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Patient Education: Preparation for Cesarean Birth


Patient Education: “Preparing for Cesarean Birth”



Not all babies can be born vaginally. Sometimes they need to be born by a surgical procedure called “Cesarean section.” You may also hear it called Cesarean birth, C-Section, or just Cesarean. The surgery consists of entering the uterus through the abdomen to deliver the baby.

Some Cesareans are scheduled in advance (elective Caesarean section operations). Others take place after labor has begun or when there is an urgent situation before there is any labor at all (emergency Caesarean section operations). The reasons for this decision will be explained to you and you will be asked to sign a consent form for the operation.


Having a Cesarean Birth at TCH:

The TCH is staffed with obstetrician, anesthesiologist, nurses, and other support staff who specialize in obstetrics. Typically, there are several staff members present in the operating room to assist with the delivery of your baby. Whether your Cesarean is an emergency or planned in advance, everything is close at hand on the Obstetric Unit. 

Cesarean sections take place in an operating room. If you are having a planned Cesarean, you will be scheduled for a pre-operative visit shortly before surgery for a physical exam, lab work, and to talk with the anesthesiologist. You will also be given advice to shower while using a bottle of antibacterial soap before surgery. Your provider will let you know the date and time of your surgery. You will be told when and where to arrive on the morning of your operation. 

If you are an admitted patient on the Antepartum Unit and will be having a Cesarean, we will prepare you for your surgery in your room and then take you to the operating room (OR). We suggest you begin gathering your belongings before surgery to make your transfer to your room/Postpartum Unit easier.

If you are an admitted patient on the Labor and Delivery Unit and need a Cesarean after labor has begun, you will be taken to the OR and you will return to your room/ Postpartum Unit to recover. Your family and belongings may remain in your room during surgery. 

When you arrive at the hospital nurse will check your temperature, pulse and blood pressure. You will be asked to put on a hospital gown and your nurse will check your baby’s heartbeat with a fetal monitor.You will then need to sign a consent form for your operation if you have not already done so.


Getting Ready for Surgery:

Before surgery, talk with your partner about what to do if your baby needs to be taken to the nursery after birth. Your partner may stay with you, or can go with the baby. This should be decided before you have your surgery.

Depending on your situation, preparation for surgery may take place either in your room or in the OR. Please note that operating rooms are very cold to decrease infections.

When we prepare you for surgery, we will:

  • Ask that you do not eat or drink anything for at least 8 hours before your scheduled surgery. You must not eat after midnight the night before the operation.
  • Start an IV in your arm for fluids and medicines.
  • Draw blood for tests your provider requests.
  • Insert a tube into your bladder to drain your urine into a bag.
  • Wash and clip hair from the area where your incision will be.
  • Apply an antibacterial solution to the area where your incision will be.
  • When your Caesarean section operation is booked, you will be asked to sign a consent form after full discussion with the doctor, including the risks and procedures. 
  • If you are taking any medicines, please let us know the night before your surgery.

 

Things to bring in And not to bring in !

  • When you arrive at the hospital nurse will give you a hospital gown. Please ensure that your bag contains a dressing gown, slippers as well as other clothes, toiletries and baby things.
  • Please also bring your hospital notes.
  • Please do not wear any make-up or nail varnish or contact lenses.
  • We advise you not to bring in jewelry, watches or valuables to the hospital. If you do, please give them to your partner for safe-keeping.

Anesthesia:

If you are having an elective LSCS (lower segment Caesarean section), you will be asked to attend an anaesthetic clinic the week before your surgery. You will see an anesthetist and a nurse, who will explain the procedure to you, and you will be able to ask any questions that you may have. The anesthetist will also see you individually to decide which method of anaesthetic is most appropriate for you.

Most Cesareans are performed using spinal or epidural anesthesia. With a spinal, there is a one-time injection of anesthetic into your spinal fluid, resulting in complete numbness in the lower half of your body from below the breasts.

An epidural is different in that the anesthetic goes into the space between the vertebrae and does not enter the spinal fluid. A small catheter is kept in place for repeated injections. With an epidural, there is also complete numbness from below your breasts to the perineal/groin area. There may or may not be feeling in your legs. The sensations you may feel with an epidural or spinal are pushing, pulling, or pressure, not pain.

Most elective Caesareans are carried out under spinal anaesthetic (similar to epidural), which means you will be awake during the procedure and you can see your baby immediately. If a mother’s or baby’s medical condition makes it necessary, general anesthesia may be used. Whatever anesthetic is used, the anesthesiologist will stay with you at all times during the surgery.


What should you expect?


In Operating Room:

Once in theatre, a drip will be put in your wrist or hand, and your anaesthetic given. Once the anaesthetic is effective, a small tube called a catheter is passed into your bladder. You will then be covered by a drape, which is used to form a screen to block your view of the operation.

The baby is usually delivered within the first few minutes. During the procedure you may feel some pushing and pulling, although this should not be painful. If you experience any pain, you must tell your anesthetist at once.

The baby is usually taken to a resuscitaire at the side of the room to be cleaned and dried. Immediately after delivery your baby will be taken to the baby warmer, just steps away from the operating table inside theatre for the nurse to dry him/her to prevent him/her from getting cold, before returning him/her to you. Provided your baby is healthy and stable, he/she will be brought to you in the minutes after birth. As soon as you are ready, your nurse will help to place your baby to your breast and find a comfortable position to hold her. After some time together, the nurse will take your baby to the recovery area to be weighed while you are moved onto a comfortable bed. 

Sometimes, the baby is taken to a small nursery next to the OR for more specialized attention. This is especially important for premature babies. Some of these babies are transferred in an enclosed crib to the Neonatal Intensive Care Unit (NICU) for special care and observation.

