Working as an obstetrician, performing C sections is pretty much our ‘bread and butter’. Its the first operation we learn to perform, and we would routinely do at least 3 every labour ward shift as a registrar.
Even though for me, this set up is very normal, I am aware that as parents-to-be, being wheeled into an operating theatre, awake, often with little notice, may be an alien and terrifying experience!
C-sections are classified based on their urgency, and whilst I will cover emergency C sections in a future post, this post refers to what happens when you have a planned C section. This is known as an elective operation, or Category 4, where you are provided with a specified date and time to attend for your operation.
I am always trying to pull back that theoretical curtain, and give you an insight into what things actually look like on the day. I teamed up with my lovely friend and fellow doctor @drlauragp to give you a closer insight into what you can expect from a C section.
Laura explains exactly what you can expect at each step from a patients perspective, as she gave birth to her third daughter by C section just a few weeks ago. I have added who you can expect to meet, and tips for ensuring you have a positive experience.
Before the procedure
In the run-up to the procedure, typically a few days before the expected date, you will usually attend to have blood tests, swabs for MRSA, and a discussion with an obsetetrician and anaesthetist.
You will be advised when to stop eating and drinking, any other specific advice about your personal medication. You will usually receieve 2 doses of anti-acid tablets to take and instructions on when to take them.
On the day
On the day of babies arrival, you attend the maternity unit usually first thing in the AM, check in with the admissions desk and wait for the nurse or doctor to admit you. They may take bloods, listen to the baby and perhaps do routine vitals.
You meet the midwife that will be looking after you for the day. They will usually go through a full history, full set of vitals etc. If required you will be measured for TEDs stockings and then you wait! Usually your partner / husband would be with you for this stage, but because of coronavirus obviously this isn’t happening at the minute.
Now it’s a matter of sitting back and relaxing and waiting to be called for surgery. During this time, you can’t eat or drink.
You will also usually recieve a visit from your surgeon and the anaesthetist for the day, to check your history and any special requiriements for your operation.
In the operating theatre
Before going up to the operating theatre you change into your hospital gown (with nothing on underneath!) and usually wear your dressing gown over this.
The only other thing you need to bring to theatre is babies first outfit and some blankets. Its a good idea to have babies first outfit in a plastic bag all ready to go. In normal times, your husband or partner would accompany you up to theatre. They are usually left outside while you are brought into the anaesthetic room to get ready.
Here you meet the team that will be looking after you during the operation. They will check your details and again might go through some vitals making sure everything is ready to go. You will usually meet the anaesthetist at this stage as well, who will insert the cannula ready for theatre. They will go through your medical history again. No-one wants any mistakes made!
Next stage is to be brought into theatre. You will be moved onto the operating table and have the epidural done at this stage. To get this done, you sit on the edge of the bed, legs on a step and bent over slightly (so there is a slight curve in spine) with a pillow tucked in front of you.
The anaesthetist will talk you through every step so you know what’s happening. Once the epidural is in and meds have been given you will start to feel them working. A heaviness / hot feeling will move down your legs and you will lie back on the table. There will be lots of people around you in theatre at this stage and they will start getting everything ready.
You won’t be able to feel your legs after a couple of minutes and usually right up to your nipples. The theatre nurse will be setting everything up and putting up a drape in front of you so that you can’t see what’s happening. Your arms are usually brought out at right angles to your body, and hooked up to BP monitors etc.
While this is all happening they will usually be placing a catheter into your bladder and getting you all cleaned for surgery. All of the goes by really quickly! You will often be very suprised that the next thing you will be told is that baby is coming out.
Time from knife-to-skin to baby being born is pretty quick, around 5-10 minutes if it is your first baby, slightly longer if you have had operations before. It’s the closing everything up again that takes much longer!
The whole operation (without any issues) takes 45 minutes-1 hour
While the drape is up in front of you during the operation, they will pull the drape down and show you baby once they are out! If possible they will do delayed cord clamping (More on this below!).
