C-Section Information

We’ve put together some useful information if you are electing to have a C-Section or if you are worried that you may end up having one. Remember it is always your choice even if you have had an emergency C-Section the last time. It is even your choice if you have had 3 emergency C-sections before. Asking as many questions as you can to be really clear about your situation and what is best for you and your baby is key! There are many reasons why you may have a planned or emergency caesarean, rather than a vaginal birth such as:

• You've already had at least one caesarean section.

• Your baby is in a bottom-down, or breech, position.

• Your baby is in a sideways (transverse) position or keeps changing his position (unstable lie).

• You have a low-lying placenta (placenta praevia).

• You have a medical condition, such as heart disease or diabetes.

• You have lost a baby in the past, either before or during labour.

• You’re expecting twins or more.

• Your baby is not growing as well as he should be in your womb (uterus).

• You have severe pre-eclampsia or eclampsia, making it dangerous to delay the birth.

Occasionally, something happens during labour which means a baby needs to be born quickly and by emergency caesarean. In this case, everything will be explained to you and you will need to consent to have the c-section. You will then be taken to the theatre in good time to make sure you and your baby stay well. The urgency of the situation will determine how quickly this needs to be and whether your birth partner can come with you, but there are many reasons for this ranging from:

• Labour being very long and slow. This is called “failure to progress” and can happen in an induced or spontaneous labour. It either means the neck of your womb (cervix) is not opening quickly enough in the first stage of labour or there is a problem while pushing your baby down and out of the birth canal.

• Your baby may also be becoming distressed or you may be becoming unwell.

• Your baby is in a position which makes it difficult for him to be born vaginally, such as the breech position. A useful tool to apply to all the content presented to you or any research you undertake personally, and crucially when you need to make any choices during birth is B.R.A.I.N:

B = What are the BENEFITS?

R = What are the RISKS?

A = What are the ALTERNATIVES?

I = What does your INTUITION tell you to do?

N = What are the outcomes or possibilities if we do NOTHING?

When faced with a decision, or when at a cross-roads, take a moment to ask yourself and/ or your midwife/doctor questions based on the above, to help you make informed choices.

Most caesareans are carried out under regional anaesthetic. This numbs your belly and the lower half of your body, and means you’ll be awake for your baby's birth. A regional anaesthetic is safer for you and your baby than a general anaesthetic, which makes you go to sleep.

Your anaesthetist will either give you a spinal or an epidural. A spinal is usually the preferred choice, as it works more quickly.

Sometimes, you may have the option of a combined spinal epidural (CSE), particularly if you’ve already started labour with an epidural. The spinal helps numb you quickly, while the epidural can be used to give you more anaesthetic if required during the operation.

If there's time, you may be able to discuss your options with your anaesthetist before your operation. For example, you may want to add to your plan that you’d like a conversion to a general anaesthetic to be considered if you are in severe pain.

Remember, it’s always best to enter birthing with an open mind and it’s natural to want to be prepared for all the different kinds of situations that could arise. It may turn out that you will elect to have a C-section in which case here are a few things worth exploring:

• A c-section is major surgery even though as many as 1/3 of babies are born this way it is still major surgery so prepare lots of questions beforehand and get lots of information about you and your needs.

• Get a thorough consultation with both the obstetrician and the anaesthetist beforehand. The anaesthetist’s role is very important and you may well find that you are talking to her/him a lot more than the surgeon during the op.

• Check who will be operating, and who the anaesthetist will be, on the day the operation is scheduled. It would be a shame to spend hours talking to a consultant and an anaesthetist about your preferences, only to find that they are off-duty on the day, and the doctors on the team have only your notes to go by.

• Book an early morning appointment if possible, then there is less risk of your operation being postponed as emergencies/delays crop up through the day.

Pain Relief

• Most caesareans are carried out under regional anaesthetic. This numbs your belly and the lower half of your body and means you’ll be awake for your baby's birth. A regional anaesthetic is safer for you and your baby than a general anaesthetic, which makes you go to sleep.

• Your anaesthetist will either give you a spinal or an epidural. A spinal is usually the preferred choice, as it works more quickly.

• Sometimes, you may have the option of a combined spinal-epidural (CSE), particularly if you’ve already started labour with an epidural. The spinal helps numb you quickly, while the epidural can be used to give you more anaesthetic if required during the operation.

• If there's time, you may be able to discuss your options with your anaesthetist before your operation. For example, you may want to add to your plan that you’d like a conversion to a general anaesthetic to be considered if you are in severe pain.

Having a Catheter

• Having a catheter is not mandatory during a caesarean. You can refuse to have one but please note, many midwives would advise against this as refusing a catheter does carry risks; catheterisation helps to avoid accidental bladder damage where, for example, a full or partially full bladder is ‘nicked’ during the operation. Your midwife will insert a fine, soft tube (the catheter) into your bladder. The catheter drains into a bag, which collects your urine. This will usually be removed the morning after your operation.

