Caesarean Section: Lets break it down



A Caesarean Section (CS) may be indicated when there is serious risk to the health of mother and/or baby, it saves lives. In recent times, It has gone from being a ‘last resort’ measure to save the life of the baby or mother, to being considered simply as an alternative birthing mode, with many more CS being performed in the private hospital system - some around (and above) 50%


The World Health Organisiation (WHO) has analysed global data and states that a Caesarean Section rate of up to 10% is proven to save lives. Although they also found that once that rate climbs above 15%, there is no reduction in neonatal or maternal death. You can find more information on this here;

https://www.who.int/reproductivehealth/topics/maternal_perinatal/faq-cs-section/en/


Absolute reasons for a CS are;


🔺The placenta is totally blocking your cervix- there is no other way out!

🔺Your baby is in serious distress and needs to be born immediately

🔺Your baby is malpositioned- laying across your cervix

🔺Your baby is unwell

🔺You are very unwell


Other reasons you may be offered CS;


→You are birthing with a private Obstetrician- CS rates are well above the WHO recommendation of 15% (Private hospitals in W.A have rates from 30-57%- ask your Obs what their rate is!)

→Your baby is in a breech position (bum first)

→Unsuccessful induction of labour

→You have had a previous CS

→Your baby is estimated to be very big

→Your baby is potentially growth restricted

→You are carrying multiple babies


Dodgy reasons for CS (without other risk factors);

During labour…

“It's 4pm and you’ll probably need one anyway at 3am, so let's just do it now”

“Your skin doesn’t look like it will stretch well”

“Your baby is in a posterior position”

“Your Great/Grand/mother/sister had a rough birth/CS so I think it's best for you to have one too…”

“Your baby is too special to come out of your vagina (IVF)”


These are all ACTUAL reasons people have recounted from their Doctors and some I have heard first hand!


Types of CS births

There are categories of CS birth, the first 3 are all classified as ‘Emergency’ but their urgency are always to a varying degree;


Category 1 - Life threatening to Parent or baby, to be undertaken within minutes/ASAP (often under GA)

Category 2 - Urgent but no immediate danger, within 30min to an hour (most common)

Category 3 - Not urgent/no life threatened (ie; a booked CS that begins to labour)

Category 4 - Pre planned/Elective surgery booked


Impacts

As with any other major surgery, it does come with risks (that you will need to weigh up when making your decision, but also to help you formulate a plan to prepare for your birth). Major surgery always comes with an increased risk of excessive blood loss, infection, a recovery period where mobility will be affected and increased risk of clotting disorder


For CS birth specifically, the surgical incision can impact upon future pregnancies as the uterine scar presents a risk to abnormal placenta attachment - check out this link for more info on this https://www.preventaccreta.org/


When babies are born through the vagina, they become colonised or ‘seeded’ with their parents' microbiota. This is said to become an important part of the baby’s immune system and even influence their genetic code. When babies bypass this process during CS, they tend to be colonised with a different set of microbiota, and often far fewer species. There have been studies on how we can help to recreate the vaginal seeding, through swabs taken from the vagina which are then wiped over the baby post CS birth. More information on this process can be found here; https://microbirth.com/


There also have been links to a reduced incidence of breastfeeding, increased need for assistance and support to establish feeding and feeding for a longer duration. This is why it is important to consider investing in a postpartum doula and/or the services of a Lactation Consultant so you can reach your feeding goals

https://www.breastfeeding.asn.au/bf-info/breastfeeding-after-caesarean-birth

https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-0876-1


How does it happen?


There are many staff in the theatre doing various jobs, a Midwife and Paediatrician to oversee the wellbeing of the baby, an Anaesthetist and their technician, one scrubbed/sterile Nurse, one scout Nurse to run around and help where needed, once Obstetric Consultant and sometimes one or two junior Doctors


In most cases you will be wheeled in and transferred onto the theatre table, and you will await the siting of either an epidural, an epidural top up, a spinal anaesthetic or a general anaesthetic (this is generally only done if it is a true emergency or if an epidural is not providing enough coverage). If you need to have a CS under a GA, your support person will not be permitted to stay on theatre with you


Once it is determined that the epidural/spinal/General Anaesthetic is working effectively, they will prepare the sterile field which may include placing a catheter into your bladder, cleaning your abdomen with a sterile solution, covering you with sterile drapes and placing a screen of drapes up to keep the surgery out of yours and your partners view


The baby is born through an incision just above the pubic bone (in most cases) and generally takes only a few minutes to get to baby, through a number of layers of skin, fascia, and uterine layers

After a quick check over providing all is well with baby, there should be support for you to have skin-to-skin contact in theatre (and even a breastfeed), whilst the placenta is being removed and incision repair is occurring. Closing the wound may take around 20-30 minutes. At the very least, breastfeeding should commence in the recovery room (be sure this is on your birth plan and you discuss with your care provider if this is your preference)


Although...


