This is an elective section for a medical, surgical or obstetric reason in relation to the mother or baby or both. This can be a maternal choice with informed consent from your obstetrician. There is of course risks associated with surgery and your obstetrician /midwife will discuss any of your concerns for reassurance. Mother Nature still thinks she is in the 15 the century. Being pregnant or delivering a baby then (weather a member of the royal family or a peasant) was not a good “diagnosis”! We thankfully are in the 21st century and through medical and obstetric advancements these risks have been reduced enabling a positive outcome for mother and baby. I call a C section a “vaginal by-pass”…most importantly is a positive outcome .Your obstetrician will explain the operation procedure with you prior to signed consent.
This is a caesarean section which occurs within 4-6 hrs. There is no threat of maternal or fetal compromise but the mother requires delivery to minimise any risks. Therefore there is no rush . eg. You are a booked caesarean section and you have started to contract or your “water “ ( amniotic fluid ) may have broken .
This is a caesarean section which occurs within 30 minutes due to an obstetric complication that is not immediately life -threatening. The staff will be with you every step of the way.
Is an extreme emergency if life threatening to a mother or baby . If this ever happens, the team of midwives will be with you at all times supporting both yourself and partner. This is an uncommon situation.
These categories can be escalated or de-escalated depending on the situation.
The date will be booked at 38-39 weeks gestation. Sometimes earlier if required due to a particular reason. A consent form will be signed by you with your obstetrician.
A pre-admission will be attended a week or 3 days prior to your booked date. It can be a face to face or telephone ( depending on COVID restrictions ). A midwife will get your antenatal/medical/ surgical/family history .You will give consent for baby for Vitamin K , Hepatitis injections, hearing screen and the new born screening. The midwife will explain the hospital admission and what the process is .Blood tests for the procedure will be attended within 72 hours prior to admission. It is advisable if you have pubic hair a wax of hair you can see with legs closed. Hospitals have surgical clippers so do not worry if you cannot do it at home. Wear minimal jewellery. We can tape jewellery if it cannot be taken off. A hair tie if you have long hair. Bring a camera ( we take lots of photos of the birth ) and any music you would like played during the procedure.
The anaesthetist the day before will either ring or meet with you to go through their procedure. They will advise you of fasting time .
The hospital admissions team will ring the day before advising you of your admission time .Generally CSection’s are done from 7am .
Once admitted to the post-natal ward , the midwife will orientate you to the ward .You will be put into a surgical gown ,your partner will be placed in scrubs ( wear closed in shoes).Teds (compression stockings ) on your lower legs .These prevent clots from forming in your legs whilst immobile. You will receive a small injection in your abdomen( daily) for 4-5 days to prevent clots from forming.
Your blood pressure and fetal heart will be taken.
You will be transferred to theatre with your partner. You will meet your midwife, that will be with you and your partner. The anaesthetist will place a intravenous (IV)cannula in your hand. IV fluids will give. You will sit up for the administration of the spinal block. The doctor will talk you through the process. It is effective and is designed to work very quickly .You will feel very heavy from the waist down .You will be place on your side .You may feel very “shivery “ and /or nauseated . You will be given medication through the IV if this occurs. Remember your midwife is there to support you.
You will be transferred onto the operating table .It is quite cold in the theatre .This prevents bacteria from growing .We will give you lots of warm blankets . The table is quite narrow. But you will not fall off ! A “wedge “will be put under one of your buttocks to keep the uterus form compressing a major blood vessel. A urinary catheter will be inserted ( the anaesthetic is very effective now so you won’t feel anything .The catheter protects the bladder during surgery and will be removed in 24 hours .Calf compressors will be on your calves this keeps blood following in your legs whilst immobile .These will stay on until your movement returns in 2-3 hours .The anaesthetic block will be tested before they commence .A screen will be placed in front of your chest until bub is born.
A paedatrician will be present. Post birth, they will review the baby everyday in hospital and then it will follow their care for the future.
Your skin is cleaned with anti-bacterial solution, then surgical drapes are placed on you. The surgical procedure is not complicated and your baby is out in a few minutes ,the screen is taken down and you will witness their emergence into the world ! Staff take lots of photos for you so you can enjoy their arrival. The baby will be blue but will start crying and turn pink . Delayed cord clamping for 1 minute . The baby will be given to the midwife, your partner can come over to cut the cord. The baby is reviewed , kept warm and given their immunisations. Weighed and measured, identification bands, wrapped (to keep warm )then brought over to you and your partner .We give you as much skin to skin time as you want , but the theatre is cold so we want the baby well wrapped until we transfer you to recovery .Sometimes babies need some breathing support …they come from breathing like a “fish “ to a human .Known as “wet lung “. If this happens they will need to be transferred to a special care nursery for extra support. The partner will come with us and the baby.
