YOUR COMPLETE GUIDE TO HAVING A CAESAR

Around half of all Caesars are unplanned. Here's what to expect, how to stay in control and how to care for baby and yourself after "C" day.

Most women agree that their natural birth experience was empowering, and that they accomplished something hugely meaningful. But how will you feel if you end up having a caesar, either through choice or necessity?

Approximately 50% of all caesars are planned. The others, emergency caesars, are decided on when you're in labour. This doesn't mean that you or baby is in any kind of danger, but simply that your medical caregivers believe that it would be safer to deliver baby by caesar.

Our guide will answer all your questions about caesars, and help you get back into shape, both emotionally and physically, so you can make the most of those unforgettable early weeks with your newborn.

A cut above?
Why an emergency caesar?
Step-by-step surgical procedure
Will it be painful?
Scars and stitches
Breastfeeding after a caesar
A helping hand
Take it easy
Watch your diet

A cut above?

Elective, or so-called designer deliveries have become the birth method of choice, not only for celebs like Victoria Beckham, but for an increasing number of women. In South African private hospitals, the estimated caesarean rate is around 60 percent.

You might decide on an elective caesar for a number of reasons. You may have had a previous traumatic birth experience or caesarean delivery, or your caregiver may advise a caesar because of a health problem that would make it difficult to cope with a vaginal delivery. A caesar might also be necessary because baby is lying in an awkward positions, such as breech (bottom first) or transverse (crossways).

Other reasons could that baby is too big to pass through your pelvis or you have a low-lying placenta - where the placenta develops close to or covers the cervix, which can make it difficult for baby to be born vaginally. If you're pregnant with twins or triplets, many doctors believe it's safer to deliver your babies by caesarean.

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Why an emergency caesar?

After hours of labour, if your cervix isn't dilating or baby isn't moving down the birth canal, you might be too tired to carry on. Your carers might decide to try forceps to ease baby out, but if this method doesn't work you may be advised to have a caesar. If you go into labour too early, and it's thought that baby is too young to withstand a vaginal delivery, it's safer to deliver her by caesar.

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Step-by-step surgical procedure

A nurse will prepare you for surgery. Your pubic hair will be shaved and you'll be given an enema to empty your bowels. You' ll then be taken to theatre where you'll meet your obstetrician, and assistant, anaesthetist, a midwife and a theatre nurse. A paediatrician will also be there to care for baby immediately after birth.

You'll have either a local or general anaesthetic. With an epidural or spinal block, you'll be able to stay awake to see baby being born and your birth partner can be present to lend support and cuddle your newborn after the delivery.

During the operation a screen will be put up at your chest level so you can't see the procedure itself. But you can ask to have a small mirror positioned in such a way that you can watch baby being born.

Behind the screen your abdomen will be swabbed with antiseptic and the obstetrician will check that the anaesthetic has taken effect. Then a small horizontal incision is made along your "bikini line". The bladder is pushed to one side and a second incision is made into the uterus wall.

You may feel a gentle tugging once the surgeon starts to lift baby out, but you won't feel any pain. Usually, the obstetrician shows you your baby after he's lifted it out of your uterus. After this, the umbilical cord is clamped and cut. You can ask if you or your partner can cut the cord. The actual delivery probably takes no more than 10 minutes.

Baby will then be handed to the paediatrician and midwife for examination. Sometimes a baby delivered by caesar doesn't start breathing immediately, which is why it's essential for a caesar baby to be attended to by the paediatrician straightaway.

During this time the placenta is removed through the same opening and you may be given an injection to prevent heavy bleeding. While you're being stitched, baby's weighed and cleaned and may be given to you to hold if all's well. Each tissue layer will be repaired separately and stitching can take up to 45 minutes.

A general anaesthetic means that you're unconscious during the procedure but this tends to be used only if there isn't enough time to wait for a local anaesthetic to take effect. With a general anaesthetic, it's unlikely your birth partner will be allowed into the operating theatre.

