Your feelings about caesarean birth
Women often have strong feelings, expectations and preferences about giving birth to their babies, whether they're planning a vaginal or a caesarean birth.
Some women feel fine about having a caesarean birth, whereas others feel disappointed or sad that they won't be giving birth vaginally.
Whatever your feelings, it can really help to talk through those feelings with your partner, family, friends and health care professionals. You can also call the Pregnancy Birth and Baby Helpline on 1800 882 436 for free advice and counselling, 24 hours a day, 7 days a week.
I didn't want a caesarean, but one of my twins wasn't in the right position for birth. After talking with my doctor I realised that it was the safest choice for my babies and for me.
- Samantha, mother of twins, born by planned caesarean
Types of caesarean section
There are two types of caesarean section - a lower segment caesarean section and a classical caesarean section.
From looking at your tummy, you won't be able to tell the difference. That's because the difference between them is where the cut is made on your uterus. And sometimes the cut on your tummy is different from the cut on your uterus.
Before you leave hospital, it's a good idea to ask the obstetrician what kind of cut was made on your uterus during your caesarean section. This is helpful information to have when you're making decisions about future births.
A lower segment caesarean section
This is the most common type of caesarean section. The obstetrician makes a horizontal cut across the lower part of the uterus, usually along your bikini line. Advantages of this type of caesarean section are that it usually heals well and there's less chance that it will cause problems in other pregnancies.
A classical caesarean section
This is when the obstetrician makes a vertical cut on the uterus. A classical caesarean section isn't very common and is generally used only in very serious emergencies. If your baby is very premature or lying sideways, or if your placenta is lying very low, you might need to have a classical caesarean section.
This kind of caesarean section can increase the risk of problems in future pregnancies and births because it increases slightly the risk that your uterus will tear.
Caesarean sections are common in Australia. About one in three babies are born via caesarean section.
Before you go to hospital: getting ready for your elective caesarean
You'll need to fast before an elective caesarean birth. This means having no food or drink, including water, for six hours before the surgery. The length of fasting before surgery varies from hospital to hospital.
Most hospitals give you a list of what to bring, like clothing for yourself and your baby. Before you leave home it's a good idea to check that you have everything you need.
You might like to ask your support person to bring a camera or camera phone, but remember to check with the hospital staff that it's OK to take photos or video of your baby being born. You'll also need permission to take photos of hospital staff or equipment.
In the maternity ward before your elective caesarean
At hospital, you'll usually be admitted to the maternity ward. You might have to arrive at the hospital very early in the morning.
If you're at risk of getting blood clots, you'll be given medication to help prevent them. You'll also be given compression stockings to wear during the surgery.
Your pubic hair and lower tummy might be clipped. This is so the area is clean. It might also make it less likely you'll get an infection.
Before you have a caesarean section, your doctor will want to talk with you about whether you have any health problems, allergies, and bleeding or bruising problems and whether you take any medications.
If you feel worried or there's something you want to know, talk with the doctors or midwives before the surgery. Let them know beforehand about any special preferences you have for the birth so they can try their best to support you.
In the operating theatre: anaesthetics and other preparations
You'll be taken to an operating theatre for your elective caesarean.
Here you'll be prepared for your anaesthetic so that you don't feel any pain during the surgery. A spinal anaesthetic is most common for planned caesarean births. An epidural is more likely to be used for an unplanned (emergency) caesarean birth.
With spinal anaesthetic and epidurals, you're awake and can breathe normally.
You'll have a general anaesthetic only if you can't have a spinal or epidural anaesthetic. You might also have a general anaesthetic if your baby needs to be born very quickly. In this case, you'll be asleep during your baby's birth.
You'll have a needle inserted in the back of your hand or the crook of your elbow for your drip.
Your tummy will be cleaned with antiseptic by the theatre team and covered with sterile cloths to lessen the chance of infection. A plastic tube (a catheter) will be put into your urethra (where urine comes out) to keep your bladder empty.
Operating theatres can be quite cold, so ask for some extra blankets if you feel cold.
It's normal to feel anxious and sometimes teary as you go into surgery.
During preparation and surgery, you can probably have a support person with you, unless you need a general anaesthetic or there are serious medical problems. Your support person can sit next to you and hold your hand.
Your caesarean section operation
Caesarean section surgery usually takes 30-60 minutes.
There'll be quite a few people in the operating theatre with you, including the obstetrician, an anaesthetist, theatre nurses and probably a paediatrician and a midwife.
You'll have a drape over your chest area so that you and your support person can't see the surgery.
Once the anaesthetic is working properly, the doctor will make cuts in your tummy and your uterus. Both cuts will be about 10 cm long.
Your baby will be lifted out through the cuts. You might feel a tugging or pulling sensation, but there won't be any pain. Sometimes the doctor might use forceps to help lift out your baby's head. If everything is OK, you can ask the doctor to hold your baby up so you can get a first look.
The umbilical cord will be cut and your placenta removed. Then the doctors and midwives will check your baby very carefully.
If everything is OK with your baby, it's recommended that you have skin-to-skin contact as soon as possible. Skin-to-skin contact helps to keep your baby warm and lets you and baby bond physically straight away. If you can't hold your baby in the operating theatre, your support person will most likely be able to hold your baby instead.
Your doctor will recommend an injection or medication through an intravenous drip to make your uterus contract and to reduce bleeding. You'll be given antibiotics through your drip to reduce the risk of infection.
The doctor will stitch the layers of the uterus, muscle, fat and skin in your tummy back together and put a dressing over your wound.
Warm skin-to-skin contact and soft reassuring stroking from you or your support person as soon as possible after birth will make your baby feel secure.
After your caesarean birth
Midwives and nurses will look after you in the recovery room until you're ready to go back to the maternity ward.
You'll most likely have your baby stay with you. You can ask a midwife to go with you to the recovery room to help you breastfeed your baby for the first time. If the medical staff are worried about your health or your baby's, this might not be possible at first.
After a general anaesthetic, the midwife or nurses will look after you in the recovery room until you wake up and for around 30-60 minutes afterwards. Once you're awake you should be able to see your baby.
It's normal to feel pain and discomfort after a caesarean, especially when you move. Let the midwives know how you're feeling. It's best to keep on top of pain, because this will help you recover faster. If you're breastfeeding, check with your doctor or midwife that any medication you're using is safe for your baby.
The midwives will keep checking your blood pressure, your wound and the amount of vaginal bleeding you have for the first few hours. You'll probably have a drip and a urinary catheter for the first 12-24 hours. After the first 12 hours, a midwife will help you get up so that you can shower.
Breastmilk is the best possible food to help your baby grow healthy and strong.
After a caesarean, starting to breastfeed can take a while. It's a good idea to ask for support from midwives and a lactation consultant, if the hospital has one. They can show you the most comfortable ways to hold your baby while breastfeeding.
The sooner you start with breastfeeding, the easier it is for you and your baby.
Some hospitals encourage women to breastfeed their babies in the recovery room if there's a midwife to help.
It's good to ask for practical help, especially in the first six weeks after caesarean. For example, you can ask friends to help with housework or with driving your other children while you recover.