25 important things you should know about Caesareans
Around one in four UK births are by C-section, but how much do you know about the op?
1. Caesareans are either elective or emergency
An elective is scheduled, and may be recommended for medical reasons, including the position of your baby or the placenta. An emergency one may be carried out if you, or the baby are in distress. In the UK, roughly 10,000 are done electively. The other 32,000 are done for reasons like breech birth or labour progressing too slowly.
2. You’re less likely to need one if you exercise
‘One common reason for needing a C-section is having a large baby – classed as weighing over about 9lb – but exercising through pregnancy reduces the risk of this,’ says Professor Margie Davenport from the University of Alberta. ‘Prenatal exercise also helps increase or maintain fitness, which makes it more likely that you’ll cope with labour better. After all, it’s called that for a reason – it’s hard work,’ she adds.
3. C-sections may raise the risk of obesity
That's in the baby as they grow up, not you, several studies have found. But don’t let it put you off the op. ‘Increased risk doesn’t mean every baby born by caesarean will automatically be obese,’ says one study’s author, Dr Matthew Hyde. He says it’s very likely that a healthy diet and exercise will help counteract the extra risk.
4. A caesarean halves your risk of stress incontinence
Natural birth is hard on the body and it’s common for the muscles of the pelvic floor to be weakened. This doesn’t happen with a C-section.
5. Your next birth can be a vaginal delivery
Docs call this a VBAC – vaginal birth after caesarean. ‘About 70 per cent of women are successful,’ explains consultant obstetrician Christian Barnick from Harley Street clinic Nuada Medical. After two caesareans it can be more tricky, and depends on the circumstances leading to your C-section.
6. You could be home after 24 hours
The NHS says the average stay is three to four days but you can go home sooner. ‘If everything goes as planned you can be home the next day,’ confirms Anne Henderson, also from Nuada Medical. ‘The main reason is that we use different anaesthetics now. You’re very unlikely to have a general anaesthetic but rather a block to numb your lower body so you and the baby are likely to be perky and alert after delivery.’ It takes about six weeks to recover completely, so you’ll need extra help at home at first. You also can’t drive for six weeks.
7. VBAC success increases with midwife-led care
Dr. Helen White, who’s studied this, explains: ‘Midwife-led care is based on the philosophy that pregnancy and birth are normal events; women who see fewer antenatal carers potentially hear fewer conflicting views and a stronger message about the safety of a vaginal birth and their ability to achieve it; they also have longer to decide as it’s discussed at their first appointment.’
8. Scars have got smaller
The first C-section incisions were vertical and quite long. ‘Now a traditional caesarean scar is about five to six inches long and runs horizontally across the abdomen,’ says Anne. It’s normally just above your knicker line and while it will be red to start with, it should fade to a silvery streak. Some mums call it “the baby badge”.
9. Skin-to-skin is possible
Advances in anaesthetics used during delivery mean you’re more likely to be given your baby immediately after birth. ‘In an elective caesarean there’s not normally any reason why this shouldn’t happen – especially if you tell your doctor it’s important to you,’ says Anne. In an emergency C-section there may be some reasons why it can’t happen, but do ask.
10. Take those vitamin D supplements
A dose of 10mcg a day of vitamin D is now recommended during pregnancy – and here’s another good reason to take it. A study from US researchers has found that women with low D levels are four times more likely to need a caesarean. According to the study’s author Dr Michael Holick, vitamin D is associated with good muscle strength.
11. It’s a myth that a caesarean prevents you from bonding
This was believed to be the case because in vaginal delivery a bonding hormone called oxytocin is produced that’s not present in a planned caesarean. ‘But there’s scant evidence that this has any long-term effect on bonding – plus one of the drugs used to induce labour is a synthetic version of oxytocin so most women having emergency C-sections have usually been exposed to plenty of it,’ says Linda Geddes, author of Bumpology (£9.99, Bantam Press). And breasfeeding also releases oxytocin.
