Planned
Caesarean
If you
are having a planned caesarean done under a general anaesthetic, you will be
told not to eat anything for at least six hours before the operation. You will
only be allowed sips of water. If you happen to need a general anaesthetic
during an emergency c-section, the contents of your stomach will be pumped out
through a rubber tube.
Your husband is usually not allowed to go with you into the operating
theater. Even in the rare hospital that permits this, if your caesarean section
turns into a true emergency, or if you need a general anaesthetic, your husband
will be asked to leave.
Before the surgery, you'll be prepared in the following ways:
o You'll be asked to change into a
sterilized hospital gown.
o You'll have to take off all your
jewellery.
o If you have a brace or false
teeth, you'll need to remove them, too.
o If you are wearing any make-up
and nail varnish, they will also be removed. This is so your skin tone can be
monitored during the operation.
o You won't be able to wear contact
lenses or glasses.
o At some hospitals, a sample of
your blood will be taken to check that your iron levels are high enough and you
haven't got anaemia. If are anaemic and happen to have huge blood loss, you
will need a blood transfusion. The hospital will make preparations for this.
o You'll be made to lie on your
back on an operating table. The table may be tilted or wedged to the left so
the weight of your uterus doesn't reduce the blood supply to your lungs and
make your blood pressure drop.
o A drip will be inserted into a
vein in your arm. This will give you fluids and make it easy to give you drugs
if you need them during the operation or later.
o You'll be given an anaesthetic.
Depending on the type of anaesthesia used, your position on the operation table
may be changed. Regional anaesthesia - a spinal or an epidural - may be used.
This type of anaesthesia numbs your bottom half and is safer for you and your
baby than a general anaesthetic, which puts you to sleep.
o A thin tube, or catheter, will be
inserted into your bladder via your urethra. This will make sure your bladder
is empty.
o The area on your tummy where the
cut will be made will be shaved and cleaned with an antiseptic. Then it is
covered with special sterile sheets, which are cut in the centre, so that only
the part to be operated on remains exposed.
o You may be given blood-thinning
injections to reduce the risk of a clot forming in one of your leg veins.
o You'll have a cuff put on your
arm to monitor your blood pressure.
o Your anesthesia expert will
monitor your heart rate at all times, before, during and after the operation.
Your heart rate may be monitored manually or electronically. If you are being
monitored electronically, electrodes will be put on your chest. You may have a
finger-pulse monitor attached, too.
You'll be
given:
o an injection of antibiotics to
ward off infection
o anti-sickness medicine to stop
you from vomiting
o strong pain relief during and
just after the caesarean
o pain relief for lasting soreness
o oxygen through a mask, if your
baby is in distress.
o You may be surprised by how many
people are needed to perform a caesarean section; the operating theatre will be
full of people all busy doing their specific jobs.
What happens during a caesarean?
Once your
lower body is completely numb, the doctor will make a small horizontal cut into
your skin, about two fingers' width above your pubic bone. This type of cut is
called a bikini cut.
Less commonly, the doctor may make a vertical cut, extending from two fingers'
width above your pubic bone to an inch below your belly button. Bikini cuts are
favoured more nowadays, as they tend to heal better.
The layers of tissue and muscle are opened to reach your uterus. Your tummy muscles
are parted, rather than cut. Your bladder will be moved down to expose the
lower part of your uterus.
Your doctor then makes a second cut, in the lower section of your uterus. This
cut is usually small. Your doctor will make it bigger using scissors or
fingers, so that it is torn. This causes less bleeding than a sharp cut. These
days the opening is usually made in the lower part of the uterus. This is why
the operation is sometimes called a lower segment caesarean section
(LSCS).
The bag of membranes is opened, and you may hear fluid gushing out. Your baby
is then lifted out. You may be aware of the assistant pressing on your belly to
help your baby be born. If your baby is breech, he will be born bottom first. It
only takes a few minutes to take your baby out.
Your baby will be quickly checked over by the paediatrician, if he or she is
available. At some hospitals the paediatrician may have to be summoned, or your
doctor may hand over your baby to one of her trained and experienced assistants
or staff. Your baby is then shown to you.
