Planned caesarean birth
What does a caesarean birth involve?
A Caesarean birth is when the baby is born through the abdomen. A cut is made just below the bikini line on the front wall of the abdomen and womb.
Why do I need to have a Caesarean birth?
When you and your doctor decide this is the best route for your baby to be born they will fully explain the reasons why to you.
Where will I have my Caesarean birth?
Staff will try to ensure that you have your operation in the hospital that you have chosen to give birth in, this would either Princess of Wales Hospital in Bridgend or Prince Charles Hospital in Merthyr Tydfil. Unfortunately, on the rare occasion that one of the units is very busy we may ask you to go to the other unit for your birth. If both units are busy this may result in a delay or an alternative date may be discussed. Once you have made the decision to have a caesarean birth. Your consultant will complete a proforma with you, and they will give you an approximate date for your operation.
The proforma is sent to the multi- disciplinary team, where the date, time and priority order will be decided for each surgical list. We try to book your caesarean 1-2 weeks in advance where possible. You will be informed by a Midwife via telephone, so it is important we have your correct contact details on the Proforma. The
Midwife will inform you of the date, time and order you will have your caesarean birth. They will also give you a date and time to attend a pre-assessment appointment, which you need to have prior to surgery.
We will always try and accommodate any requests for certain dates to give birth but this may not always be possible.
Can I be awake whilst having my Caesarean birth?
Yes, this is what we usually advise as it is the safest way for both mother and baby. An epidural or spinal anaesthetic (needle in the back) will usually be used so that you are awake during the operation.
You will be numb from your tummy to your toes - but you will be aware of some tugging and pulling sensation, but you should not feel pain. A drape will be in place, in front of your face, shielding your view and maintaining sterility. Your birthing partner will be able to stay with you during the operation.
For information regarding the anaesthetic please visit www.labourpains.org
Sometimes, if the spinal or epidural is ineffective, you have chosen not to have either of these, or in the event of a complication, a general anaesthetic may be given. This means that you will be asleep during the operation and your birthing partner will not be able to remain in theatre with you.
Before your Caesarean birth
To minimise the risk of infection, we recommend that for 7 days before your planned caesarean
birth you shower / bathe daily using soap, paying attention to your underarms, groin, vulval area and skin folds and you do NOT shave or wax your pubic hair.
Before your operation you will be asked to attend a pre-assessment clinic with the team, this includes a midwife, obstetric doctor and anaesthetist. This appointment will be at the same hospital that you will have your caesarean birth.
The pre-assessment appointment will involve being checked by a Midwife. They will listen in to your baby’s heart rate, take observations and take bloods from you. The bloods include checking you are not anaemic. We will also check your blood group in case a blood transfusion is required during your operation. The team will talk you through that to expect during the operation and answer any questions you have. The anaesthetist will explain what to expect regarding anaesthesia during your operation and the obstetric doctor who will talk you through the operation.
Personalised choices will be offered to you for your surgery. This will include:
- whether you would like the drapes dropped so that you can see your baby being born.
- whether you would like us to tell you the gender of your baby or if you would like to see this for yourself.
- If you would like immediate skin to skin with your baby.
- either you or your birth partner would like to trim the cord.
If you choose these options, they will only be available if your operation is uncomplicated and your baby is well. If there are any concerns regarding the birth or your baby, they may be taken directly to the neonatal team to be checked over and given support if this is needed. There will be a midwife present who will be able to support you with all your choices.
Medication will be prescribed by the doctor to reduce the acid in your stomach. You will be given instructions on when to take this. Depending on the time of your planned caesarean you will be advised when to stop eating and drinking. Usually, your caesarean birth will be planned for the morning and you will be advised to eat and drink normally until the night before and not to eat or drink anything other than plain water after midnight.
This includes chewing gum, boiled sweets or smoking.
You may drink sips of water after midnight until you are called to theatre, which is based within labour ward.
If you have any queries, please contact:
Maternity Priority Assessment at The Princess of Wales Hospital:
01656 753652
Day Assessment Unit at Prince Charles Hospital:
01685 728849
You will be asked to sign a consent form giving permission for the caesarean to take place. The doctor who signs this form with you will also discuss any risks or complications that may arise during or after the operation. Please do not hesitate to ask any questions you may have regarding these risks during this time.
