Caesarean section is either an emergency or elective operation.

An emergency Caesarean section is done when there is an urgent complication in pregnancy or labour which significantly compromises your or your baby's well being (or both). This implies that continuing the pregnancy or labour for a significant time will be very dangerous. How quickly the Caesarean needs to be done will vary from extremely urgent (viz immediately) to within the next few hours.

An elective Caesarean section is a pregnancy planned event. The reason could be previous pregnancy or labour problems, maternal health issues, complications in this pregnancy and sometimes personal patient request.

Some women prefer to have a Caesarean section rather than a vaginal birth.  I am agreeable to this personal choice as long as the risks are understood.

An elective Caesarean section is booked on a date close to term but before the onset of labour. In these situations it is safer to avoid labour.

If you are booked for an elective Caesarean section and you go into labour before the scheduled date please advise the hospital and attend immediately. I  will do your Caesarean section as soon as possible after you arrive at the hospital.

Theatre Procedures 

Before you arrive in the operating theatre.

• You will be prepared for theatre in your room on the postnatal ward (if elective) or in Labour ward  or Birth Unit (if emergency).
• You should be fasting for six hours at least before a Caesarean section. Sometimes this is not possible with an emergency Caesarean section. 
• You will be given a pubic shave (if needed)
• You will be given Sodium Citrate drink (to neutralise acids in your stomach in case a general anaesthetic is needed).
• You will also need to sign a hospital consent form for a Caesarean section. If elective this will have been done in my office. Please remember to bring your completed consent form to hospital with you. 
• Blood is usually collected for a grouping and holding (in the unlikely chance you will need an urgent blood transfusion).
• You will be taken to an area in the theatre complex but outside the actual operating theatre on a trolley (with your midwife escorting if emergency).
• When you arrive at the theatre complex your personal details will be checked and you will have a consultation with the anaesthetist (if this has not already happened).

In the operating theatre

• An intravenous line will be set up by the anaesthetist if you don't have one already
• The anaesthetist will then administer the regional anaesthetic which is usually a spinal anaesthetic. A spinal anaesthetic is considered safer than a general anaesthetic, you can see you baby immediately after birth and your husband can be with you. If you have an epidural in-situ this will usually be used instead.
• Once the spinal anaesthetic is working I will catheterise your bladder.I will do this before you are asleep if you have a general anaesthetic.
• I will then clean your abdomen with antiseptic solution.
• I will place sterile drapes over you. 
• Your husband / partner will be given a seat beside your head so he can support you and share in the joy with you.
• I will do the operation though I will have a surgical assistant to support me with the operation.
• I will make a transverse cut in your skin about 10cm long (width of your baby's head) and about 1 cm below the pubic hair line. If you have a scar I will use the same incision lien with excision of the old scar
• The drape runs vertical from your chest so you can't see the operation happening. When I am delivering your bay I will ask the staff to lower the drape so you and your husband / partner can see your baby being born. .
• I will encourage you husband / partner to take lots of photos.
• I will invite you to touch your baby.
• Your baby will be given to the midwife attending for checking and wrapping. 
• Your husband / partner can cut the umbilical cord at this time.
• Your baby will then be brought back to you and will stay with you and your husband / partner as long as possible.
• Skin wound closure is with a special subcuticular stitch that dissolves.
• At the end of the operation a special dressing over your wound and the drapes are removed
• A special rectal suppository will usually be administered at the end of the operation for pain relief.  These will be offered to you twice a day, but soon you will only need oral analgesia. As well as there are other pain relief  options such as a "PCA" setup. 
• You will be taken from the operating theatre to recovery ward and then to the postnatal ward.

Husband / partner in theatre.

• Your husband/partner is encouraged to be with you for support in operating theatre. This is another reason for a regional anaesthetic. Make sure he brings the camera so he can take lots of baby photos of your baby being born and afterwards.

After your Caesarean section.

• The midwife, your husband and baby will return to the maternity section toward the end of the operation.
• You will go to recovery ward for the minimum time possible and then to maternity to join your baby and husband.

"Baby friendly" Caesarean section.

• At the San we will request you have a "baby friendly" Caesarean section if it is an elective procedure. That means that the your baby, your husband and the midwife all stay with you in recovery ward and so you are not separated from your baby after birth. This is only possible if  your baby is well after birth and the labour ward is not too busy
• Please advise me when we are booking your Caesarean section if a "baby friendly" Caesarean  section is your preference.

The next days

• The catheter and intravenous line are usually removed the day after.
• You will resume a normal diet
• You are encouraged to be as ambulatory as you can as soon as possible the day after your Caesarean section.
• You will will switch to oral analgesics, and will be given a supply to take home.
• As skin wound closure was with a special subcuticular stitch that dissolves, there is no stitch or staples to be removed.
• The special wound dressing I applied in theatre will remain on at discharge for hospital. I encourage you to leave it on as long as possible as the longer it is left on the better looking the scar. Often I take it off at the 6 week postnatal check up Adjacent is a scar photographed at the 6 week postnatal check up just after I removed the dressing. This was the scar after this patient's second Caesarean section.
• You can be discharged home when you and your baby are ready. Particularly patients who have had previous babies are often keen you be discharged early. Sometimes discharge is on the third postoperative day.

When you get home

• Rest for the first week then gradually resume normal activities.
• If you get tired or doing something hurts you then slow down.
• You can resume driving when pain free. If you can do an emergency brake and it doesn't hurt you then you can drive.I have had patients report they started driving 2 weeks after their Caesarean section.
• You can resume sexual relations when the lochia ceases but you will need contraception cover in case there is early ovulation.
• See me for your postnatal visit 6 weeks after your delivery.

  See also Caesarian section in the Questions and Answers section.