Caesarean Section is the operation used to deliver the baby through the mother's abdomen. It involves a cut on the tummy at the top of the "bikini line", about as long as a pen, to enable safe delivery of the baby from the womb. Most women choose to go home after 3-4 nights if the baby is OK.
It is a major operation with risks to both the mother and baby, but is sometimes the only option.
Why is it carried out?
Caesareans may be planned (elective) or emergency. They may also be carried out during labour.
Elective caesareans are usually performed where there may be a difficulty for the mother or baby with delivering through the vagina or where labour may cause a problem. Typically this would be the baby lying in an abnormal position, or the placenta is covering part of the cervix (placenta praevia), and serious bleeding might occur if labour started. It may be for medical conditions in the mother, e.g. diabetes. In other circumstances, the baby may have severe growth problems and might not withstand labour.
Emergency caesareans are most commonly performed for "fetal distress" when abnormal heart rate patterns are detected in labour, when the labour is not progressing, for bleeding, or when attempts at delivering a baby through the vagina fail.
What are the benefits?
The benefit of caesarean section is to safely deliver the baby and avoid the risks of labour and delivery if these appear greater than the risk from caesarean.
The baby does not pass through the vagina, so this avoids any damage to the vagina and perineum due to childbirth.
If the baby or mother has specific medical problems, the operation can be timed to have the appropriate medical expertise on hand, e.g. if the baby might need an operation soon after birth.
What are the risks?
Babies born through caesarean section are more likely to have breathing difficulties, especially if born before 39 weeks. They are also at risk of injury during delivery and cuts from the scalpel used to open the womb.
The risk to mothers is also increased by surgical delivery. During the procedure there are risks from surgery of damage to bowel, bladder or other organs. Bleeding may be excessive and in some circumstances hysterectomy is required (particularly with repeat caesareans).
Post-operative complications include wound infection, pain, uterine infection, urinary tract infection, deep vein thrombosis, chest infection, temperature and the need for blood transfusion.
Long term problems can include formation of adhesions, intestinal obstruction, bladder injury, and increased risk of placental problems and scar rupture in subsequent pregnancies. A longer stay in hospital away from family, separation from the newborn at birth, lengthy recovery periods and difficulty breastfeeding are further complications.
Future deliveries
After one caesaren section, a vaginal birth is often possible. If there is no medical reason for another caesarean, there is now good evidence that vaginal birth may be safer than caesarean. There is also a greater risk of hysterectomy following future caesareans.
The Royal College of Obstetricians and Gynaecologists has produced guidelines for consultants on this subject, dated February 2007.
Alternatives
If caesarean section is clinically indicated, then there is no safe alternative. However, consent must be obtained from the mother, or the Consultant Obstetrician and Supervisor of Midwives will be informed of a decision not to proceed at your own risk.
Hopefully we haven't put you off a caesarean section if you need one, but we wanted to give you the full picture so that you understand what's involved. If you have any questions, please speak to your doctor or a midwife.
