Caesarean Section

As you know from discussions with your gynaecologist, your baby will be delivered by Caesarean Section, also called a C-section. This brochure provides you with information about the procedure, including preoperative preparations, the actual surgery, the different types of anaesthesia and postoperative care. 

What is a Caesarean Section?
A caesarean section is an operation in which your baby is delivered through an incision in your abdomen and the wall of the uterus. The procedure is done under regional anaesthesia (an epidural or spinal block) or general anaesthesia.

Preoperative preparations
You will be admitted to the hospital at 11am the day before your C-section is scheduled.

• You will first be received by a nurse who will ask you a variety of questions, such as about your family situation, where your partner can be reached, how you plan to feed your baby, and if you have already arranged maternity home care (kraamzorg) for yourself and the baby. The nurse will also help you fill in a medical history form, which will inform the nurses of any specific care you may need after the surgery. The nurse will tell you more about the operation and what happens on the maternity ward.
• A CTG will be done to monitor your baby’s heart rate and the strength and frequency of uterine contractions. This is done by placing bands with two external electrodes on your abdomen.
• Your pubic hair will be partially removed using clippers. Please do not shave yourself ahead of time as you could cut yourself, increasing the risk of infection of the wound.
• The nurse will give you an enema.
• To prevent the formation of blood clots, you will be receive an injection of a blood thinner called Fraxiparine in your upper leg.
• An intern will perform a general medical examination and ask you questions such as what medicines you use, if you drink alcohol or use drugs, if you smoke, etc.
• You will be visited by your attending gynaecologist and/or the junior doctor who will be present at the operation.
• If the doctor gives permission, you may sleep at home the night before the operation and the nurse will tell you what time you must be back on the ward the next day.

The day of the operation
You may have nothing to eat 6 hours before the operation and nothing to drink 3 hours before. All jewellery, hair pins, and contact lenses must be removed before the surgery, as well as nail polish and make-up. You will be given a hospital gown to wear. The clothes you brought for the baby will be laid ready in the baby room and will be put on the baby after the delivery. The baby’s heart rate will be monitored again before the surgery begins.

Shortly before the operation you will be transported in your hospital bed to the recovery room. Your partner may accompany you and remain with you during the operation. The epidural will be administered in the recovery room. From there you will be taken to the operating theatre.

Anaesthesia
In most cases a C-section is performed under regional anaesthesia, also known as an epidural or spinal block. The major benefit of this type of anaesthesia is that you are fully awake and alert so you can actively participate in the birth of your baby. Moreover, your baby is not affected by the anaesthetic. The epidural block temporarily numbs your entire lower body, including your legs. An IV will be placed in your arm so that fluids, medicines and, if required, blood can quickly be administered.

To perform the epidural, you will be asked to lie on your side or to sit on the edge of the bed with your head bent over and your legs curled up. The skin on your back will be disinfected and a local anaesthetic will be injected to freeze the spot where the epidural needle will be inserted. The anaesthetist will insert the epidural needle between two vertebrae and thread a small catheter through the needle into the epidural space. The anaesthetic is then administered through this catheter, which ensures that you will be pain-free during the operation. The needle is then removed but the catheter is left in place for 2 to 3 days so that anaesthetic can be administered after the operation by means of the catheter and a pump. When the anaesthetic has taken effect - this will take about 20 minutes - you will be taken to the operating theatre.

If an emergency C-section has to be performed, the thin catheter cannot always be left in place in the epidural space for the administration of pain medication after the operation. In that case, other forms of pain relief are given by means of injections, suppositories or tablets.

In exceptional cases, regional anaesthesia cannot be administered and the operation must be performed under general anaesthesia. This does not happen very often, however.

The operating theatre
Because your bladder must remain empty during the procedure, you will be given a urinary catheter. This is a thin tube that is passed through the urethra into the bladder so the urine can drain directly into an attached bag.

NB! Filming is not permitted in the operating theatre, but you may take pictures.

