Caesarean birth: what happens? l Suggestions to improve the experience l Risks & Benefits l Healing l Statistics for SA l FAQ's l Breech Baby

What happens during a caesarean section?

A caesarean is neither an easy or the safest way to have a baby, especially when compared to an uncomplicated vaginal birth (a vaginal birth that is routinely intervened with is not uncomplicated). There are circumstances where a caesarean is essential for both the mother and baby's health or either one. For example Placenta Praevia or a transverse lie (baby lying so the shoulder is presenting) are clear indications for caesarean section. What we aim to provide for women who need a caesarean is a clear description of what to expect for the operation and recovery; and ways of personalising what can sometimes be a sterile (no pun intended) environment of the operating theatre.

People today are very unaware of the physical and emotional impact of a caesarean. We have provided you with what we hope is a comprehensive overview of the issues facing the decision to have a caesarean and dealing with any emotions that you may feel after. These emotions can surface days, weeks, months even years after a caesarean. I have recently met a wonderful, educated woman who 20 years ago had the first of 3 caesareans - she admitted to me that she has never felt like a real woman because her babies couldn't be born vaginally. I was completely shocked and dismayed that this woman has been carrying this pain for so long.

The information about caesarean section is often brushed aside by a first time pregnant woman. She honestly does not believe that she needs to know about caesareans because she wont be having one.

Some problems in this thinking arise when women today are treated as low risk throughout all their pregnancy, then at the end of pregnancy they are told that they are post-dates, their baby is breech or transverse, or their baby is 'looking like it is going to be over 4 kilo', or that we 'need to keep an eye on the protein in your urine'. The labour talk with the specialist or the ante-natal education classes introduce women to the 'wonderful thing' called an epidural. If she hasn't been brainwashed by all her friends to have one by this time, then the reassurance by the health provider of its safety is likely to encourage her to ask for one when in labour. Unfortunately, this low risk woman is now at risk of undergoing any number of interventions, thanks to the seeds of doubt being planted about her ability to birth her baby because it is facing the wrong way or that she has a serious condition that makes vaginal birth dangerous.

The cascade of interventions is written about often, but most birthing women would never have heard of it. This is when a woman in some way has her labour started, or 'helped'. On going into hospital she will have a vaginal examination, which will inform the health care provider as to what stage she is at and then initiate timing of her labour. There is a dictum within obstetrics called the Friedman Curve, where are woman should dilate at approximately 1 cm per hour. A first labour can feasibly last for 24 hours with no danger to mother or child, however, interventions to speed things up can pose potential danger to both.

Here is an example of the Cascade of Intervention (it is hypothetical but very real). Woman goes to hospital and is 3 cm dilated, it is from approximately 4cm dilated that you are considered to be in first stage labour and you may stay at 3cm for hours or even days for some women (this is called prelabour or prodromal labour). If this happens to you and you are in hospital in the early stages of labour it can be very difficult emotionally and psychologically and you may become tired and unable to cope with the contractions. You may then be given an injection of pethidine (narcotic drug) to help with the pain. Pethidine can make some women very drowsy, but feeling out of control and nauseous. By this time you are most likely to be reclining on your bed exhausted, with a worried partner next to you who is also exhausted. At regular intervals the midwife or obstetrician visit to check your progression of dilation. You may have not dilated at all in hours, a common occurence when you change your place of labour e.g. moving from home to a hospital room. This can be devastating to your confidence! You will probably be told that you will be checked again in another 4 hours, at which time you should be well progressed. In another 4 hours you have not progressed much and the obstetrician decides to break your waters (amniotic sac - called artificial rupture of membranes) to get things moving. With an implement that looks very similar to a crotchet hook he/she ruptures your baby's amniotic sac, for some women this is painful. You will feel a warm gush of fluid come out and it may seem like a tidal wave. If the fluid has any signs of black meconium, the baby's first bowel movement, then the health provider will be concerned and suggest that you are monitored for the baby's safety. Now you are concerned that your baby is in danger. (baby's often have bowel movements during labour and the danger is if they breath in the meconium).

After your membranes are ruptured your contractions will intensify as the baby's head should be on the cervix, you will find it more difficult to get through the contractions and with a monitor on you are forced to lie still. This is a position which is totally unnatural and uncomfortable for a labouring woman as it makes the contractions very difficult to cope with without pain relief. You will probably by this stage be asking for or offered an epidural which you no doubt would accept as the pain you are experiencing is almost impossible to cope with. You have an epidural, your blood pressure will drop, you may feel dizzy or nauseous, the epidural may not work effectively leaving you with a window of pain. The epidural and the position that you have no option to be in, makes the progress of labour even slower. To counteract this the obstetrician may suggest that they need to get the baby out and that we can give you a drip of oxytocin which will help things along. Any number of things can happen at this stage, you are given two options have oxytocin and see how it goes or have a caesarean. Most women will want to know what is the best thing for their baby and how much longer are they likely to be in labour. There may be suggestions that the baby is getting tired, the monitor may dislodge and they lose that baby's heartbeat for a moment - long enough to terrify you. It is highly likely that you would chose a caesarean, after all it guarantees you a healthy baby.

You will then go through the proceedure of having a caesarean section as described on this site.

Our aim is not to scare women here, but to enlighten them as to what birth is for most women in Australia today. It is has become a medical process instead of a physical and psychological process that transforms a woman into a mother. Some women can not understand what all the fuss is about why would you go through all that bother and pain, not knowing when you baby is going to chose its birthday. To those women we say that we respect your right to your choice and we will assist you in making it informed. It is important that they in turn respect the right of women, who having researched, read and become acquainted with the well evidenced safety of VBAC, wish to use their bodies as they were designed and experience the rawness and very human experience of childbirth. However, it is easy to see why a woman who has been through this 'hypothetical' experience of birth would chose an elective caesarean next time. We would like to show you that it can be different with the right information and support.

Caesarean birth: what happens? l Suggestions to improve the experience l Risks & Benefits l Healing l Statistics for SA l FAQ's l Breech Baby