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Caesarean section

If you are considering a Caesarean section or have an operation planned, it is important to know all you can about it. This includes:

 

  • why you need this operation

  • what it will be like

  • how it will affect you

  • what risks are involved

  • any alternatives.

 

The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

 

What is a Caesarean section?

This is an operation to deliver your baby and placenta. The Caesarean section may be done as an emergency or as a planned operation. You may hear it called a C-section, a section or a Caesarean, for short. We divide the many reasons for needing a Caesarean into three groups. They are:

 

  • Reasons connected with the mother.
  • Reasons connected with the baby.
  • Reasons connected with placenta.

 

Caesarian

Problems during labour are the most common reasons for needing a Caesarean section. The labour may not go well if the baby is in the wrong position, is too big or becomes distressed. Bleeding may be another reason for needing a Caesarean section.

 

Reasons connected with the mother

 

  • Cephalopelvic disproportion - This is when the mother’s pelvis is too narrow or the baby’s head is too large to allow a vaginal delivery. This can obstruct labour and need a Caesarean delivery.
  • Pre-eclampsia - This condition causes the mother’s blood pressure to rise. It may lead to a fit or stroke. Drugs may reduce the high blood pressure but sometimes the only treatment is to deliver the baby as quickly as possible. Normal delivery may be unsafe as the blood pressure can reach dangerously high levels while waiting for labour to start.
  • Previous Caesarean section - Needing a Caesarean section is much more likely if you have had one in the past. The scar on the uterus from the previous Caesarean could give way during labour. You can have what is called a ‘trial of scar’ to see if you will deliver normally. You may still have a good chance of a vaginal delivery after one previous Caesarean section. However, the chances are much lower if you had more than one previous section. If we feel normal delivery is not safe, then we will do a Caesarean section.
  • Fibroids - These are non-cancerous growths in the uterus. They can block the baby’s passage through the cervix.
  • Medical or surgical reasons - There are a number of other reasons for having a Caesarean. For example, we will advise it if the mother is HIV positive. The mother may have had an injury or previous spine or pelvis surgery, which may prevent them from having a normal delivery. It is important to tell your doctor of any illness and any previous operations or medical history.
  • Maternal request - Some mothers request a Caesarean section for personal reasons, such as convenience or fear of labour. Your doctor will discuss your reasons for wanting this and outline the risks and benefits compared to a vaginal birth. You may be offered counselling if the reason is fear of labour. If your doctor feels your decision is not justified he can decline your request and will offer to refer you to another doctor for a second opinion.

 

Reasons connected with the baby

 

  • Fetal distress - This is when not enough oxygen reaches the baby. Changes in the baby’s heart rate may be seen on a fetal monitor. Changes in heart rate may be enough to diagnose fetal distress or we may confirm it by testing a sample of the baby’s blood, called a fetal blood sample or FBS. If we confirm fetal distress we need to deliver the baby. If a vaginal delivery is not possible or would cause further distress we would deliver the baby by Caesarean section.

Caesarian 2

 

  • Wrong presentation - The baby needs to come out head first for a normal delivery. If the baby is lying feet or buttocks first this is called a breech presentation. If the baby lies across the tummy this is called a transverse presentation. In either case, we will recommend a Caesarean section.
  • Wrong position of baby’s head - The correct position for the baby’s head during labour is called occipito-anterior or OA for short. This is when the back of the baby’s head, called the vertex, is towards the front of the mother’s pelvis. In this position the smallest width passes through the birth canal. If the baby’s head is in any other position the delivery will take longer and be more difficult. If the baby’s head comes through the birth canal with the top of the head presenting instead of the vertex this is called a brow presentation. The increased width may lead to the baby becoming stuck and a Caesarean delivery is then needed. Other common abnormal positions of the baby’s head could be:

 

    • Occipito-posterior, or OP for short, when the back of the baby’s head is towards the back of its mother
    • Occipito-transverse, or OT for short, when the back of the baby’s head is towards the side of its mother’s pelvis.

 

For these positions a Caesarean section may be required if an assisted delivery with forceps or suction is not possible.

 

  • Multiple births - Sometimes it is safer to deliver twins by Caesarean section. Reasons for this include fetal distress and wrong position of the first twin. You may need a Caesarean section for delivery of the second twin even if the first is delivered vaginally. We deliver most triplets or more by Caesarean section because it is much safer.

 

Reasons connected with the placenta

 

  • Bleeding from the placenta - The placenta can bleed if it comes away from the wall of the uterus too early. This is called an abruption. This can happen during labour or pregnancy. If the bleeding is severe enough it will cause shock in the mother. It can also distress the baby, as there is not enough blood flowing to it. A Caesarean section may be the safest way to deliver and stop the bleeding. In a rare condition called vasa previa there are abnormally placed blood vessels in the membranes from the placenta. These can burst causing bleeding and distress to the baby. A Caesarean section will be needed to safely deliver the baby.
  • Placenta previa - If the placenta is placed abnormally low in the uterus it may block the cervix. It may stop the baby passing into the vagina or cause severe bleeding during labour. There are different types of placenta previa where the cervix is completely obstructed or only partly obstructed. In the more severe types a Caesarean section may be the safest way to deliver the baby.
Caesarian 3

 

  • Cord prolapse - Sometimes the umbilical cord, which connects the baby to the placenta, comes through the birth canal. This is an emergency situation, as the baby’s blood supply, and hence its oxygen, may be cut off. An emergency Caesarean section may be the safest way to deliver the baby if an assisted delivery cannot be performed.

 

The aim

The aim is to deliver your baby safely and make sure you come to no harm.

 

The benefits

You should safely and quickly return to normal health.      You and your baby will avoid undue trauma or distress.

 

Are there any alternatives?

Any possible alternatives depend on the reason for you needing a Caesarean. You should discuss these issues with your obstetrician.

 

What if you do nothing?

If you have a pregnancy complication and refuse a Caesarean your baby may suffer trauma or distress, leading to permanent brain damage or even death. If the labour is left too long you may suffer a ruptured uterus, damage to your vagina, bladder and other organs in the pelvis or possibly death. However, you have the right to refuse a Caesarean section. It is important to carefully discuss all the options with your obstetrician.

 

Author: Dr Chineze Otigbah MRCOG. Consultant obstetrician and gynaecologist.

© Dumas Ltd 2006

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