Once your obstetrician is satisfied with your and baby's progress, you can go home - this usually after about five days. You may need to come back though, to have your stitches removed and the incision checked.

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Will it be painful?

A few lucky moms get through the first few days after a caesar without too much pain, but even so you're likely to need pain relief. The anaesthetist will have topped up your epidural or given you an injection to see you through the first few hours, and you may have been given a pain-relieving suppository too.

Ask for more pain relief just as this begins to wear off. A catheter fitted to empty your bladder will be removed after 24 hours, and the drip that was attached for surgery is likely to remain in place while you're carefully monitored over the next day or two. It may be uncomfortable to roll over in bed, and lots of women feel frustrated that they can't reach for their baby.

Make the most of the help available in hospital and rest as much as possible. You have, after all, undergone a major surgical procedure.

By the time you're ready to go home a painkiller should easily control the pain. You'll bleed just as you would after a vaginal birth, so make sure you're prepared with plenty of maternity pads.

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Scars and stitches

When the dressing is removed after a few days, your wound is likely to still look red and angry. There will be bruising around the scar and the thought of wearing a bikini will be depressing. Within a few months though, the scar will fade to a pale line and be hidden by your underwear.

Initially your scar may pull and ache, and it could feel hard and raised. Cover it with a warm towel or well-wrapped hot water bottle to soothe it. This will gradually settle as it heals, although many women notice some numbness for a few months afterwards, as well as itchiness as hair grows back.

Stitches vary from hospital to hospital - your doctor will let you know whether yours will dissolve or be removed. Keep the area clean and wear loose clothes that won't rub and irritate your wound. It's perfectly safe to shower or bath - although you shouldn't soak the wound. Pat the scar dry with a clean cloth or towel.

You'll have been given intravenous antibiotics, but a caesar stills carries risks of infection. Contact your doctor or midwife straightaway if you develop any sudden pain or infection (such as swelling or pus) around your scar.

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Breastfeeding after a caesar

Breastfeeding after a caesar is vital in helping you bond with baby, especially if you were separated after the caesar, or had a traumatic birth.

Breastfeeding baby has emotional and physical benefits too. It helps your womb shrink to its normal size, and you'll lose most of the fat accumulated during pregnancy, so you'll have less difficulty returning to your pre-pregnancy weight. Breast-feeding also promotes feelings of competence and fulfilment.

Without the full use of your tummy muscles, you'll battle to sit up or shift position, so get yourself into a comfortable position before you begin.

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A helping hand

For the first week or so care only for yourself and baby. Someone else should clean and cook, or order takeaways. It may help to stay in pyjamas all day, so that people can see you" re still recuperating. Friends and visitors often offer to help out - accept their help readily.

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Take it easy

For the first two weeks avoid lifting heavy objects and children. It's good to take a gentle stroll, but dont overdo it. In the first few weeks you may experience discomfort, but pain is often a signal that you did something before your body was ready. Theres a limit to how much youre going to be able to do, so listen to your body.

Giving baby a bath will need extra care. Avoid lifting or carrying water by using the big bath, or filling the baby bath in the big bath, but always let your partner empty it afterwards. If you want to bath with baby, get in a comfortable position with your back supported by an inflatable pillow, then have someone pass baby to you. If all this feels too much to manage, simply give baby a top and tail, or a sponge bath on a changing mat.

Have everything you need close at hand when changing nappies. If you have stairs at home, set up two or more changing areas upstairs and downstairs, as carrying baby upstairs will strain your wound and tire you.

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Watch your diet

Any abdominal operation can make your bowels sluggish, with a tendency to constipation. Says one mom. The first time my tummy worked I remember pushing and being terrified I was going to burst my scar. After that I ate lots of fresh fruit and veggies and supported my scar with my hand when I strained. It's the sort of thing everyone who has a caesar goes through, but no one discusses it as it's so embarrassing. Remember that you will suffer from flatulence too!

Try to have bran cereals or oats porridge and fruit with plenty of fluids to keep you regular. Stewed prunes, soaked in rooibos tea overnight, are very effective.

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