• Think about whether you would prefer your midwife to insert the catheter in the privacy of your room before going into the theatre. Or perhaps you would prefer it to be done after you've had your anaesthetic when you’re in the theatre. This is all things to think about and discuss.

• You can walk to the operating theatre and put yourself on the table if you decide to have your catheter put in after you have had the anaesthetic.

Birth Partner’s Role

• Your partner should be able to stay in the theatre for the whole time if you have a regional anaesthetic. Your obstetrician will ask him/her to sit down and avoid certain areas of the theatre, to help maintain the sterile conditions in the room.

• Hospital staff will provide your partner with thin cotton theatre clothing, as well as a mask, hat and special footwear. Once dressed appropriately, they should be able to stand near enough to you to offer reassuring words while your baby's brought into the world.

• Newborns love to be cuddled skin-to-skin. If you're not in a position to have your baby placed on your chest, your partner can hold her instead. Just ask for a bigger theatre top than is needed, so there's plenty of room to tuck your baby next to their chest.

• Having said that as soon as you can get some skin to skin with your baby the better as it is only you that will regulate baby’s heart rate and calm their nerves. So as soon as you can snuggle them into your chest you’ll find that they will probably root around looking for your breast milk.

• If you need to have a general anaesthetic, your obstetrician may not allow your partner into the operating theatre. Ask if they can be just outside the theatre door so they can hold your baby as soon as possible if that's important to both of you.

• Although an operating theatre may not be your ideal birth environment, there are still requests you can make to personalise your experience:

Ambience

• Would you like the lights dimmed or music playing in the background to relax you and take your mind off the operation?

• Would you like the staff and the operating theatre to be as quiet as possible so that the first voices your baby hears are her parents'?

• Think about whether you want the surgeon to talk you through the operation or not, and make sure she/he knows your preference. Some people find it reassuring to be told exactly what is happening, others just do not want to know when the first cut is being made.

• A screen is put up by your chest so think about whether you would prefer the screen to be lowered or to have a mirror ready, so you can see your baby being born. Or would you like the screen to be kept raised until your surgeon finishes stitching your cut?

• And one for the Birthing Partner: think about where you would like to stand or sit if the screen is up. Would you like to be able to see the moment of birth, so you can share the memory? Or prefer to stay in eye contact with the birthing mama, breath with her and keep her focused and clam? Also, ask the hospital what its policy is on photos or filming during or after the caesarean. You may be able to capture some or all of your baby's birth.

• Do you want to discover the gender of your baby for yourselves, or to be told by the medical team?

Managing nerves

Using the Golden Thread Breath and the mindfulness techniques you were taught in our classes and the Hypno Birthing-Quests will help massively with any nerves that develop before, during and after the birth of your baby.

Skin to Skin

• Skin to skin with mum is very important not only for bonding but to regulate baby’s heartbeat. And whilst sometimes it is necessary for the baby to have skin to skin with dad in the first 30 mins of being born, it doesn’t have the same effect in terms of regulating the heartbeat and connection with mum. If it can happen with mum first, then make sure they have good quality bonding time together before dad gets a cuddle.

• To have skin-to-skin contact with your baby immediately, or wait for her to be cleaned before a cuddle?

• Once your baby has been born she/he can come and lie right next to your head where you can get all those sniffy kisses in. As long as everything is o.k, they can stay with you there whilst they stitch you up and then Dad can carry the baby into recovery where you can then take over with some lovely skin to skin.

Breast or Bottle

• We can have the best of plans when it comes to feeding our babies before our baby is born but when they are here those plans can go out of the window. Try to be in the moment with this, be gentle with yourself if you have your heart set on breastfeeding and because of numerous reasons it doesn’t happen. Or if you are adamant you will bottle feed, only to find your baby takes to the breast like a real pro and all those expensive bottles you bought are never used. Have a think about what you would like to try and then let your midwives know so they can support you with your choice.

Delayed cord clamping

THE GOLDEN MINUTE - the first 90 seconds after the birth gives the baby the oxygen they need and the iron for growth, so it is very important to leave the cord unclamped for around this length of time - or until the cord has finished pulsating. This ensures the remaining 1/3 of the baby’s blood which resides in the Placenta and cord has the time to transition into the baby. It’s estimated that a 2 or 3-minute delay in cord clamping can increase your baby’s blood supply by up to 30%. This can mean your baby has 60% more blood cells. This is usually the standard procedure with a vaginal birth, but the surgeon giving 3 good swishes up the cord can be just as good in a C-Section. If there are any complications or the baby needs medical assistance this may not be possible but it worth putting this on your Birthing Wish List and having a chat with your surgeon about what’s the best they can do.

What to do with the Placenta?