The baby will then usually be passed to the midwife looking after baby takes them to check over everything. 10 fingers,10 toes; umbilical cord clamping, weigh baby etc.
After this it is a case of stitching you up. If there aren’t any issues, they can be done really quickly and you can be out feeding baby in no time.
The main risks to be aware of for the operation include:
- infection of the wound (they give antibiotic during most sections to prevent this).
- Bleeding, which can be severe enough to require blood transfusion
- Blood clot in your legs (this is why you wear stockings and get injections to thin the blood).
- Damage to bladder (1 in 100 cases) and bowel (1 in 1000 cases).
After the operation
You then spend the next hour or so in recovery. This is so the midwives can keep an eye on vitals like your blood pressure, temperature etc. This is a great chance to do skin-to-skin with baby and get that first feed in. Once everyone is happy they can get you moved down to the post-natal ward.
Most women will stay 1-2 nights in hospital after an uncomplicated C section, and that will depend on how your recovery goes. If you want more tips on recovery after C-section, check out this post.
Who is present in theatre:
One thing that many women, and their partners, are often quite surprised by, is how many people are often present in the theatre. It can make you feel quite overwhelmed.
Therefore it can be really helpful to understand who you could expect to be there, and remember that everyone there has a role to play in looking after you and your baby:
Obstetricians
These are the surgeons who perform the C section. We need 2 people (at least), and they are usually a junior and senior doctor who work together to do the operation.
There is usually a third obstetrician, the consultant, who may be present in theatre, elsewhere on the labour ward or available by phone to call if there are any complications.
Scrub nurse
These nurses are specially trained to assist in operations by scrubbing in, and handling all the instruments, ensuring the surgeons are presented with the tools they need at the right time.
Anaesthetist
This is a doctor who is specially trained at providing pain relief, as well as putting you to sleep if needed.
They sit near your head, closely monitoring all your vital signs and can reassure you and talk to you throughout.
Operating department Practitioners (ODP)
These are the assistants to the anaesthetist and prepare the environment and equipment they need
Midwife
Even if your birth is by operation, a midwife is there to support you for birth, check over your baby and help you with feeding and your postnatal recovery
Paediatrician
In most hospitals the baby doctors will be present for any emergency C sections, and some elective ones to check the baby at birth and assist if needed.
Healthcare Assistant
Vital team members for moving patients, cleaning and assisting other staff.
Other staff members may be called on including:
- Urology/ bowel doctors
- Midwife in charge
- Extra scrub and ODP staff
- Extra anaesthetists
Ideas for things you can ask for a positive C section experience:
1. Ask to play your own music. Make a playlist and usually the staff will enjoy it too! You can bring a speaker as well in case there isn’t one there. Sometimes in emergencies we may need to turn it off or lower the volume so staff can hear eachother, so it’s not a guarantee you can have music on.
2. Hypnobirthing – I’ve talked about this a lot. Breathing and calming techniques don’t just need to be used in labour – you can relax yourself and separate your mind from the beeping of machines and sickness/ discomfort by practicing these ideas.
3. Ask to drop the drapes – during the operation usually the sterile drapes will act as a barrier so you don’t need to see what’s going on inside. As the baby is delivered, you can ask them to lower the drapes so you and your partner can see the baby as they enter the world. Ask your doctors if you want this before the start of the procedure.
4. Delayed cord clamping – this means waiting for a few minutes before clamping the cord. Traditionally it wasn’t offered because of concerns about mum bleeding. However we now know if the procedure is going well and bleeding isn’t too heavy it is beneficial for baby to recieve the extra blood by allowing delayed cord clamping. Your doctor may not be comfortable with this, or it may not be suitable for you if there is a bleeding risk so discuss it first.
5. Skin-to-skin – this is when your baby is put on your chest after they are born. It’s more tricky in a C section because of drapes and machines but often if baby is well your midwife can help you to achieve this even while the operation is ongoing.
What do you wish you’d known about your C section?