The anaesthetist will check your medical details and discuss the anaesthetic and pain relief after the operation with you.
When do I come to the hospital?
You will be asked to attend the hospital on the morning of your caesarean birth, however occasionally you may be admitted to hospital the night before. You will be informed when to come into the hospital by the doctor at your pre-assessment clinic appointment.
Day of the caesarean birth
Please shower / bath prior to attending the hospital using soap, paying attention to underarms, groin, vulval area, skin folds and umbilicus (belly button).
Make up, nail varnish, false nails, contact lenses and all jewellery will need to be removed. Your wedding ring will be covered with tape if you are unable to remove it. We ask that all personal possessions that are of importance to you remain at home as we are unable to offer anywhere secure for these to be if left unattended. Please bring with you any medication that you are taking.
Where in the hospital do I need to go?
You will be informed of the location you need to attend by the midwife undertaking your pre- assessment on the days before your operation.
What will happen when I arrive in the hospital?
On arrival you will be met by a midwife who will provide care for you and may be with you when you give birth. If your caesarean birth is planned because your baby is in a breech presentation, an ultrasound scan will be performed prior to theatre to check the baby’s position. If baby has turned head down, then the operation may not go ahead. You will be advised to have a further antenatal clinic appointment to make a further plan for your care.
You will be given a hospital gown and an identity arm band to wear. A theatre check list will also be completed which will ask questions about your health, allergies and any medication you are taking. You will be given a pair of surgical stockings to wear before going to theatre. These are worn to reduce the risk of a blood clot (DVT - deep vein thrombosis). We will check your risk score after you have had your baby and we may suggest you have injections into your tummy for either 10 days or 6 weeks depending on your personalised risk assessment.
What happens when I go to theatre?
A midwife will accompany you and your partner to the theatre and will stay with you during the operation and care for you afterwards. One birth partner is able to accompany you before, during and immediately after the procedure. You will have a small tube placed in a vein in your arm so that you can receive fluids via a drip. A small soft tube (catheter) will be inserted into your bladder to help urine drain away. This may be left in place until the morning after the birth of your baby. It is usually removed once you are able to move around. Pads will be placed on your back to monitor your heart during the surgery but keeping your chest clear so you can hold your baby once it is born, if you wish to.
Before surgery and following the operation there will be verbal safety checks undertaken by the staff and they will all introduce themselves to you by name and role. You can choose the music you would like to be played during the surgery if you wish.
Before surgery starts, the anaesthetist will need to site a spinal anaesthetic. For this to be safely inserted you will be asked to sit up and curl your back. It is very important to try and keep still for this to be done. Your back will be cleaned and a local anaesthetic given. You will feel a slight sting in your back as this is given. Then another needle will be put in your back to give the spinal, it is important you tell the anaesthetist at this point if you get any pain or tingling in your leg while they are doing this.
When the needle is in the right place the local anaesthetic will be injected and the needle removed. This usually takes just a few minutes but can take a little longer. Your legs will feel heavy and warm quite quickly after this. You will be made comfortable on the theatre bed and will check that this is working well before the operation starts. You may feel sick due to the medication, let the anaesthetist know if this happens.
Please note, we do not routinely ask baby doctors (neonatologist) to attend a planned caesarean birth.
What happens when my baby arrives?
The midwife will dry the baby and wrap them in a towel and bring them over to you. We will encourage you to put baby skin to skin, if this is your choice we can also support you with their feeding choices, should you wish to do so at this point.
Skin to skin is important as it calms and relaxes both mother and baby. It regulates the baby’s heart rate and breathing, helping them to better adapt to life outside the womb, stimulates digestion and an interest in feeding. Skin to skin is also great for regulating baby's temperature and we will support you to ensure baby is kept warm during the first few hours.
You will be given pain relief following your operation in theatre to keep you comfortable. Once the surgery is completed the sutures (stitches) will be dissolvable and nothing will need to be removed.
Risks of caesarean birth
10-20/100 women have minor complications such as, bladder infection or bruising to the abdomen during a caesarean birth. Blood loss can be heavy and you might require a blood transfusion.
More serious risks are less common.
• Approximately 1 in 1000 risk of damage to the bladder, ureters (tubes that connect the kidneys and bladder), bowels and blood vessels.
