23 Oct Delivering by Caesarean Section

We talk, in depth, to two doctors about caesarean sections and the reasons for having them.

For some women, a baby’s birth will happen in a hospital operating theatre via a caesarean section. This form of delivery accounts for 25 to 35 per cent of all babies born in Australia.

A caesarean section is a surgical operation where the baby is delivered through a cut in the mother’s abdomen.

Caesareans are almost always undertaken for medical reasons, where the risk of a normal vaginal delivery is greater to the baby and/or mother than the risk of a caesarean delivery.

The decision to deliver by caesarean can be made before the onset of, or during, labour. An ‘elective’ caesarean is when the decision to deliver by caesarean section and the operation itself are undertaken before a woman goes into labour, while an ’emergency’ caesarean occurs when labour has already commenced. An elective caesarean is often scheduled ahead of time when it is already known that a normal vaginal delivery carries higher than normal risks, and the operation is usually done about one or two weeks before the baby’s due date.

An emergency caesarean may be chosen during labour if it is decided that it is safer than continuing with a vaginal birth.

During pregnancy, a mum-to-be will be cared for and monitored by her antenatal team. They may advise her to consider an elective caesarean delivery if the risks of a vaginal birth are increased.

An Elective Caesarean Delivery May Be Suggested If:

• She has previously had a caesarean delivery and it is felt that the risks of a vaginal delivery are still high.
• There is a breech presentation where the baby’s bottom (rather than his/her head) is facing the birth canal.
• She has placenta praevia, where the placenta is too close to the opening of the birth canal and may be damaged during labour and lead to bleeding.
• There has been or there is a risk of placental abruption, where the placenta separates from the wall of the uterus, causing the mother to lose blood.
• There are concerns about how the baby is developing inside the womb.
• Cephalopelvic disproportion – the baby’s head seems too big to pass through the birth canal.
• The mother becomes medically unwell or has pre-existing medical conditions, which make it unsafe for her to be in labour.

An Emergency Caesarean Delivery May Be Suggested If:

• The mother has gone into labour, but it is not progressing normally, or if the baby becomes ‘distressed’.
• The mother becomes medically unwell and it is safer to do a caesarean.

Usually the mother’s partner, a family member or a close friend can also be present during the operation. This person may stay with the baby while the mum is being cared for by health staff immediately after her operation.

Typically the caesarean operation takes about 20 to 30 minutes.

It involves a cut in the woman’s skin and the muscles of the abdomen and uterus. The cut is about 10cm to 15cm long and most commonly runs horizontally across the top of the pubic hairline. The baby is usually delivered fairly quickly, in about five to 10 minutes. The placenta is then delivered through this same opening. The preparation time (including the administering of anaesthetic, usually into the epidural space) and the time needed to stitch up the wound in the woman’s abdomen mean that the time in the operating theatre is about one hour.

After the Procedure

The baby may be checked by a doctor or midwife once he or she is born, before being returned to the mother. This can happen while the operation is still being completed. Occasionally, if a baby is unwell, they may need to go the special-care nursery. The most common reason for this is that the baby’s breathing may be a little fast and they may need some warmth and oxygen – this happens more often with a caesarean delivery than with a vaginal delivery.

A woman’s recovery after a caesarean is often a little slower than after a vaginal delivery, requiring medicines for pain, but she can usually begin breastfeeding and bonding with her baby straight away.

She will be advised not to drive or lift anything heavy for a few weeks afterwards.

These conditions can be different for different women, and their health team will guide them. Following a caesarean, a woman will usually remain in hospital for three to five nights, depending on the hospital and how she and the baby are going.

She will need a maternal and child-health nurse or her GP to monitor her wound as it heals.

Often after having a caesarean delivery, women are advised to have a caesarean for future deliveries, too, because the risks of a normal vaginal delivery increase (because of the scar in the uterus) and the reasons for choosing a caesarean over a vaginal delivery are often still present. However, some women may be able to try for a vaginal delivery under the advice and care of their antenatal team.

Where a woman tries for a vaginal delivery after already having a caesarean delivery in a previous pregnancy, this is referred to as a vaginal birth after caesarean section (VBAC).

Note: This article provides general health information and in no way constitutes medical advice. Ideas and information expressed may not be suitable for everyone. Readers wishing to obtain medical advice should contact their own doctor.

Words By Dr Manisha Fernando and Dr Katrina Reid