Caesarian Section

Babies born by caesarean (c-section) come out through incisions in your uterus and abdomen.

Babies born by caesarean (c-section) come out through incisions in your uterus and abdomen. Some women choose to give birth this way; other women know it's a strong possibility; other women expect to give birth vaginally, and the caesarean takes place after they have gone into labour. This article also appears on www.bbc.co.uk/parenting/having_a_baby

To cut or not to cut

If you choose to have a caesarean it's called an 'elective' caesarean. One that takes place after you have already gone into labour is called an emergency caesarean. In your notes, you may see it written as CS, LSCS, or LUSCS. These other letters simply mean Lower Segment Caesarean Section, or Lower Uterine Segment Caesarean Section.

Reasons for a caesarean section include:

• your baby's head is too large to fit through your pelvis
• the shape or size of your pelvis makes it more difficult for a vaginal birth
• the placenta lies low in the uterus (this condition is called placenta praevia) and blocks your baby's way out
• if you have twins or triplets (one of whom may be lying in a difficult position)
• if your baby is lying in a position across the uterus, or is breech (lying bottom or feet first)
• (after labour begins) if your baby is distressed (suffering from a lack of oxygen) and isn't far enough down the birth canal for forceps or ventouse to be used
• if you have eclampsia or severe pre-eclampsia
• if you are ill, have high blood pressure, or (in labour) are becoming exhausted.

How it's done

You will be given an anaesthetic (if you haven't had one already). The anaesthetic used is almost always given via an epidural, which allows you to stay awake without feeling the operation. Occasionally, a general anaesthetic is used.

"...you might feel quite a bit of tugging and pulling..."

You'll be in the operating theatre and lying down. You can usually have someone with you if you are conscious. Neither you nor your companion will see any of the 'action' as there is normally a small screen placed over your abdomen, and the doctor works behind this.

The surgeon makes an incision in your abdomen, just above your pubic hairline, and then cuts through the uterus. The baby is then helped out. You might feel quite a bit of tugging and pulling when this happens.

When the baby comes out, the cord is clamped and cut and you can hold him if everything's ok. The placenta and the membranes are brought out, and you will be stitched up. The whole thing takes about 45 minutes.

After your caesarean

It's normal to feel very tired for a few days and possibly in some pain, just as you are with any abdominal operation. Trapped wind is a common problem. You can take pain relief to help with this, or any soreness you have round the site of your cut. Recovery after a section can take longer than a vaginal birth. Some women are uncomfortable for a while after their caesarean. There may be complications such as infection (which is why you will usually be advised to take antibiotics after your section, to try to prevent this).

In the first day or so, you may be attached to a little tube which collects any blood pooling under the scar. A drip in your arm is there to make sure you remain hydrated. At the very beginning of your recovery, you may need a catheter or a bedpan to help you wee, as you won't be able to get up to go to the toilet.

Ask what sort of stitches you have. They may dissolve, or need removing later, or you may have clips which will also need removing when you have healed.

How you'll feel

Some women feel very disappointed at having a section. If you feel like this, talk about the reasons why a section was used " understanding this can sometimes help you come to terms with it.

If you do feel disappointed, don't feel guilty... how you feel is up to you. Similarly, you may have no negative feelings at all about your section. This, too, is fine.

Next time

You may well be able to have a vaginal birth with a future baby, depending on the underlying cause of your section. This is called 'VBAC', pronounced 'vee-bak', meaning 'vaginal birth after caesarean'.

If you're told you have a very small pelvis and will always need a section, but would like to have had a vaginal birth as an option next time, then ask for a second opinion. The diagnosis isn't always a final one.

Q. Can I choose to have a caesarean? I am very worried about birth and I think I would have a better pregnancy if I didn't have that anxiety hanging over me.

A. You need to talk through your options with a midwife or doctor. Having a caesarean section isn't necessarily 'easier' than a vaginal birth. It's not automatic that you would be given a caesarean section on request " at least, not on the National Health Service. Most doctors would expect a physical reason for it as well. Though they should listen to your reasoning and consider it.

If your doctors and midwives are insistent you have a vaginal birth, it's because they are confident you and your body are capable. Understanding what happens during birth might be one way of coping with your anxieties. If it's pain you are worried about, then think about having an epidural right from the start of labour.

There is certainly no evidence that 'once a caesarean always a caesarean'. There is a very small risk that the scar on your uterus might start to rupture when you go into labour, but with proper care, this can be spotted well before it becomes a problem.

"Info:
Caesarean rates: England & Wales " 21.5%
North East " 19.3%
North West " 19.6%
E. Midlands " 20.4%
W. Midlands " 21.8%
East " 21.4%
London " 24.2%
South East " 22.6%
South West " 19.4%
Wales " 24.2%
N. Ireland " 23.9%"

There is some controversy about the number of caesareans performed these days " the total is rising year on year, and it's generally agreed by professional organisations and parents groups that many of them are not needed. Many mothers and babies, they say, would benefit if they were helped to give birth vaginally. The climate of 'over-medicalisation' of childbirth and fear of litigation if a vaginal birth goes wrong are seen as some of the reasons for the rising trend.

A study carried out by the Royal College of Obstetricians and Gynaecologists for the Department of Health collected statistics that showed one in five babies is born this way, with many regional variations. In London, and in Wales, it's over 24 percent. The World Health Organisation recommends a rate of between 10 and 15 percent.

Thirty years ago the numbers of caesarean births in the UK was much lower " just three percent. You can find out more about the report at BBC News.