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Caesarean birth

Published by Sarah Horrocks
Published on September 5, 2008

When childbirth doesn’t go as planned, resorting to a Caesarean section is sometimes inevitable. In the past, they were only used in extreme emergency cases, but today Caesareans are becoming more and more common, and the rising trend for Caesarean births does present problems. What are the consequences on mother and baby? Here’s an outline.

Why have a Caesarean?

When a natural birth is not possible, for different reasons:

- The mother’s pelvis is too narrow

- The child is too big to pass through normally

- Baby is in the wrong position (at an angle or upside down)

- There’s an obstacle preventing the baby from coming out, for example a fibroid, cyst or placenta praevia (where the placenta has attached itself to the uterine wall close to or covering the cervix, preventing birth through the canal)

The necessity to end the pregnancy before term for the sake of mother or baby’s health:

- The baby has medical problems (diabetes, pre-eclampsia, delayed growth, etc.)

- Hemorrhage

- Multiple births

- The mother has medical problems

- Rhesus incompatibility

Necessesity to end the delivery:

- The mother is too tired or has cadiovascular problems that make continuing labor dangerous

- The cervix does not dilate

- The baby's head has not engaged (moved downwards towards the mother's pelvis)

- If medical surveillance shows the fetus is suffering

The operation

A Caesarean section is a surgical operation that does not take place in the delivery room, but in theater. To be able to cut the abdomen and uterus properly, the pubic hair is shaved and a catheter is placed inside the bladder so that it doesn’t disrupt the surgeon or become pierced during the operation. The skin on the abdomen is disinfected. The surgeon first cuts the skin, then the muscles of the abdominal wall, then the uterus. The baby is then taken out, followed immediately by the placenta.

The tissue is glued or sewn back together with thread or with staples that need to be taken out 5 to 7 days afterwards. The operation lasts around 60 to 90 minutes.
A Caesarean is done under local anesthetic (spinal or epidural, or general in extreme cases). The anaethestic takes around 15 minutes to become effective.

Post-op

After a Caesarean birth and the mother is in the recovery room, fatigue can be greater than it would be for a normal birth. Getting back bowel movements can cause abdominal pain, therefore a well balanced diet that is high in fiber is recommended.
Scarring can also be painful, especially after birth contractions, however, the scar does not have to be an aesthetic concern as it is hidden by pubic hair. It looks as it always will after around 8 months but should not be exposed to the sun for at least a year.
In regards to the relationship with the baby, milk can take time to come because of fatigue. Care that is given to mother and baby just after the birth can also be experienced badly as it may involve separation. Skin-to-skin contact or kangaroo care with your baby should be encouraged so you both have that warmth and bonding experience.
Mother and baby can usually go home after
Mother and baby can usually go home after two or three days. Normal activities should be taken up gradually and slower than after a normal birth, but in most cases a Caesarean is nothing but a memory after a month or so.

The mother’s experience

A Caesarean can be planned in advance or be resorted to during labor, which obviously changes the way it is perceived by the mother (whether or not she's prepared for it or not). Many women can feel as if the birth has been taken away from them if they are not prepared for a Caesarean.

Too many Caesareans?

In some cases it has become quite ordinary, with some areas of the UK reaching a Caesarean rate of over 25% (although 15% is quite normal, according to specialists). A Caesarean is not inconsequential. The risk of infection for the mother is 3 times greater than it is with a natural birth. The increase in Caesarean births can be explained by:
- Improved awareness of the suffering of the baby during labor
- Improved understanding of the risks for the child, eg if the baby is too big or small, in the wrong position, premature, etc.
- The increase in risky pregnancies, notably multiple births and late pregnancies
- Increasingly demanding mothers who would rather suffer less and make the baby suffer less than go through a long and difficult birth
- Developments in anesthesia and surgical techniques

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