An elective Caesarean is when the decision to have a Caesarean is made before labour starts.
The most common reasons for babies to be born this way are if the baby is breech; the baby’s head is too big to pass through your pelvis; or if you are pregnant with twins or multiples
You may also need a Caesarean if you suffer from certain medical conditions like placenta praevia. If you have had a Caesarean with a previous baby, you may need another, because there is a small risk of uterine rupture when you go into labour. Your doctor and midwife can advise you on this.
Elective Caesareans are often carried out under a spinal block or epidural. This means the mother will be conscious throughout the procedure and will be able to hold the baby as soon as it is born. The birth partner can be present if they wish, and will have to wear hospital gowns throughout.
When the mother is conscious during a Caesarean, a screen is put up so that she cannot see what the surgeon is doing. Often the screen is pulled down when the baby is lifted out, so that the parents can see the moment their baby enters the world, much like a vaginal birth.
You will have to have a catheter fitted if you have a Caesarean so the bladder can be emptied, preventing it getting in the surgeon’s way. A catheter is a small tube which runs into your bladder and drains out the urine. It is also helpful afterwards when your movements are restricted till you feel strong enough to walk to the toilet on your own again. The catheter is fitted while the spinal block is in place so you will not feel a thing. Removal is not painful, just a little uncomfortable.
What happens in a Caesarean?
Once you have been injected with the anaesthetic, the effects will be almost immediate. You will be sprayed with ice-cold water to confirm the anaesthetic is working. You may feel a tingling sensation in the lower part of your body, and your legs will start to feel heavy. There will be no feeling from your bump downwards and you will feel no pain (tell the surgeons if you DO feel any pain or you regain feeling in your legs etc as the operation progresses - although this is very rare).
Once the surgeon is certain the anaesthetic is working, an incision will be made in your lower abdomen (most hospitals these days favour a horizontal bikini cut, just below the top of your pubic hair). You may need to be shaved before the procedure.
A second incision is then made into your uterus and the amniotic sac is opened and drained.
The baby is pulled out of your stomach gently, either manually or by using forceps. Your baby’s airways will be cleared and you will probably hear the first cry. If the screen has been pulled down, you will be able to see your baby entering into the world. As in a vaginal delivery the cord will be clamped and cut, and the doctor will do a quick routine check on your baby, while the placenta is being removed from your uterus.
Your baby will be handed to you, and while you coo over how amazing he or she is, you will be stitched up – but you're unlikely to notice a thing, as your thoughts will be on your brand new baby.
How do I prepare myself for a Caesarean?
You will be told not to eat or drink for a number of hours before the procedure, and you might need an overnight stay in the hospital beforehand. A consent form needs to be signed before the operation, and you will be talked through the procedure by someone on the medical team. Now is the time to ask any questions you have and flag up any needs you might have, for example, do you want to find out the baby’s sex yourself, or do you want to be told? And do you want to try to breastfeed straight away? Your midwife should be able to help you with any concerns.
The top of your pubic hair will need to be shaved before the Caesarean, so it might be a good idea to take care of this yourself at home, if you know when the procedure will be.
Are there other types of Caesarean?
Emergency and crash Caesareans won’t be planned and will probably take place once labour has started.
Emergency Caesareans usually take place if the baby is showing signs of distress or if labour is progressing very slowly. Epidurals can still be used in an emergency, but your partner may not be allowed to be present at the operation.
A crash Caesarean is an emergency when the baby needs to be delivered quickly, and the mother will probably be given a general anaesthetic. A mother might need a crash Caesarean if she shows signs of placental abruption, a prolapsed cord, or if the baby is showing severe signs of distress.
Recovery after a Caesarean
Most women will be able to walk again (if slowly) the day after they have had a Caesarean. The best thing to do is attempt walking as soon as you feel ready too. Each time you walk it will be less painful than before and the strength will slowly return to your lower body. You will probably be given pain relief drugs which will help with the initial stages of recovery. If you still have a catheter inserted, it may make it difficult to be fully mobile and to attend to your baby, but the more mobile you are, the quicker your recovery will be. It is also advisable to get moving as this will reduce the risk of blood clots forming - you will probably be given special socks or tights to wear during your hospital stay to reduce the risk still further.
How you will feel emotionally
Lots of women feel disappointed after having a Caesarean, especially if they didn't even go into labour (if they had an elective Caesarean for a medical reason such as the baby being in the breech position, for example). This may be because they feel as if they missed out on the "true" birth experience. But studies show that there is no difference in the bonding process between mums who delivered their baby vaginally and those who have had a Caesarean birth.
A Caesarean is a major operation and it can be tough recovering from one while looking after a helpless newborn. Ensure that any visitors know that you need time to recover from the operation, and keep guests to a minimum in the early days.
If you are feeling dissapointed that you didn't have a vaginal birth, remember that your Caesarean happened for a reason. That was the way your baby was meant to come into the world and you will have your own special memories of this time. The scar you receive is likely to be very small and just below your bikini line so you will still get into a tiny bikini (if you are brave enough!). Lots of women like their Caesarean scars as it is a reminder of their status as a parent.
Also bear in mind that just because you have had a Casarean does not necessarily mean you will have to have one the next time.