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July 27, 2016

One in four babies are born by caesarean in New Zealand. Tamara McLean explains why you might deliver this way, and what actually happens on the day.

The thought of giving birth by caesarean section puts some mums-to-be at ease and fills others with dread. But regardless of which camp you sit in there’s a chance that, come delivery day, this incredible procedure will bring your baby into the world.

Statistics show that one in four Kiwi babies are born by c-section, either at the mother’s request or by necessity. But what exactly does it involve and in what circumstances are you likely to get one?

Obstetrician Dr Olivia Stuart explains that a c-section is swift, safe, straightforward and one of the most commonly performed operations in New Zealand hospitals. “They’re an absolutely standard procedure these days, and something surgeons do over and over again with complete confidence,” says Olivia, a specialist at Auckland’s Fertility Associates.

Elective or Emergency

In a caesarean section, the baby is delivered via an incision in the abdominal wall. There are several scenarios that can lead to either an elective (planned) c-section or what’s known as an emergency (unplanned) c-section.

An elective c-section is most commonly carried out at the wish of a mum-to-be, usually as a request following a previous c-section. It also occurs when the baby is in the wrong position – usually bottom down or transverse – or the placenta is low-lying, barring the baby from coming out first. “Both of these issues we usually know about long before the birth, so we can plan for them,” Olivia explains.

Emergency c-sections tend to happen because the baby is distressed or labour is not progressing. “If we have a situation where the mother is in labour but the cervix isn’t dilating to allow the baby out then a c-section may very well be advised,” says Olivia.

It could also be ordered if the baby’s unusual position is only noticed at the last minute or there’s a cord prolapse, when the umbilical cord drops through the cervix into the vagina ahead of the baby.

While these are all referred to as “emergency” situations, Olivia says there’s usually nothing frightening or panicky about them. “Most of the time it isn’t like what you see on TV,” she says. “Emergency just means it’s organised on the day but it’s still quite cool, calm and unrushed.”

Making the Cut

Regardless of whether a c-section is elective or emergency, the process is the same. A woman is assessed by an obstetrician who will set the delivery plan before handing her to the surgeon and anaesthetist to explain the risks and ask her to sign consent forms. The theatre is booked and blood tests ordered to check for anaemia and blood group just in case blood is required urgently. It’s then time to get a catheter fitted to the bladder, the top of the bikini line shaved and the gown on. “After that it’s off to theatre and first up they will get two types of anaesthetic: a local into the skin and then a shot into the fluid that surrounds the spinal cord,” says Olivia. Ice is applied to the top of the stomach to ensure she’s thoroughly anaesthetised in her mid-zone before the drapes are raised, and the site is cleaned with antiseptic.

It’s operation time: 

A swift 60-second manoeuvre in which the surgeon cuts through the layers of the tummy wall, pushes the bladder off the front of the uterus and then makes another cut in the uterus to deliver baby. “This part happens very fast and the baby is very quickly out, getting checked over and then given to mum for that all-important skin-to-skin time,” Olivia says.

There should be no discomfort throughout the procedure. “Patients will feel pushing and pulling, but not temperature or pain.”

On the Mend

The stitching up can take up to 15 minutes and includes a check to ensure the uterus is contracting nicely and bleeding is limited. The whole procedure takes an hour, with another 30 minutes of close monitoring in recovery to follow.

The new mum will then spend five to seven days recovering in hospital, and six weeks avoiding heavier lifting as the deep abdominal muscles heal. The only physical sign of the procedure, the 12cm-long incision, should be hidden under the bikini line once the hair grows back.

Post caesarean some mothers find themselves with strong emotions including guilt, check out our tips on dealing with these haunting feelings. 


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