After your baby is born, your doctor will gently tug the umbilical cord to pull
out the placenta.
What happens when my baby is
born?
After
your baby is born, his cord is clamped and cut. He is cleaned and his initial
checks are made. He is given Apgar scores at one minute, 5 minutes
and 10 minutes after birth. The scores measure your baby's wellbeing.
If your baby is well, he is simply kept covered and warm. But if your baby is
very small or unwell, he may need more attention from the paediatrician. He may
need to go straight to the paediatric intensive care unit.
Your doctor will concentrate on stitching you up. Each layer of muscle and skin
needs to be closed using clamps, staples, or sutures. Your doctor will probably
use a double layer of stitches to repair your uterus. Finally, your skin wound
will be closed with stitches or staples.
When you're ready, you'll be moved to your ward where you, your husband and, if
all is well, your baby (or babies) can be together. You may start shivering,
because your body temperature drops during the operation. Your nurse will warm
you up with blankets and help you breastfeed your baby. You may find
it more comfortable if you both lie on your side and face each other. It often
takes some time to find comfortable feeding positions after a
caesarean, but it's worth persevering, and it does get easier.
How will I feel after a
cesarean delivery?
Like
any new mother, you'll probably feel both euphoric about and overwhelmed by the
new person in your arms. But you'll also be recovering from major abdominal
surgery while dealing with typical postpartum issues such
as engorged breasts, mood swings, and vaginal discharge.
C-section
patients typically stay in the hospital for two to four days before going home.
But your recovery will be measured in weeks, not days, so you'll need help
taking care of yourself and your new baby.
How will I feel right after
surgery
You
may feel groggy and possibly nauseated right after surgery. Nausea can last up
to 48 hours, but your caregiver can give you medication to minimize your
discomfort. Many moms also feel itchy all over, particularly those who received
narcotics in their epidural or spinal. If this happens to you, let your
caregiver know so you can get medication to relieve the itchiness.
When will I be able to
breastfeed?
If
you plan to breastfeed, you can start in the recovery room right after surgery.
Ask the nurse to show you how to nurse in the side-lying position or using the
football hold, so there won't be pressure on your incision.
Breastfeeding can be challenging in the days after a
c-section because of the pain from a healing incision. Ask to see a lactation
consultant as soon as possible to help you position your baby comfortably so
you don't end up with sore nipples. If the hospital doesn't
have a lactation consultant, ask for the nurse who's the resident expert.
What's recovery like during
the first few days?
You
may feel numbness and soreness at the incision site, and the scar will be
slightly raised, puffy, and darker than your natural skin tone. Your doctor
will come by daily to see how you're doing and check that the wound is healing
properly.
Anything
that puts pressure on the abdominal area will probably be painful at first, but
you'll feel a bit better day-by-day. Be sure to use your hands or a pillow to
support your incision when you cough, sneeze, or laugh.
Your
nurse will come by every few hours at first to check on you and help you.
She'll take your vital signs, feel your belly to make sure your uterus is firm,
and assess the amount of vaginal bleeding. Like any woman who just delivered a
baby, you'll have a vaginal discharge calledlochia, which consists of blood, bacteria, and sloughed-off tissue from
the lining of your uterus. For the first few days, this discharge will be
bright red.
Your
nurse will also instruct you on how to cough or do deep breathing exercises to
expand your lungs and clear them of any accumulated fluid, which is
particularly important if you've had general anesthesia. This will reduce the
risk of pneumonia.
If
everything's okay, your nurse will remove your IV and urinary catheter soon
after surgery, usually within 12 hours.
Depending
on your situation, you may be able to drink fluids – and start eating a light
diet if you feel like it – within six to eight hours after your surgery. In
some cases, though, your doctor may recommend waiting longer before eating.
You
might have some gas pain and bloating during the first two days. Gas tends to
build up because the intestines are sluggish after surgery. Getting up and
moving around will help your digestive system get going again.
