What is a Caesarean Birth or Caesarean Section?
A caesarean section (referred to here as a caesarean birth, as it is still the birth of your baby) is where an operation takes place to enable your baby to be born via an incision in your abdomen, usually just above the pubic line. It takes place in theatre and is led by an obstetric surgeon.
It can be a life saving operation, and the World Health Organisation say that a country should perform Caesareans in no less than 10% of all births, but no more than 12%.
In this country over 30% of all birth is via this method.
What are the different types of caesarean?
A Caesarean may be Planned - also known as elective (whether you feel you elected for it or not!) and Unplanned - also known as Emergency (even though it may not be a true emergency!)
You may have heard the terms Gentle Caesarean, or Natural Caesarean - this refers to some of the choices available during the procedure to ease the stress to you and your baby and increase the hormones of love, bonding, and milk let down reflex.
Is it my choice to have a caesarean, or not?
Nobody has the right to make any decisions about the birth of your baby, or procedures which effect your body except you. Your consultant may recommend caesarean birth due to complicating factors, or may recommend against.
You can discuss the reasons for and against and ask for information to take away and consider.
You are entitled, by law to choose a caesarean for your own reasons too.
The final decision rests with you.
And you can change your mind at any point.
If you do not feel supported you can:
- Go home until you feel able to deal with the situation.
- Ask for a second opinion.
- Speak to your Head of Midwifery - it is her job to be on your side, and support your decisions.
- Change your care team.
- Change hospitals.
- Speak to me (Emma - 079225052752) or a Doula, or anyone else who you feel can support you.
- Contact AIMS (Association for Improvements in Midwifery) +44 (0) 300 365 0663 firstname.lastname@example.org
What are the effects of having a caesarean?
Although having a caesarean is widely accepted as a safe way for your baby to be born, it is still major abdominal surgery. You may want to weigh up the risks and benefits carefully before making your decision.
- Longer recovery period - no driving for 6 weeks, and you may find lifting your baby difficult.
- May make breastfeeding more difficult, as certain positions may irritate your scar and milk production takes longer to get started.
- Risks of surgery - although small, there is risk of problems arising from anaesthetic drugs, and damage to internal organs.
- Infection to scar tissue.
- Having the scar will complicate future birth options - although vaginal birth after caesarean is much more widely supported now.
- The beneficial hormones of labour not present to prepare baby for breathing.
- May need to be taken away briefly or for longer to have help to start breathing.
- Higher risk babies cord will be cut early, affecting babies iron stores for 1st six months of life. (Although delayed cord clamping is possible during caesarean births)
- Greater risk of eczema, asthma, obesity in later life - now thought to be due to missing microbes from vagina.
During the Birth
Although a caesarean is surgery and some protocols must be strictly adhered to for safety - the team will make you and your partner feel as relaxed as possible, and you will have a midwife and anaesthetist checking on you throughout.
Over the past few years many women up and down the country have worked with their surgical team, to develop the techniques to maximise both theirs and their babies health, and to feel more involved in the process, and empowered during the birth of their baby.
Options for a Gentle Caesarean
Waiting for labour to start - It is very well researched, and accepted that baby's born during an In Labour caesarean do much better due to
receiving all the beneficial hormones that kick start their system to be ready for life outside the womb. You also know that it's the right time for your baby to be born, as it is the
baby that ultimately send the message for labour to start - and they will have good stores of Brown Fat, a special substance lain down in the 24 hours before labour, which keeps them
going whilst breastfeeding is established.
This practice is certainly not common at the moment, as it is more convenient for hospitals to schedule a time, and in certain circumstances it is much safer to not wait for labour to start. However if you have chosen to have a caesarean for a Breech baby, for instance, this may be something to consider (especially since babies can turn to head down during labour!!)
