Caesarean Section: What You Should Know
The natural way for a baby to be born is a normal (vaginal) delivery. When a normal delivery is not suitable for a pregnant mother, however, a caesarean section is recommended. At present about one in three births in Sri Lanka is by caesarean section, and facilities for it are available at most base hospitals in the country. The operation usually takes less than an hour.
Although a caesarean section is a common operation, complications can sometimes occur. For that reason it is recommended only when a normal delivery is not suitable. There are two main types.
Planned caesarean section
The doctors identify in advance that a caesarean section will be needed, and the operation is scheduled for a suitable date.
Emergency caesarean section
If a mother who is preparing for a normal delivery, or for a caesarean section planned for a later date, develops a complication in the meantime, an emergency caesarean section may become necessary. In that situation the operation has to be done without delay, to keep the harm the complication could cause to the baby or the mother as small as possible.
During the operation
Most caesarean sections are done while the mother is awake, but she feels no pain. Before the operation, an anaesthetic injected into the spine numbs the body below the navel. Only then does the operation begin.
Before the operation, a tube (urinary catheter) is placed to drain urine, and the hair on the lower abdomen is removed. The abdomen is then cleaned and covered with sterile drapes. A small horizontal cut of about 10 cm is made low on the abdomen. This is usually called a bikini line incision, because it lies at the very bottom of the abdomen, in the area covered by underwear.
The layers beneath the skin are then opened to enter the abdomen. Another horizontal cut is made in the lower part of the womb (uterus) to open the sac in which the baby lies. The doctor lifts the baby out carefully, and the umbilical cord is then cut. At this point the mother can see her baby, and breastfeeding can begin even before the operation is finished. After the birth the placenta is removed and the inside of the womb is cleaned. The layers that were cut are then stitched back step by step: the womb, the abdominal wall and the skin.
After the operation
After the operation the mother is checked for bleeding, and then mother and baby are both taken out of the operating theatre. The numbness in the legs takes about 4 hours to wear off. After that the pain of the operation can be felt, so pain-relief medicine is needed. The mother is then able to eat and breastfeed on her own. The urinary catheter is removed about 12 hours after the operation, and medicines by injection are usually no longer needed. By the second day most mothers can get out of bed and walk a short distance on their own. Taking pain relief as advised and continuing to breastfeed are important during this time. If there are no complications, the mother can go home 3 to 5 days after the operation.
The skin is usually closed with dissolvable stitches, which do not need to be removed. If non-dissolvable stitches were used, they have to be removed about 5 days after the operation.
Normal day-to-day activities do no harm, but it is best to avoid activities such as lifting heavy weights for about two weeks. Because there is a risk of becoming pregnant again from 6 weeks after the operation, talk to your public health midwife or your doctor about starting a method of contraception.