If
you're in great discomfort, the nurse may give you some over-the-counter
medication that contains simethicone, a substance that allows gas bubbles to
come together more easily, making the gas easier to expel. Simethicone is safe
to take while breastfeeding.
You
will be encouraged to get out of bed at least a couple of times the day after
surgery – or even the day of surgery – to walk. (Do not, however, attempt to
get up by yourself. The nurse should be at your side the first few times.) In
the meantime, get the blood going in your legs by wiggling your feet, rotating
your ankles, and moving and stretching your legs.
Just
walking to the bathroom may seem impossible at first, but moving around is
important for your recovery. It will help your circulation and make it much
less likely that you'll develop blood clots. What's more, it will make your
bowels less sluggish, which will help you feel a whole lot more comfortable a
lot sooner.
For
these reasons, you'll be encouraged to walk each day. Try to take your walks a
short time after you've taken pain medication, when you're likely to feel more
comfortable.
It's
also important to get to the bathroom to urinate regularly. A full bladder
makes it harder for the uterus to stay contracted and increases pressure on the
wound.
Your
doctor will probably remove your sutures or staples on the third or fourth day.
This takes just minutes, and you may feel a small pinch but you shouldn't feel
any pain. This is usually done before discharge from the hospital, or it may be
done later in your doctor's office. This might be the case if you elect to go
home on the second day after surgery or if your doctor feels that you need
extra time to heal (for example, if you're obese or you have diabetes).
Finally,
before you leave the hospital, you'll get any necessary vaccines that you
haven't had already (such as rubella, Tdap, chicken pox, and a flu shot). And your practitioner will
check in with you (if she hasn't already) to make sure you have a plan for birth control.
What's
recovery like after I leave the hospital?
Expect
to need help – and lots of it – once you get home. If nobody offers, ask for
support from your partner, parents, in-laws, and friends. If you're worried
that you may not have enough support, hire paid help if you can afford it.
You'll
likely be given a prescription for more painkillers and a stool softener before
you leave the hospital. You may need prescription painkillers for up to a week
after surgery, gradually transitioning to over-the-counter pain relievers. (If
you're breastfeeding, don't take aspirin or drugs containing acetylsalicylic
acid.)
Drink
plenty of fluids to help you avoid constipation. Your incision will likely feel
better day-by-day, quite noticeably so after several days, though it may
continue to be tender for several weeks.
Call
your caregiver if you have signs of an infection, including:
·
warmth,
redness, swelling, or oozing at the incision site
·
worsening
pain or sudden onset of pain
·
any
fever (even if your incision looks fine)
·
foul
smelling vaginal discharge
·
pain
or burning when urinating, the urge to pee frequently when not a lot comes out,
or urine that is dark and scanty or bloody
Your vaginal bleeding and discharge should be diminishing, though it may
last up to six weeks. It should gradually turn from bright red to pink and then
yellow-white. If menstrual-type bleeding continues past the first four days
after delivery or comes back after slowing, call your healthcare provider.
You'll
also need to call your caregiver without delay if you have any signs of a blood
clot, such as severe or persistent pain or tenderness and warmth in one area of
your leg, or one leg that is more swollen than the other.
How active should I expect
to be?
While
it's essential to get plenty of rest once you're home, you also need to get up
and walk around regularly. Walking promotes healing and helps prevent
complications such as blood clots.
Of
course, you shouldn't overdo it. Start slowly and increase your activity gradually.
Since you're recovering from major abdominal surgery, your belly will feel sore
for some time. Take it easy and avoid heavy household work or lifting
anything heavier than your baby for eight weeks.
What will my scar be like?
At
first, the scar will be slightly raised, puffy, and darker than the rest of
your skin, but it'll start to shrink significantly within six weeks of surgery.
A
c-section incision is only 4 to 6 inches long and about 1/8 inch wide. As the
incision site continues to heal, your scar will more closely match your skin
color and will narrow to about 1/16 inch wide. It might be itchy while it's
healing.
C-section
scars are usually very low on the abdomen. A low-lying horizontal scar will
eventually be hidden by your pubic hair, probably way below the waistband of
your underwear or bikini bottom.
