Date issued: May 2018
For review: May 2020
Ref: B-189/SF/Your Elective Caesarean Section v7
Important telephone numbers
Day assessment unit: 01752 763676
Labour ward (triage): 01752 763610
Community midwife: 01752 517888*
*Message handling number. They will put you in touch with the community midwife during office hours (8:30-16:30 weekdays) or transfer you to labour ward triage out-of-hours.
You and your medical team have decided that your baby will be delivered by Caesarean section. This leaflet will give you more information about the process. Your team of midwives and doctors will be happy to answer questions you may have at any point.
Your Operation Date
Your Caesarean section will be booked during the 39th week of your pregnancy unless you have been told otherwise by your medical team. Should you go into labour before this time, your Caesarean section will be performed as an emergency.
For logistical reasons we can’t give you the exact date for your operation too far in advance. We will telephone you with the actual date about 4 days before surgery and ask you to attend for a pre-assessment. It is therefore essential that we hold accurate contact details for you.
If you are a smoker, try to stop or reduce smoking in the weeks before surgery. This will greatly reduce your risk of a chest infection after surgery and help the wound healing process. For more advice ring the free NHS Smoking Helpline on 03001231044.
Your Assessment Visit
A few days before your operation we will invite you to attend the day assessment unit for an appointment. This will allow us to prepare you for your operation and enable you to ask any questions. Please allow approximately 2 hours for this visit and ensure that you bring your notes.
During your appointment you will see a midwife, who will check your pulse and blood pressure and also listen to baby’s heartbeat. The midwife will also take blood samples for routine pre-operative tests and measure you for some elasticated stockings.
One of our anaesthetic doctors will assess you and discuss the options for anaesthesia for your Caesarean section. (for further detail see paragraph, “your anaesthetic”) You will be sent home with antacid tablets (a routine pre-med before Caesarean sections), with instructions on how to take them.
Before your Caesarean section
Shaving of pubic hair has been shown to increase wound infections after Caesarean sections. We would therefore ask you to avoid shaving for at least one week before your operation. Wax or hair removal creams are safe alternatives.
At 10 p.m. the night before your operation you will need to take one antacid tablet (Ranitidine 150mg).
You can eat until 2 a.m./…………………of the night before your operation and have clear fluids until 6 a.m./……………. before coming into hospital.
Clear fluids are ones you can see through that are not fizzy. Black tea or coffee is fine.
On the day of your Caesarean section
You can take your morning antacid tablet (Ranitidine 150mg) at 6 a.m./……………………. with a glass of water.
We will ask you to attend Central Delivery Suite at 7 a.m./……………. on the morning of your operation.
Here you will meet your midwife, who will check you in and get you to change into a hospital gown and TED stockings. Your chosen birth partner will also have to change into scrubs (green hospital clothes) if he or she wants to come to theatre with you.
Once the team is ready you and your partner will be taken to the operating theatre. Here you will meet the team of midwives, surgeons, anaesthetists and theatre practitioners who will assist with your operation. We will attach some routine monitoring to you and the anaesthetist will put a drip in the back of your hand. After that you will be given the anaesthetic. (for more details see “Anaesthetic for Caesarean section”) Once the anaesthetic is working, the midwife will put a catheter into your bladder before the surgeon will proceed with the operation. The surgery takes about an hour from start to finish.
After your Caesarean section
Provided your operation is straight forward, you will be offered discharge the day after surgery. This will mean minimal disruption to your family life and has been shown to improve patient satisfaction without posing increased risks for yourself or your baby.
There are a few important points to consider that will speed up your recovery and return to your own home:
Eating and drinking can be started as soon as you feel
able to after the operation. This will help with your overall
recovery and enable us to remove your drip at the earliest
Sitting out of bed early will reduce the chance of
thrombosis (clots in your legs). However, a midwife needs
to make sure that sensation and power in your legs have
returned sufficiently before you get fully mobile. Once
you’re up and about we will be able to remove your catheter (usually about 12 hours after your operation).
Walking around once you’re mobile will enable you to have a wash, get into your own clothes and feel a bit more “normal”. Being mobile also aids deep breathing and speeds up recovery of your bowel function.
Good pain control is important, for you to be able to be mobile, breathe deeply, eat, drink and sleep well. You will be given regular pain killers. You can also have an anti-sickness medicine, should nausea be a problem.The midwives on the postnatal ward will assist you with caring for and feeding your baby. They will ensure that you are happy with this before you go home. A paediatric doctor will do a routine baby check before you are discharged.
The obstetric surgical team will see you on the morning of discharge and make sure you are medically fit to go. You will be seen by a community midwife the day after you go home.
Please contact 01752 517888 if you have any questions or worries in the meantime.
When planning your return home you may want to organise some extra help for the first few days, to give you a hand with shopping/cooking/help with other children.
Frequently asked questions
Q. Are there risks to me or my baby?
A. Every operation has risks, and your hospital doctors will
have explained the risk of a Caesarean section compared with a vaginal birth. For you a Caesarean is considered the safest option for you and your baby. Make sure you fully understand the potential risks and benefits before signing the consent form.
Q. How long does it take?
A. The whole operation normally takes around an hour.
Q. Does it hurt?
A. During the operation you may feel a tugging or a pulling sensation, but you should not feel pain. If you do experience discomfort, tell the anaesthetist immediately, so they can treat your symptoms appropriately. After the operation you will be given strong pain relief.
Q. I’ve had a caesarean before. Will the surgeon use the same scar?
A. If your scar is at your bikini line, yes.
Q. Can my partner stay with me?
A. Yes, if you are having a spinal anaesthetic. Your birth partner will need to wear theatre ‘greens’, a disposable hat and theatre shoes. All of those items are provided and your partner can use the staff changing facilities.