Use Self Hypnosis / Yoga & Breathing techniques - Whatever techniques you learned during your antenatal preparation - breathing, acupressure, self hypnosis etc - A
caesarean doesn't mean these go out of the window! If you are stressed your heart rate fluctuates, and stress hormones can flood your body, and pass to your baby (directly if still
attached via the cord, and indirectly afterwards) Staying calm IS GOOD FOR YOU ALL. So remember to use everything you've learned so far :-)
Walking the baby out - This is the name given to the process that allows baby to emerge more slowly from your uterus, mimicking a vaginal birth. The surgeon may gently
squeeze the baby as if they were passing through the birth canal. We do not know if this has a beneficial effect on breathing or general health, but there are little to no risks and
some people believe it is less of a shock to the baby.
Immediate skin to skin (Kangaroo Care) - while your baby's cord is still attached, they are still receiving all the oxygen they need and can be passed straight up on to your
chest which is so beneficial to you both. Helping baby to stabilise and regulate their heart rate, body temperature, blood sugars, and lower the stress response they experience.
Your chest is 2 degrees warmer than the rest of your body at the moment of birth - you are primed to be your baby's perfect heater!
Babies need to be in continuous skin to skin contact, usually for around 40 minutes before they are able to self initiate breastfeeding (known to be the easiest, and most beneficial way for the first feed to happen). If this is interrupted they may be too tired to start the process again.
Delayed cord clamping - in the absence of any complications you can wait a number of minutes for all your baby's oxygen rich blood to be transferred from the placenta.
This can take 5-10 minutes, but each minute you wait is so beneficial.
Some surgeons have worried about the length of time your incision is open, however this has now been well studied, and risk level is very low.
Wear your own top - Rather than a surgical gown (choose one that will stretch around baby to enable skin to skin) this can just help you feel more human and is a
Play your own music - you might already have a birthing playlist. You will be in theatre for around an hour in total, most of this is the suturing after baby
is born and then in recovery afterwards. This is your magical hour - do all you can to make it feel as magical and special as it can be.
Watch your baby be born - ask for the screen to be lowered when the time comes. This isn't as icky as it sounds! It's certainly not everyone's cup of tea, but
consider that you will be lay flat, looking over your boobs / bump, so won't see much except your baby emerging. Do watch some videos before making your final decision it can be a
really magical and beautiful experience!
Take pictures / videos - See Clare & Ste's gentle caesarean birth. You will need to let the team know this is what you are planning to do.
Have lights dimmed for the moment of birth - once the incision has been made, and surgeon has located your baby, the bright surgical lights can be dimmed whilst your baby
emerges and is passed to you for cuddling.
- Baby can be checked and receive oxygen on Mum's chest. - Often caesarean born babies need a little oxygen to help them get going. You can discuss with your care team how & where this may be given - see the videos below of baby receiving this whilst on mums chest in skin to skin contact. Remember on of the benefits of skin to skin is that it helps baby to regulate their heart rate and breathing.
Will these choices be supported?
Not all surgeons will have heard of all of these methods, and some will be more open to researching new ideas than others. You can use the resources below to share with your team, and if your surgeon is unable to support something that is important to you, then just like Clare and Ste, another surgeon can be found. There are a good number in, and around Manchester who are progressive and have experience with these techniques.
Emma's Antenatal offers practical and emotional support in all areas of pregnancy and early parenthood: Call Emma 07922505272. We also offer antenatal courses which are a great way to find out more about labour and life with a new baby.
Pregnancy yoga is a great way to connect with other women and learn skills in hypnosis, and feeling more empowered.
Article published in the British Journal of Obstetrics and Gynaecology https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2613254/
AIMS offer evidence based information and support https://www.aims.org.uk/
NHS Choices have a section on caesarean birth https://www.nhs.uk/conditions/caesarean-section/
NICE are the organisation who set guidelines which all hospitals should adhere to. You can read the guidelines here https://www.nice.org.uk/guidance/cg132
http://www.caesarean.org.uk/ - Offers further evidence based information and support.