• We take every care not to but there is a risk of a cut to the baby of around 1 in 50, if they are head down this may be to their face, if they are breech this may be to the bum.
• Risk of blood clots in the leg and lung which can become life threatening.
All of the above will be discussed with the doctor as part of your pre-assessment, they will be able to answer any questions or concerns you may have.
What happens afterwards?
You will be transferred to a more comfortable ward bed and taken to a recovery area.
You will need to remain there for a few hours as we need to know that you and your baby are well following birth.
During this time, you will be closely monitored. Your wound dressing, blood pressure, pulse, temperature, respiratory rate, urine, blood loss and your level of pain will be checked regularly. You will be offered regular pain relief and encouraged to drink sips of water if you are feeling well enough.
Later you will be offered to wash if needed and surgical stockings will be required. If you and your baby are well, you will be transferred to the postnatal ward after a couple of hours.
Following birth, you are encouraged to eat and drink as normal and once you are able to do this we will be able to remove your drip. Your catheter will be removed once you are able to mobilise.
The following day
Normally your catheter is removed once you can walk around and the drip will be taken down if you are eating and drinking normally. Help will be given to you for you to have a shower / freshen up. Your wound dressing will not be removed before you are discharged from hospital, but it can be
removed after 24 hours once you are at home. It may be easier to remove this once you have had a shower to loosen the stickiness. Sometimes you may have a different type of dressing that needs to be on for longer - you will be informed if this is the case.
It is normal to have a vaginal blood loss which should be the same as the first few days of your period. This should settle over the next 2-3 weeks. It is important to tell your midwife if you lose any blood clots or the loss is getting heavier.
When can I go home?
If there have been no problems following your caesarean birth and your baby is well, you can go home 24 hours after your baby’s birth. Women who require additional support may be offered to be discharged and have further postnatal care at the Birth Centre in Neath Port Talbot, Tirion Birth Centre at Royal Glamorgan Hospital or Tair Afon Birth Centre at Prince Charles Hospital.
We will ensure that any extra medication you require will be given to you before discharge but would advise that you purchase a supply of paracetamol and ibuprofen before coming into hospital so that these are at home ready for you.
After discharge
Your community midwife will visit you the day after you have been discharged from hospital. They will check your blood pressure and urine and have a look at your wound. Please let them know if you have any concerns about your wound, particularly if there is any redness, any discharge or any swelling.
If you do not see or hear from the community midwife by 3pm of that day, please contact your local maternity unit who will be able to ensure you receive a visit.
Recovery and aftercare
Following discharge from hospital you will continue to receive care from your community midwife. You will be provided with the contact details of your local midwife on discharge from hospital.
Your midwife and health visitor can provide advice in relation to when it would be advisable to resume normal day to day activities. It is recommended that you avoid driving for the first 6 weeks after the birth of your baby to ensure your body is healed.
Please discuss this with your midwife or GP when you feel ready to drive, advice from insurance companies can differ so please ensure to contact them when you feel ready to drive.
It is important you rest and look after yourself and take the opportunity to enjoy your new family!
Next pregnancy
After one caesarean birth we usually encourage a vaginal birth in your next pregnancy. If this is not suitable for you, this will be discussed before going home. After two caesarean births we usually recommend birth by caesarean for any future pregnancies although this can all be discussed with your doctor.
If you have any questions regarding your care please ask staff, who will be able to talk you through your care. Any issues with care should be addressed by the ward manager prior to discharge home.
Your Birth Preferences ABC
Ambience
- I would like my own music
- I am happy for the team's choice of music
- I do not want music played
Birth
- I would like to see my baby once they are born before they are passed to me
- I would not like to see my baby until they are passed to me
Gender
- I would like to see the gender of my baby for myself
- I already know the gender of my baby
- I would like the team to tell me the gender of my baby
- I would like my partner to tell me the gender of my baby
Cord
- I would like baby to be passed immediately to me for skin to skin
- I would like baby to be dried and wrapped before coming to me for skin to skin
- I would like my partner to have skin to skin
- I do not want skin to skin
- I would like the team to cut the cord
- I would like my partner to cut the cord
- I would like to cut the cord
Contraception
- I would not like a coil to be placed at the time of my operation
- I would like a copper (non-hormone) coil to be placed at the time of my operation
- I would like a hormone coil to be placed at the time of my operation