Depending on the surgeon the whole procedure takes 30 -40 minutes. The placenta is removed 1 minute after baby’s birth. Some mothers worry they cannot breast feed due to a C-Section . Once the placenta is removed, oxytocin and prolactin are released from the pituitary gland in your brain. This process brings down the colostrum and contracts the uterus .Whether a vaginal birth or C-Section . You are allowed to lose 500mls of blood at birth.
The wound will have a special dressing that heals the incision site. Usually it will stay on for 4-5 days, the dressing and sutures will be removed depending on your doctor’s orders.
You will be transferred to a more comfortable bed, the baby who is now in a nappy will be placed skin to skin between your breasts with warm blankets for your recovery . Once in recovery your midwife will assist you with breastfeeding as you will have limited mobility for at least another two hours when the spinal block wears off. You and your partner will usually stay in the recovery with your midwife for at least 30 minutes until you are stable . While in recovery we will give you some forms to sign being the birth registration, Medicare and your baby’s “bluebook” ( which will record for baby for the next 5 years all mile stones and immunisations) .
Then you, your partner and your baby will be transferred to the post-natal ward for the next part of your journey .The anaesthetist will have a regulated pain medication protocol and “break through” pain medication for you. Please take the meds for 2-3 days to get mobile and be comfortable with breastfeeding! If your pain score is above 3 out of 10, request extra medication. It is safe for bub . The anaesthetist will review you during your stay. Remember the midwives are there to support you and you can ask us anything …anytime. A sponge is done a few hours after your return until you are able to be assisted to the shower .Usually this will occur on the next day . The urinary catheter is removed at this time . 3 urines are measured after it is removed . Your vaginal bleeding will decrease over 3-4 days .Your stay is generally 4-5 days depending on your recovery progress. Regular aperient will be given daily to prevent constipation due to the surgery and some of the pain medications .
At discharge you will have a referral to the early childhood centre , you see the doctor at 6 weeks for a post natal check .The baby is also reviewed by the paediatrician at 6 weeks . You cannot lift no more than the weight of your baby or drive depending on your obstetrician’s advice.
Sometimes your baby can pick their “birthday “.They do not know they are an elective C-Section. If you feel you are having contractions ,your “waters “may have broken , any vaginal blood ( with or without pain),reduced fetal movements or you feel unwell…contact the labour ward at your hospital .It important to go in sooner than later !
The above happens a lot more quickly depending on the situation / Category of the C-Section. But remember we are there every step of the way to support you and your partner. It can feel very scary because of the speed of which everything is happening . You and your partner can feel you have no control of the situation .It is important after the event to debrief on your emergency event with a midwife .
Just because you have a C-Section does not mean a future vaginal birth can not happen with your next pregnancy .
Discuss your options with your obstetrician .
]]>The pelvic floor muscles are under enormous strain during the pregnancy and have to stretch to allow delivery of your baby. Weak pelvic floor muscles can lead to problems of bladder and bowel control, allow pelvic floor organs to sag ( prolapse and reduce sexual pleasure ).Strengthening exercises are therefore very important both before and after you have your baby . Signs of weak pelvic floor muscles include stress, incontinence ( leaking of urine when you cough , sneeze or laugh ),inability to keep a tampon in place and vaginal flatulence. One in three women who have had a baby develop some degree of incontinence.
My recent labour and birth of my twin boys was the easiest and most favourite part of my entire pregnancy. Everyone puts so much focus on the delivery aspect of pregnancy but for me this has always been such a small, quick part of the overall long and tough process of getting pregnant, carrying the pregnancy and then caring for your baby/babies once they are born. I would give birth again over and over if I didn’t have to go through the conception, pregnancy and looking after baby part 😊
My pregnancy with the twins was incredibly challenging, both physically and emotionally, and the stress of carrying two babies safely to term definitely took its toll on my mental health (not to mention the fact that I could barely walk towards the end as I was so huge!). I couldn’t wait to give birth and relieve myself of all that pressure, plus begin to feel like myself again physically (or at least begin that long process!). I was literally counting down the days towards the end. I had constant vomiting and nausea for the first 16 weeks which had me lying comatose by the heater on my living room floor for most of that period (with the one silver lining of COVID being that enforced working from home allowed me to work from the floor or my bed and not have to see anyone or get out of my pyjamas for much of that time). I ended up in hospital with severe constipation complications at about 10 weeks, and then was admitted for surgery to fix a twisted ovary full of enlarged cysts midway through my pregnancy so it certainly wasn’t all smooth sailing. Towards the end of the pregnancy I needed a few iron infusions as my levels were pretty low, which is common with twins, and there was some concern with the slow growth of one of my twins which required me to be scanned every week from about 30 weeks onwards and caused quite a bit of stress as I was only ever one scan away from being told the babies had to come out if the results weren’t good enough.
