesarean section is one in twenty five thousand (this number includes emergency and elective procedures). Vaginal delivery is generally safer for you, but an emergency procedure in labour has more risks than a planned elective one
Can I have a vaginal birth in the future?
If you have had one caesarean section, the midwives and doctors at the Queen Elizabeth Hospital would normally encourage you to have a vaginal birth in your next pregnancy, as long as everything else is normal. Up to seven in ten women can achieve a vaginal delivery.
Please refer to our Vaginal Birth after Caesarean Section (VBAC) patient information leaflet.
In addition, there is a specialist antenatal session to help inform, support and prepare you for a vaginal birth after caesarean section within the Queen Elizabeth Hospital in your next pregnancy; this can be booked through maternity reception.
How can I find out more information?
Please discuss any queries or concerns with your midwife or consultant during your appointment; alternatively if you need any more information please do not hesitate to contact the Maternity Pregnancy Assessment Unit to speak to a midwife.
Other information
- National Childbirth Trust
- Royal College of Obstetricians and Gynecologists, Birth options after previous caesarean section patient information leaflet
- National Institute of Clinical Excellence
- Obstetric Anaesthetists’ Association
- Royal college of Anaesthetists
Data Protection
Any personal information is kept confidential. There may be occasions where your information needs to be shared with other care professionals to ensure you receive the best care possible.
In order to assist us to improve the services available, your information may be used for clinical audit, research, teaching and anonymised for National NHS Reviews and Statistics.
Further information is available via Gateshead Health NHS Foundation Trust website or by contacting the Data Protection Officer by telephone on 0191 445 8418 or by email [email protected].
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