12. Baby bugs differ
As the baby travels down the vagina during a natural delivery it picks up bugs on its skin that help form its immune system. It doesn’t happen with caesarean babies and this has been linked to the slightly increased risk of asthma and allergies in caesarean kids.
13. You can breastfeed straight away
The idea that women who’ve had a caesarean can’t breastfeed is another hangover from the days when the op was done under general anaesthetic and mums were too groggy (and docs didn’t want drugs to be passed to the baby in mum’s milk). Now it’s often possible to breastfeed immediately after a caesarean – particularly an elective. The normal position of cradling the baby might be a bit painful though. ‘Try the rugby hold, where the baby is tucked under one arm,’ says Kicki Hansard, doula and author of The Secrets of Birth (£7.99, CreateSpace).
14. You’re more likely to have an elective if you go private
The incidence is roughly double according to an Irish study. But it didn’t look at why; it might simply be that more women who want caesareans go private, or because older women might be more likely to afford private care and age increases the chance of caesarean.
15. The likelihood of a caesarean increases if you're nervous
Women fearing childbirth are in labour 90 minutes or so longer than more relaxed women. ‘Longer labour increases the risk of instrumental delivery or emergency C-section,’ says Samantha Salvesen Adams of the University of Oslo. Hypnobirthing may help to quell nerves.
16. The bigger you are, the more chance you’ll need one
One in five overweight women have emergency caesareans as their contractions aren’t strong enough. Now we may know why. A substance called hERG prevents the uterus contracting prematurely; in labour a protein is produced to switch it off. Australian research reveals that overweight mums don’t produce enough of this protein so labour doesn’t start.
17. Talk about it
An emergency C-section when you planned a vaginal birth can be a shock. ‘Often how we feel emotionally can affect our physical wellbeing and recovery so it’s important to talk through your feelings,’ says Kicki. Chat to your midwife, a friend – anyone who helps.
18. Seeding is still not recommended
Seeding is placing a cloth in your vagina during birth, then wiping your newborn’s face with it. In theory this provides the immunity boost they’d get with a vaginal birth. ‘But there is no data to date as to whether it results in improved health outcomes for babies, yet it carries an infection risk. On current evidence, I wouldn’t be willing to have my child seeded,’ says Dr Matthew Hyde.
19. Expect some gas!
This situation will resolve when your bowels start moving normally again, explains Christian Barnick.
20. There's now a 'natural' caesarean
The surgeon makes an incision, but the baby wriggles out on its on rather than being lifted out by the doctor. Word is it’s growing more popular (really?) but Christian warns that it can require a larger incision (and therefore scar) and that you can expect the surgeon to push on your stomach to help your baby out.
21. Silicone gel is your friend
‘It’s often recommended by plastic surgeons to minimise scars, and helps post-caesarean,’ says Anne. ‘You can start to use it five to six weeks after delivery – never on a new scar (it may hinder healing).’ Try Dermatix Silicone Gel (£29.99, boots.com).
22. Massage may help
‘There’s a lot of scar tissue deep in the abdomen, especially after emergency C-sections,’ says physiotherapist Nikki Robinson from Holisticare. If this doesn’t heal properly it can lead to pain or postural problems. A massage technique called myofascial release can help.
23. Stand up straight
Moving normally is important to help you recover but you can still get a bit of pain. ‘The natural inclination here is to bend forward – but the more you hunch, the greater the chance that scar tissue will form in a shortened state, causing problems later,’ says Nikki.
24. Don't listen to the haters
Some see choosing a caesarean as a bad thing, almost like cheating, but it’s your absolute right to do so. ‘Don’t let people put you off. Having a planned caesarean can be a very positive experience,’ says Christian. ‘Overall it’s every bit as safe as a vaginal birth for both of you – and done well your recovery time can be much quicker than expected.’
25. Australian mums do it for themselves
Down Under there’s a trend for maternally-assisted caesareans. Instead of the doctor lifting out your baby, you do it. But even though mums ‘scrub in’ to kill germs, they might still, say, touch their face and transfer bugs into the wound – and infection is one of the biggest concerns post-caesarean.