If you are having a general anaesthetic your partner will have to wait outside and you will meet them in the recovery area after the operation.
Q. When will I be able to hold/feed my baby?
A. When your baby is delivered it usually stays attached to the umbilical cord for another minute or so. This has been shown to be beneficial for new-borns in the early days andweeks of life. Once the cord is cut the midwife will dry your baby and make sure he/she is breathing properly, before passing him/her to you for a cuddle. We encourage placing your baby onto you, “skin to skin”, and if you are happy for this, we do it as soon as possible (i.e. in the operating theatre) You can start feeding baby as soon as possible after the operation in recovery.
If you are having a general anaesthetic the baby will be with your midwife, who will then take him/her out to your partner or family member in recovery. You will meet them once the general anaesthetic has worn off.
Q. How long will I need a catheter?
A. Your catheter is usually removed about 12 hours after your operation, provided you are up and about. The midwife will make sure that you pass urine normally afterwards.
Q. How long will I need a drip?
A. Your drip is removed when you are eating and drinking
Q. Will I bleed afterwards?
A. There may be some leakage onto the dressing covering your wound. If you are worried about this please speak to the midwife looking after you. Sometimes the doctor needs to put in a drain near the wound during your operation. This is removed when it has stopped draining, usually this is after 24-48 hours.
You will bleed vaginally, usually for up to a week, becoming less every day. On the day of your operation you may need some help with your personal care. The staff will be happy to assist you.
Q. When can I have visitors?
A. Visiting hours are from 8 a.m. – 8 p.m. for your partner and 4 p.m. and 7 p.m. for others. Your own children are allowed to visit. However, we encourage you to keep those visits short and be mindful of other patients.
Q. When will I be back to normal?
A. A Caesarean section is a big operation. With assistance, you should be up and about the following day. However, don’t be surprised if it takes several weeks, sometimes longer, to feel “back to normal”. You will be given guidelines regarding exercising/driving.
Q. Will I have a single room?
A. When you are transferred from the theatre to the postnatal ward, you will be placed in a four-bedded room with other mothers who have also had a Caesarean section.
Q. When do my stitches come out?
A. The obstetric surgical team will advise you on how to look after your wound and let you know if any stitches need removing. This is usually done by your community midwife on the fifth day after your Caesarean section.
Q. When can I go home?
A. You would usually go home after 24- 48hrs. If you wish to leave hospital earlier you need to discuss this with your team of midwives and doctors.
- Your maternity notes. We are unable to do the operation without them.
- Camera or smart phone for taking pictures
- Music? (There is a radio in the operating theatre, with the option to play music via Bluetooth.)
Small case with:
- Dressing gown
- Maternity pads
- Nappies, wipes and something for your baby to wear (a vest, baby grow and a hat and cardigan.
We advise you leave your main things in the car until after you have been transferred to the post-natal ward.
For when you go home
- Ensure you have plenty of paracetamol and ibuprofen at home
- Take painkillers regularly, whether you are in pain or not
- Remember to drink plenty of fluids and eat regularly
Anaesthesia for your Caesarean Section
There are several options for giving an anaesthetic for a Caesarean section. Women can either be awake (with a regional anaesthetic) or asleep (general anaesthetic).
More than 95 percent of women are currently opting for a regional anaesthetic. This can be a spinal or a combined spinal epidural anaesthetic; the exact details will be explained to you by your anaesthetist.
Spinal and epidural anaesthetics are extremely safe, but, like with any other medical procedure, we need to make you aware of possible problems and side effects:
- Itching is common and can be treated with tablets if troublesome.
- A drop in blood pressure after the spinal injection occurs occasionally. This will be monitored and treated accordingly by your anaesthetist.
- Some women (less than 1 in 200) develop a treatable headache post-operatively.
- Rarely (about 1 in 2000), there can be an area of temporary numbness or weakness in the leg, which will resolve with time.
- The risk of serious complications (such as permanent nerve damage) is extremely low (1 in 50 000 to 1 in 150 000).
On balance, a regional anaesthetic is the safest technique for your Caesarean section. It will allow you to stay awake and witness the moment of birth in the company of your partner or chosen supporter. Unlike with a general anaesthetic, you will not be sleepy after a regional anaesthetic, nor will your baby be affected in any way. You will be able to breastfeed as soon as the operation is finished, should you wish to do so.
Regional anaesthetics involve the injection of local anaesthetic into the lower back. This produces numbness from the feet up to the level of just above the nipples.
As the anaesthetic takes effect, it is not uncommon to feel “strange” and sometimes a little light-headed, but these feelings are usually very brief.
Before surgery starts, your anaesthetic will be tested to confirm numbness of your lower body up to your nipples. You will not be able to move your legs.
During surgery it is normal to be aware of pulling and pushing sensations (especially during the birth itself), but you should not feel pain. Your anaesthetist will be with you throughout the operation and you need to let him/her know if you are feeling uncomfortable or if you are worried in any other way. The anaesthetist will be able to assist with any queries and treat troublesome symptoms.
Having a regional anaesthetic usually means that there is little need for strong pain killers after the delivery. Regular Paracetamol and Ibuprofen (if tolerated) taken by mouth are usually all that is required.
Very occasionally, a general anaesthetic becomes necessary. This only occurs if it is impossible to produce adequate loss of sensation with the spinal injection or if surgery is prolonged and becomes too uncomfortable to tolerate.
Any concerns you may have regarding your anaesthetic should be discussed with the anaesthetist when they see you at the pre-operative visit. They will be happy to answer any of your questions.
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