Gentle CS

Over the last decade there has been a shift in view of CS birth, in an effort to make the birth as parent-centred and baby friendly as possible. This method of “Gentle caesarean” is slower, gives the baby more time for the lungs to be squeezed during emergence, encourages the drapes to be dropped and baby to go straight up to be skin to skin with their parents. It also supports the routine delaying of cord clamping - here are some more details;

https://www.bellybelly.com.au/birth/gentle-c-sections-better/

https://www.bellybelly.com.au/birth/delayed-cord-clamping-c-section/


If you would like to see a birth video of a gentle CS, click this link (not for the squeamish)

https://www.youtube.com/watch?v=ZGmjEtvM7B8


Maternal Assisted CS

Even more parent-centred is a Maternal Assisted CS, where the parent gets to ‘scrub in’ and be the person who helps their baby emerge and brings them up for immediate skin to skin - follow this link for more;

https://www.belleverdiglione.com.au/blog/the-birth-of-leilani-a-maternal-assisted-caesarean


Being skin to skin with your new baby provides incredible benefits - it helps to regulate their breathing, heart rate, temperature, reduces their stress response, helps them to maintain their blood sugar levels and also covers baby with your family's unique microbiota. Evidence is overwhelming is support of skin to skin, even in theatre or as soon as possible after CS birth;


https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/implementing-standards-resources/skin-to-skin-contact/


Many babies born by CS find it difficult to clear their lung fluid as they don’t get the same squeeze on the way out as they do during a vaginal birth, so a larger proportion of babies need some help to start breathing and someti

mes, further assistance in the nursery. Due to this potential separation, it is import to consider antenatal expression of colostrum if you are intending to breastfeed, to avoid needing to supplement with formula - here is my video detailing hand expressing https://fb.watch/7IhrXOkGud/


Back in the postnatal ward

You are closely monitored for 24 hours, will have a urinary catheter in place and be bedridden during this time. Women require strong pain medication, You will need to be fully assisted with baby care, and will need additional support to establish breastfeeding. If for any reason you need to be separated for your baby (for your needs) that wonderful skin to skin can be achieved by your partner


The CS wound may be closed with staples or a long internal suture, and have a small dressing to cover it. Sutures or staples are generally removed days 5-10, and you may need ongoing pain relief. Once the dressing is removed, keep the incision clean and dry and keep a lookout for any possible signs of infection (swelling, redness, odour, pain)


It is best to get out of bed as soon as you feel able, this assists with your recovery. This usually takes place the day after your surgery, with the assistance of your Midwife, you will love that first shower! Ensure you keep as comfortable as possible with pain relief meds, you want to make sure you are not distracted by discomfort during those first few days with your baby. Contact staff if you don't get adequate pain relief or need a top-up, don't be afraid to press that call bell, staff EXPECT that you will need a lot of assistance with baby cares and general support


You will be offered an injectable medication to reduce your risk of postoperative blood clotting, the course varies between a few days to several weeks (this will depend upon your care providers preference and your individual risk factors) post birth of giving yourself subcutaneous injections into the skin of your abdomen - as with everything, assess your own risk and decide if this is right for you


Heading home

It will take several weeks to recover, all the while you are learning to be a new parent. Be kind to yourself and let your body recover! One of the most important plans for you to make is for the immediate postpartum period. This is where you will need to open your heart to say YES to any offers of help, and even ASKING for help when you need it. Put in place supports so that you can allow yourself the rest - do some batch cooking for the freezer during the last trimester, see if someone can help with school drop off and pick up if you have older kids, hire a cleaner and if a visitor asks if they can help with anything - them a job!


A Postpartum Doula is an absolute godsend and an expert for this time, helping support your feeding journey, being able to attend to your older kids, a bit of tidying up or even cooking you some family meals. This will allow you to recover, both physically and emotionally and dedicate your time on yourself and your new family


Birth Planning


As with any birth preparation, it is really important to know your options and be able to clearly communicate those desires to your care team. Even if you don't plan on having a caesarean birth, it is great to know what it is all about and also your options. There is no reason that you can’t have a family-centred, empowering Caesarean birth!


There are so many easy ways for you to customise your birth experience - your own music playing in theatre, requesting the presence of 2 support people (perhaps your Doula) so that in the event of separation you will have a support person for both you and baby, immediate skin to skin and breastfeed in theatre, photos or video of your birth, waiting to go into labour so your baby gets to come when they are ready, maternal assisted CS, walking into theatre rather than being wheeled in, the drape dropped so you can see baby emerge, making sure you get to announce the gender of your baby In preparing for any birth, delayed cord clamping. It is wise to map out what your preferences are, in ANY eventuality. This means you can approach your birth fully informed and prepared, ready to meet your new baby, however you end up meeting them


More links;

https://sarahbuckley.com/how-to-have-the-best-cesarean/

https://thenaturalparentmagazine.com/a-better-way-the-gift-of-a-woman-centred-cesarean-section/

https://www.healthline.com/health/postpartum-belly-binding#what-it-doesnt-do

https://intermountainhealthcare.org/blogs/topics/intermountain-moms/2018/03/the-dos-and-donts-of-healing-from-a-csection/

https://www.verywellfamily.com/hospital-bag-for-a-planned-cesarean-birth-2759905



I'm Hayley, I am a mother of 4, I have been a birth worker for over 10 years. It is my life’s work to help new parents have the best birthing and early parenting experience as possible by providing a birthing & postpartum Doula service, and Birth and Early Parenting education. Let me help you navigate this journey with confidence and help you settle into life with your new baby. I am available for 1 to 1 support in person and also online


I am based in the Perth Hills and cover all of Perth Metro area, regional areas by arrangement

ritualbirthco@gmail.com

www.ritualbirthco.com.au

https://www.facebook.com/ritualbirthco

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