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A Caesarean section
A Caesarean section is where a baby is delivered through a cut on the lower part of a woman's abdomen. This now accounts for 25 per cent of all UK births.
The indication for Caesarean section may be decided at any time during the pregnancy (planned) but sometimes the need for a Caesarean section is evident only after the onset of labour (emergency).
Common reasons for planned Caesareans are abnormal fetal presentation, low-lying placenta, twins, a small maternal pelvis or difficult previous birth. In the emergency situation the usual reasons are fetal distress or failure to progress in labour.
Preparation for the operation on the day
On the day of the planned operation you should be nil of mouth for six hours prior to the procedure. You would be expected to arrive at the hospital three hours before the procedure. You will need to have a blood test in order to store your blood type in case you need a blood transfusion. The pubic hair just above the bikini line will be shaved.
Which anaesthetic?
The type of anaesthesia used for a Caesarean section is determined by the condition of the mother and baby. In 95 per cent of cases either a spinal or epidural anaesthetic is administered to numb the mother's legs and abdomen. Your partner will be able to attend the delivery under these circumstances. You will be awake without feeling pain.
In certain circumstances, a general anaesthetic that puts you to sleep during the operation may be preferable. See www. [website link Obstetric Anaesthetists Association]
After you are made numb or put asleep a catheter is inserted to drain the bladder and this usually stays in until you are mobile or for 24 hours. This is done as the bladder lies over the area of the womb that needs to be cut through.
What happens after the operation?
You are taken to the recovery room for approximately an hour where your baby is weighed and checked over by the midwife. You are encouraged to breastfeed the baby if this is your intention within 30 minutes of birth. Most patients are encouraged to get out of bed within 24 hours after the operation. The urinary catheter is removed within 24 hours of the operation. Any drips, fluid bags into your veins are also taken down within 24 hours.
How long do I stay in hospital?
The average hospital stay after a Caesarean section is four days.
How long is the recovery?
Most patients are able to care fully for their baby in the first week after the operation. You are able to return to driving a car four weeks after the operation with full activities in approximately four to six weeks. The recovery time is dependant upon many factors including your own fitness as well as any complications following the surgery.
Wound care after the operation
The sutures are absorbable except the superficial skin suture. The whole wound is covered with a large plaster that can be removed between 24 and 48 hours after the operation. The easiest way to remove the large sticking plaster is to soak it in the shower so as it becomes moist and then remove it. It is common to have oozing for the first few days after the operation. The superficial skin suture is removed on the fifth day, sometimes by the community midwife at home.
What happens after I go home?
Your NHS midwife and health visitor will visit you at home to check that all is going well for you and the baby. The Consultant will make a routine appointment to see you some 4-6 weeks after the operation.
When can I start exercising and swimming?
Walking is possible as soon as you feel up to it, leading to light gym activities at week six and swimming just after. Some people return slightly earlier whilst others return at a later date. It will depend on how you feel.
Common complications of the operation and how to prevent them
The commonest examples of problems following surgery include:
- Infection of the wound, womb or urine - less than 5 per cent. Giving prophylactic antibiotics during the operation may prevent this.
- Bleeding at the time of operation - approximately 1 per cent of women require a blood transfusion at the time of the operation. This risk is reduced by intravenous injection of oxytocin hormone around the time of operation.
- Thrombosis in legs or lung - 1 in 500 cases. A blood-thinning drug, Clexane, can be given daily by injection for five days after a Caesarean section. Women are asked to wear support stockings while still in hospital.
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