• You can take your Placenta home with you. Many people bury it and plant a rose bush or tree over it.

• Offer it over for stem cell research.

• Get it encapsulated.

• Let the hospital dispose of it. When is Vitamin K needed - injected or normal?

• Babies born before 37 weeks

• Babies born by forceps, ventouse or c-section

• Babies have been bruised during labour

• Babies who have breathing difficulties

• Babies with liver problems at birth

• Babies whose mothers have taken drugs during pregnancy for epilepsy or to prevent clots of TB.

• Vit K helps blood to clot which some babies are deficient in. Vit K is passed through breast milk and by day 8 the baby’s reserves of Vit K are up to ‘normal’ levels. Vit K comes in a shot or oral if low risk, over a few weeks or can come as a single dose injection. Again do some more research so you can make an informed decision when the time comes.

Once you are out of the operating theatre

• Sometimes, after a caesarean birth, babies need extra care in the hospital's special care baby unit (SCBU). Your partner can either stay with you while you recover from the operation, or be in SCBU to be near your baby. Although no one wants to think of their baby being in SCBU, it may help to work through this possibility in advance.

• Think about whether you'd like your partner, or a midwife you know, to introduce your baby to you if you were asleep for the birth, or if your baby has been to SCBU.

Recovery

• Getting up and walking about is really rough at first but they do encourage you to do this from quite early on sit is beneficial to the healing.

• Stay on top of the pain and take the medication offered to you. When you stay on top of the pain you will be able to move around a bit better and be able to care for your baby.

• Women tend to stay around 3 days in the hospital after a c-section, giving you plenty of time to get the support you need in terms of feeding and caring for your baby. Remember, always ask for the help that you need, the teams on maternity wards, in our experience, are great, super knowledgeable and really helpful.

• Water retention in your body is highly likely as you receive a lot of IV fluids during the CSection so you will be given some very sexy socks to wear. We highly recommend you wear them as they will help the swelling go down.

• Take care of you and don’t overdo it. You have just had major surgery and now you are looking after your baby so please be gentle with yourself and make life as easy as you can. Practice the art of delegating if you have a significant other around and if you don’t then set up your space with everything you need within a short distance of where you are.

• Rest as much as you can and cuddle your little boo boo and eat some nourishing good food. It’s a great idea to make a lot of freezer meals and stock those cupboards up with healthy easy to eat snacks and beverages. You need to stay hydrated and fuelled up to have the energy to heal and care for your new baby.

• Asking family and friends to bring a dish when they come to visit can really help; especially in week 3 and 4.

• There’s no driving for about 6 weeks and no heavy lifting. There may be some swelling around the incision, this is normal. Watch out for infection, increased pain, swelling or redness, heat or drainage, fever or chills. Share any signs of infection to your doctor asap or if you are worried in any way please consult your healthcare professional!

• Hormones will be all over the place anyway, you’ve just had a baby so feel it all, cry when you need to and remember it’s ok to grieve if you feel some regret about having a c-section. These are normal feelings to have but remember c-sections are births too and the elected ones are a fabulous opportunity to create that beautiful conscious birth you wish for. Some people imply that having a C-Section is somehow lesser than a vaginal birth. They are not! You sacrificed yourself completely but just in a different way to bring your baby safely into the world! You are a Warrioress of the highest order! Remember that with pride when you talk about your journey of bringing your baby into the world.

• Baby blues is normal, having a baby is life changing on so many levels, having a csection is major and then having to look after baba 24-7, probably on very limited sleep, is more than enough to bring anyone down. So be very gentle with yourself and pare everything down. You don’t have to keep on top of the domestics or work or anything else so just concentrate on you, your healing and your baby. But, if you or your partner is worried in any way and feel it’s more extreme like PND or PTSD then please seek out some extra support. We offer Integration Therapy sessions via Skype so that it can fit around you and your baby. You can find out more at www.livingfree.eu Personal Sessions.

•It may help your emotional recovery to go over the reasons why your caesarean was necessary with your midwife or book in for a 1-2-1 Birthing De-Brief session. Some hospitals have a birth reflection service for mums who want to talk about their birth experience or you can raise any concerns about future births with your obstetrician.

•Take lots of pics of those early days with you in them! Even if you are all swollen and looks pants it’s important to have at least a few of you with your boo at this time! These pictures will be cherished by them when they are older; and by you.

•Recovery is longer than a vaginal birth, so take it steady. You can come back to our Postnatal classes after 8 weeks and you have had the ‘A.O.K’ by your Doctor.

•Arnica is a good remedy that can help internal healing and internal bruising. Always best to consult a Homeopath.

Remember, “Everything has a place” and while we can account and make plans foralmost all of our life when it comes to birth there comes a time when we simply have tolet go and surrender. Please reach out if you need to, to the other ladies in our group orto myself Trish or my sister Clare, we are here to help.