Undergoing a Caesarean

Something approaching a quarter of all babies born in the UK are delivered by caesarean section. But what does it involve, why are they performed and what are the risks to you and your child?

What is a caesarean section, or c-section?

It is a surgical procedure performed to enable the delivery of a baby, usually when a vaginal birth is considered inadvisable for health reasons. While in some parts of the world c-sections are performed at the request of the mother in the absence of medical reasons necessitating one, current NHS policy in the UK is that 'Pregnant women are not immediately entitled to a caesarean section if they do not have any physical or mental need for it.'

Why are they performed?

Caesarean sections are performed, as we've said already, when a vaginal birth is considered inadvisable. What this means in practice is that there are medical complications present in your pregnancy or labour, that lead the medical team caring for you to doubt whether a normal delivery would best promote either your health, or your baby's. So what sort of things are we talking about here? The list is long, but includes conditions such as pre-eclampsia, hypertension, multiple births, umbilical cord abnormalities, a baby presenting in the breech decision, increased heart rates, foetal distress, some STDs or problems in previous deliveries. The medical team taking care of you will only advise a c-section after following a protocol that considers fully the seriousness of the procedure and the risks involved.

How do planned and emergency caesareans differ?

• A planned c-section is just that; the mother has a date set for her arrival at hospital to have her child delivered in this way. The medical need for the procedure will have been established during the pregnancy. An epidural is the usual anaesthetic, so that the mother is fully awake during the procedure. Your birth partner will be allowed into the delivery room.
• An emergency caesarean is carried out with more urgency, usually because the baby is becoming distressed during a slow-to-progress labour. If an epidural has already been administered, it will be topped up, but if not, then a general anaesthetic may be considered because it acts more quickly. Depending on the circumstances, your birth partner may not be allowed into the delivery room.

In both cases, it takes about 10 to 15 minutes for your baby to be delivered, but a further 45 minutes for the surgeons to fully close up the incision.

What are the risks for you?

Thankfully, the mortality rate for mother who have caesarean sections in the West continues to fall. A crude statistical comparison of the data concludes that the risk of death for the mother is three times greater than during a vaginal birth. However, this belies the fact that pregnancies that end in a c-section often have more complexity, which in themselves place the mother in a higher risk category anyway. Repeating the procedure more than twice also brings increased risks of placenta accreta, (a life threatening condition caused by the placenta causing haemorrhage as it abrupts) and of emergency hysterectomies. Less dramatic, but no less profound in their impact, is the increased incidence of postnatal depression and birth-related post-traumatic stress disorder. And you are also at risk of infections in the incision wound, in your womb, a blood clot, or damage to your bladder and ureter.

What are the risks for your child?

There is no simple answer here, as so much depends on the 'age' of your baby at the point he or she is delivered, and what factors led to the decision to perform a c-section. A child born at 37 weeks is very different to one born at 34, 39, or 41 and the prognosis varies a great deal between these scenarios. Problems for babies delivered before term include possible respiratory distress, wet lung, jaundice and low blood-sugar, and the infant mortality risk is also increased, though again, the picture is complex.

How quickly do you recover?

Most women who have had a caesarean stay in hospital a little longer than those who haven't, though this is changing over time. In general it takes around six weeks for the wound to completely heal, but you may feel you need longer before you can do some things, like take exercise or have sexual intercourse. Do note that many car insurance companies will not insure you to drive for six weeks after undergoing this procedure.