From the time the spinal or epidural takes effect (usually 5 to 30 minutes) to the birth of your baby is about 10 to 15 minutes. The final phase of the surgery involves closing the incision, which takes about 45 minutes. The entire procedure from beginning the anesthesia to closing the incision takes about 1 to 11⁄2 hours.

In recovery:

Following the operation, your bed will be taken into the recovery area, where nurse will check your observations (such as your heart rate, blood pressure, oxygen level, amount of bleeding and  measurement of pain level) and help you to breast/bottle feed your baby. Skin to skin contact with your baby will be encouraged whatever your chosen method of feeding. If your baby has any problems he or she will be taken to the nursery for a careful check. If all is well, you will be transferred to the postnatal ward with your baby, about 2 hours after your surgery.

On the Room/Ward:

If you had a general anaesthetic, you will feel sleepy and “groggy” for several hours. If you had a spinal anaesthetic, you will be alert and awake, but your legs will stay numb for several hours.

You will also have a drip running with fluids until you are able to eat and drink.

The catheter will stay in your bladder until the following morning. Once it is removed you will be asked to measure your urine a few times to ensure that you are emptying your bladder fully.

The next day you will be helped to walk to go to the bathroom.The first few times you get out of bed, a nurse or other adult should help you.  It is important to remain mobile to reduce the risk of DVT (blood clots). You will find that it gets easier the more you move around.

You will be given help with the care of your baby while you are not able to get up. Please do not be worried about asking for help. Staff will ensure your call bell is easily available.

 Your nurse will be paying close attention to your physical needs as you begin your recovery from the surgery.

A hospital stay after a cesarean birth is usually 3-4 days. The length of your stay depends on the reason for the cesarean birth and on how long it takes for your body to recover. When you go home, you may need to take special care of yourself as advised by your doctor.

Wound care:

The wound dressing will stay in place for 24 hours before being removed. After this time the wound will remain open to the air, which encourages healing. 

Some bruising and/or numbness around the wound is normal, and will usually resolve in time. As the numbness improves, you may experience some “pins and needles”, which is a good sign that the sensation will return.

Pain management:

The abdominal incision will be sore for the first few days. Your doctor can prescribe pain medication for you to take after the anesthesia wears off. There are many different ways to control pain. Talk to your doctor about your options.

Bowels:

It is quite common not to open your bowels for two to three days after your operation. Painkillers can sometimes cause constipation, which can be prevented by drinking plenty of fluids and eating a high fibre diet. Treatment can be given if needed.

Stitches:

Internal stitches will not need to be removed. The skin can close in a variety of ways. Occasionally dissolvable stitches are used to close the skin, which do not need to be removed. More commonly, a non-dissolvable continuous stitch is used, which will need to be removed after few days of operation. You will be informed about the date of removal of your stitches.

Visiting:

We advise you restrict visitors after your LSCS as it is a major operation, and you will need to rest more than other mothers. We suggest that you only have your partner on the day of the operation, and stagger other visitors after this to ensure you get plenty of rest.

Going home:

A doctor will see you before you go home. If your LSCS was an emergency during labour, the doctor will explain what happened and why you needed the LSCS—he/she will also advise you about future pregnancies and births. This is usually after 2-5 days. We advise that you have help and support at home. 

Getting back to normal:

Full recovery takes a minimum of 6 weeks, during which time you should avoid heavy lifting (other than your baby), heavy housework and strenuous exercise. During your hospital stay you will be given information about appropriate postnatal exercises. This will include pelvic floor exercises. The weight of the pregnancy and the effect of pregnancy hormones can weaken the muscles of the pelvic floor, so it is important to perform these regularly. You need to make an appointment to see your doctor for a postnatal check at 6 weeks after the birth before you recommence strenuous activity or driving.

Follow­Up:
 
Your doctor will want to see you in the office 2 weeks and 6 weeks after your delivery. At the first appointment, your incision will be checked, your doctor will want to know how you are recovering from your surgery, and how things are going with your newborn and breast‐feeding. At the second visit, a more complete exam will be performed and your doctor will talk to you about birth control and your routine follow‐ up visits.

Make sure you know the warning signs of a problem related to surgery. Contact your doctor if you experience any of the following symptoms:

  • Vomiting
  • Fainting
  • Severe abdominal pain or cramping
  • Heavy bleeding
  • Abnormal vaginal discharge
  • Fever or chills
  • Redness or discharge from incisions
  • Redness or tenderness of the calf area
  • Shortness of breath or chest pain
  • Pain or difficulty passing urine

Do’s and don’ts:

Do’s:

  • Allow yourself time to rest
  • Take pain medications as advised by your doctor
  •  Eat high-fibre diet and drink plenty of fluids (to preventconstipation)
  • Take gentle exercise such as short walks
  • Perform your postnatal and pelvic floor exercises as outlined by your doctor
  •  Increase your activity gradually as you feel able to Keep your wound clean and dry
  •  Make an appointment at TCH for your two-weeks and six-weeks postnatal check

Don’ts:

  • Don’t  Overdo it! Listen to your body—if it hurts, wait a while
  • Don’t take to your bed—this will increase the risk of blood clots (DVT)
  • Don’t undertake heavy housework or lifting (other than your baby)
  • Don’t take up strenuous exercise until after your six-week check

If in doubt, ask your doctor.

We hope this information has been helpful. If you have any further question or worries, you can discuss them with your doctor, or contact the hospital.


Questions?


Your questions are important. If you have questions about yourself, call your obstetric provider during office hours. When your provider’s office is closed, call: Labor and Delivery Unit.


You and Your Baby are important to us. Thank You for choosing TCH.