Part I: A caesarean birth -- what you must know
Now that you know the basics about a caesarean section, here is more information you must know.
How do I plan for a C-section?
If your doctor has said you may/ will need to opt for a C-section, prepare yourself with the necessary information.
~ Discuss the procedure in detail with your doctor. He/ she can help you deal with your concerns.
~ You can witness the birth. If you are not sedated, you can watch your baby being delivered. Tell your doctor in advance if you want to do this.
~ Inform the staff. Tell them that you will be having a C-section but they must not kill your baby's appetite with sugar water. Discuss the option of a top feed and whether you would like to feed your child yourself instead from the first day itself.
~ Ask for help. Get lots of rest once you get home. Do not overstrain yourself. This does not mean you need to stay in bed all the time; it just means it's not exactly the time to go on a cleaning spree.
Parents and in-laws will volunteer to help. Don't refuse.
What kind of pain relief is given during and after surgery?
If it is an elective caesarean section, the anaesthesia given is generally spinal anaesthesia (regional anaesthesia that just makes the lower part of your body numb) along with a sedative.
You need not take the sedative if you are not overtly nervous.
A sedative can make you groggy during and after the birth.
Some women feel this reduces bonding with the baby. In emergencies, some doctors might opt for general anesthesia where your entire body is anesthetised. After the birth, the effect of the anesthesia will last for some time. You will then be given oral pain medication.
What are the possible complications?
With a C-section, just like any abdominal surgery, the post-operative pain is prolonged and the surgery could pose the following risks:
- Risk of infection
- Excessive bleeding
- Blood clots
- Injuries to the bladder or bowel (though these are very rare)
- More postpartum pain
- Longer hospital stay
- Accidental surgical cuts
- Breast-feeding problems
- Future respiratory diseases for the baby possibly because the liquid in the lungs has not been as thoroughly squeezed out
Some experts worry about mother-baby bonding. For a groggy, sedated mother in pain, bonding and breastfeeding might be tougher.
Planned C-sections might be better than emergency ones because the woman is generally healthy and not tired after hours of tedious labour. The surgical team is better prepared if the surgery is anticipated.
According to a study published in Obstetrics And Gynaecology in 2003, women who had a C-section without first going into labour demonstrated no increase in deaths, transfers to intensive care, infections or blood transfusions as compared to women who delivered vaginally.
However, constant improvements in surgical technique and the advances in the medical field have greatly reduced the incidence of complications during C-sections.
What is the course of recovery after a C-section? Any precautions I need to take?
Caesarean sections might be considered major surgery, but in general most mothers and infants do well. The typical hospital stay following a C-section is around three days. If you or your baby needs medical supervision, this may be extended by a day or two.
Your doctor will prescribe some pain medication to be taken in the first few days following the surgery. It is normal to feel fatigued when you return home, especially if you had a long and difficult labour.
It usually takes around four to six weeks for the incision to heal completely, but you are likely to feel well much before this. Some moms feel normal after a few weeks. Others take two or three months to get back on track
What about the first few weeks?
For the first few weeks, it might be a good idea to:
~ Rest and take it easy. Avoid regular housework. Don't try to lift anything heavier than your baby. Also avoid going up and down the stairs frequently.
~ Use support pillows when you feed your baby. This can make you feel more comfortable and keep your scar from hurting.
~ Follow good posture while standing and walking. Support your abdomen (the scar area) while coughing, sneezing or laughing.
~ Do not entertain too many guests. Having company all the time will prevent you from getting adequate rest.
~ Drink lots of fluids, especially if you are breastfeeding. These fluids will help replace those lost during delivery too. Pass urine as frequently as possible and maintain good hygiene to avoid urinary tract infections.
~ Avoid sex for six weeks. But make sure that you and your partner give each other some quality time everyday.
~ Do not drive until the scar heals completely. You might not be able to deal with the abrupt movements you might need to make.
Can I breastfeed after a C-section?
Of course, you can. Sometimes it might be a challenge to get breastfeeding established but it is worth the effort. Take the help of your obstetrician and paediatrician if you have any issues here.
They can help you learn breastfeeding positions that are comfortable for you in the first few weeks.
What if I have a disappointing birth experience?
Women who desperately seek the natural mode of delivery and end up having a C-section can now join Internet support groups (that are not country specific) who make them feel much better by linking them with women who have had the same experience. Writing and blogging about the experience also helps some women.
Women who undergo traumatic labour too might need a healing hand of this kind.
'Once a section, always a section.' I have heard this and am scared!
A prior C-section was once an absolute indication for C-sections for subsequent deliveries. This was due to the fear that the previous scar would tear. However, today, with the 'bikini-cut' incisions (where the cut is made just above the pelvic bone) that are being performed, the risk of scar rupture is very low.
Today the trend is for a VBAC (Vaginal Birth After a Caesarean) trial. This means your doctor might not schedule a C-section just based on the previous section. He/she will evaluate why you needed one and if the same reason exists in this pregnancy. If not, you could be allowed to go into labour and if everything goes well, you could have a normal delivery. Nevertheless, the doctor will be prepared to perform a C-section if complications arise at any point of time.
It is important for every pregnant woman to remember that MOST healthy women DO NOT have complications during labour and find childbirth (whether natural or C-section) a rewarding experience.
Part I: A caesarean birth -- what you must know
Dr Roopa Nishi Viswanathan has an MBBS from KEM Hospital, Mumbai, with a Masters in Nutrition from the University of Texas at Austin.
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