The operation
The doctor starts by making a horizontal incision in the skin right above the pubic bone, followed by cutting through the abdominal wall and then the uterus. Once the uterus has been opened, the doctor lifts the baby out. The umbilical cord is then clamped and cut, and the placenta and membranes are removed. All of this takes about 5-10 minutes.
Stitching up the uterus and all the layers that were cut during the surgery takes longer than the actual birth of your baby (about 30 minutes). First the layers of the uterus are repaired and then the abdominal wall layers.

The baby
Many babies born by caesarean section have trouble breathing initially. A paediatrician is always on hand during a C-section to examine your baby right after the birth and to intervene if indicated. As soon as your child is declared healthy, it will be placed in your arms. To prevent the baby’s body temperature from dropping, it will be placed in an incubator and taken to the ward. Your partner can choose to accompany the baby to the ward or stay with you.

Once you are back on the ward and providing the baby’s condition is stable, the baby will stay with you in your room day and night. If you wish to breastfeed, you can start immediately.

After surgery
After the surgery, your blood pressure, heart rate, blood loss and urine production will be monitored regularly. The urinary catheter will be left in place for about 2 days after the operation. Sometimes the doctor leaves a drain behind in the wound to remove any accumulation of fluid or blood around the incision.
The ward doctor does rounds every morning. To prevent blood clots from developing, you will be given an injection of Fraxiparine every day of your hospital stay.

After the operation you will have pain from the incision and/or uterine contractions. Pain medication is administered via the epidural catheter. If you don’t have an epidural catheter or if the pain relief is inadequate, pain relief can be given in another form, such as tablets, suppositories and/or injections.

The incision is generally repaired on the inside using dissolvable stitches and on the outside with steri-strips. These small plasters are removed a few days after surgery. Bowel function will gradually be restored one or two days after surgery. Your abdomen may feel bloated and you may have cramping. Usually you will be allowed to go home 3 or 4 days after surgery. 

Back home
Before you leave the hospital, an appointment for a postnatal checkup will be made for you with the gynaecologist or junior doctor who was present at your surgery. If your hospital stay was less than a week, you will still be eligible for a few days of maternity home care. Enquire with the maternity home-care service where you registered ahead of time.

A common complaint of women who have had a C-section is tiredness. This can last for quite a while, sometimes even months. This is normal! After all, you just had a major operation, so be patient with the tiredness and accept the help of family and friends!

Some women have trouble accepting the fact that they were not able to have a normal vaginal delivery and had to have a C-section. If you experience such emotions, be sure to talk about them. Should you wish to talk with other women who have gone through similar experiences, do not hesitate to contact the following organisation which supports people dealing with the emotional aspects of caesarean section:

Vereniging Keizersnede-Ouders (VKO)
Contrabas 53
4876 VG Etten-Leur
Tel.: 076 503 7117; available on Monday’s to Friday’s from 10am to 9pm
E-mail: hvweer@wanadoo.nl

Will you have to have a C-section again next time?
This depends on the reason for doing the C-section in the first place. Your gynaecologist will discuss this with you. But generally - once a C-section, always a C-section – is no longer true!

Contact us
Should you have any questions, please do not hesitate to call the Gynaecology Department at 070 - 312 46 90. 

What should you bring along to the hospital?
For mother:

• Slippers or sandals
• Dressing gown
• Toiletries
• Nightgowns or t-shirts: If you plan to breastfeed your baby, a nightgown with buttons  is recommended.
• Underwear, preferably loose and roomy enough to avoid putting pressure on the  wound.
• Magazines, easy reading material
• Camera with extra film rolls/memory card/batteries

For baby:

• Clothing/sleepers
• Hat
• Socks
• Cuddly toy
• Blanket and/or little sweater or jacket
• Maxi-Cosi baby car seat: you won’t need this until the day you are discharged.
• Zwitsal baby care products are used in the hospital. If you have a preference for other types of products, be sure to bring them along.

Edition: April 2009/95