In the end I was booked in at my selected private hospital for an induction at 35+5 due to the ongoing growth (and in that final week also reduced movement) concerns with my smaller twin, and I had everything organized for the day including care for my older kids, my anaethetist and paedatrician selected for the delivery room and also my favourite midwife Vicky scheduled to be working whilst I would be in labour. However I should have known by now that babies have no respect for even the best laid plans and will come when they decide, and not necessarily when best suits you. I went into labour the night before my scheduled induction, however I remember being unsure if it actually was labour at the time as it felt different to when I was in labour the previous times with my two girls and so I wasn’t sure if what I was feeling then was “the real deal” or not.
I was sent to the hospital by my obstetrician to be checked out, and of course it was a busy night in the delivery suite so I was essentially left to my own devices as it was deemed I couldn’t be in proper labour as I didn’t look like I was in enough pain! When I was finally checked I was 7 cm dialated apparently, despite having quite manageable contractions, and within seconds it felt like there were a lot of people in the room setting up for the impending delivery. I was quickly given an epidural, which was a condition from my obstetrician for attempting a vaginal birth with twins in case the second baby was breech and had to be manually extracted (but one I was all too happy to comply with as pain relief has always been my good friend in labour.) The epidural was given at about 2am and I managed to rest a little bit before the first twin came out (after about 5 pushes) at 5am followed 5 minutes later by his brother (also head first) who took a few more pushes as he was the bigger twin. I expected both boys to be rushed away to special care immediately as this had been what happened with my middle daughter who was born 4 weeks early, and so when they were checked and I was actually allowed to hold them for a little while before they went to the special care nursery I was almost in shock and didn’t know what to do as I hadn’t expected this would be possible. I was very lucky not to tear at all (I listened closely to my obsterician’s pushing instructions) and was up on my feet walking around within an hour or so post birth once the epidural had worn off. Whilst I was completely exhausted from having had no sleep all night and just giving birth to two babies, the physical relief I felt at having just lost over 6kgs of babies and placenta from my small frame was instantaneous. It might have been the hormones talking but I had never felt better than in that moment.
Advice I would give to mums to be about birth?
Don’t be afraid to talk openly and respectfully with your care team/OB about birthing options and what you would like in an ideal world – I was desperate to try for a vaginal twin delivery as I didn’t want to go through the tough recovery of a c-section with newborn twins and two children at home if I could safely avoid one. My obstetrician listened to me and let me try for this scenario, provided that certain criteria were satisfied at the time of delivery with respect to the twins overall health and positioning.
However whilst you can and should have an idea in your head of what you would like/wouldn’t like your birth experience to be you also need to be flexible and open-minded and realise that a safe delivery is the best delivery (and that babies don’t like sticking to plans!). So the less plans you make (including written birth plans) the less likely you are to be disappointed if things do go awry in delivery, which they often do.
Being pregnant after a pregnancy loss is tough – you are always expecting the worst and can find it hard to relax and enjoy the pregnancy when you know it can be taken away instantaneously. Once you make it through the first trimester try to allow yourself to feel happy about finally being pregnant when you have tried so hard to get there and celebrate passing the various milestones but also don’t be afraid to ask for help and talk to a professional if you need to.
The labour and birth part is such a tiny part of not only the entire pregnancy but also of your child’s entire life so don’t focus on or stress about it too much beforehand. It will be over before you know it, and what is really important is that your child arrives safely and the ensuing months and years that you spend together with them.
Knowing when you are in actual labour is not always that easy to determine – if in doubt go to the hospital or call your obstetrician (especially if it isn’t your first birth) as it might not always be as obvious as you think and just because you aren’t screaming the house down in agony doesn’t mean that you aren’t in labour.
Each birth gets easier so hang in there!
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"How were they delivered? how much did they weigh? how were they fed? did they sleep through? and when did they toilet train ?"
Remember it is your parenting journey!