Whether or not you know that you will be having a cesarean section or not, I want to walk you through what to expect if you have a cesarean section.
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First and foremost, I hope that you do not have one. I will say this until I am blue in the face. EDUCATE YOURSELF! Take a class, asap. Whether it is a live class or one of the online courses that I recommend, take a class and understand your rights and the decisions you may make within the course of your birthing experience.
It is much easier to decide the heat of a battle when you have sufficient knowledge to do so. Don’t you agree?
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Reasons You May Have a Cesarean Section
- Breech or Malpositioned Baby
- Placenta Previa or Placental Issues
- Prolonged Labor
- Fetal Distress
- Some sort of Fetal Abnormality or Birth Defect
- Maternal Health Condition
- Prolapsed Umbilical Cord
- You already had a Cesarean Section (Repeat C-section)
- CPD (Cephalopelvic disproportion) Mom’s pelvis is too small (This one sometimes irks me, Get educated…that’s all I have to say)
- Multiple Pregnancy (twins, triplets..so on)
Again you can see how birth can take a significant turn, and you might end up in an operating room having surgery. This is why I want you to #1 educate yourself, so you do not feel coerced, and #2 you have a guide to understanding cesarean sections for yourself.
Risks of Cesarean Sections
Risks to Mama:
- Blood Loss
- Blood Clots
- Adverse Anesthetic reactions
- Surgical injury
- Wound infections
- Need for Subsequent Cesareans during future births
Risks to Baby:
- Breathing issues
- Surgical Injury (nicked by surgical knife, so on)
- Higher risk of NICU admission
- Not exposed to beneficial bacteria in the vaginal tract during birth.
What Can You Expect If you Are Having A Cesarean?
I have traveled and worked all over the US. Cesarean Sections are pretty much handled the same way everywhere. With few exceptions, the steps I am going to explain to you are the same in most hospitals.
The following tasks are completed in your birthing suite (if you are an unplanned cesarean) or in the Pre-op holding area.
You will be admitted to the hospital and given an opportunity to express your wishes. (Education LADIES!)
Pre-op in the room:
- After admission, we will start an IV and get at least a liter of fluids into your system.
- Your pelvic area will be clipped to rid the area of hair.
- An abdominal cleaning with special wipes will be done.
- Sequential Compression Devices (SCD’s) will be placed onto your calves. These are to keep your blood pumping during surgery and recovery.
- You will be given an IV Antibiotic- to prevent infections.
- You will be given 1-3 medications to dry the secretions in your mouth and upper airway. The first is Bicitra, which is a little shot of medicine that I refer to as a “sweet and sour with no sweet.” If you ever had a party life in the past, then bust out your chugging abilities and chug it. A little variation comes into play with the next two medications, but most hospitals do either both Reglan and Pepcid or just one.
- If you are in labor or an induction with an epidural in place, when a cesarean section decision was made, the CRNA or Anesthesiologist will come into your room and give you a higher dose of medication through your epidural catheter.
- We will then transport you to the OR via a stretcher is you are already in labor, via a wheelchair or walking if you were admitted for a planned cesarean section.
Pre-op in the OR:
Pre-surgery in the OR goes something like this. Your partner will be asked to wait outside the OR while we prep you for surgery.
You will be given an anesthetic (general, spinal, or epidural) if you have not already been given one earlier in your labor.
We only use a general anesthetic (aka you put to sleep) for emergency cesareans because it works quickly, and the mother is out and sedated. In this case, no one else can enter the OR (Aka Daddy or partner).
You will sit up on the side of the OR table. A nurse or tech stands in front of you while the CRNA or Anesthesiologist places the spinal. The spinal and epidural anesthesia will numb your body from the abdomen to below the waist (most often the legs are numb as well) so that you will not feel the procedure.
Once you are back to a lying position on the OR table, we then do a few predictable things. We will monitor the baby’s heart rate for a few minutes. While listening to the fetal monitor, we will place a urinary catheter to drain your bladder, connect the SCD’s, put a grounding device onto your thigh (usually), and call for your doctor and baby care team to come to the OR.
It sucks, but this is something I feel you should prepare for: when we lay you back after your spinal, we will uncover you. The lights are bright, and it is awkward. I try to keep you covered as long as possible, but we must put in a catheter and scrub your stomach. I cringe for my patients during this period. It is a short period.
During A Cesarean Section
Once the doctor has confirmed you are sufficiently numb, your partner will be escorted into the OR to sit near your head.
You can expect to be in the OR for at least 45 minutes. The baby is usually out within 15-20 min, the remainder of the time is used to stitch and clean mama up.
Emergency cesarean section: The incision will most likely be vertical.
Planned or non-emergent cesarean section: The most common incision is the bikini cut or a horizontal cut right above the pubic bone. For your info: your muscles are pulled apart, not cut.
The most common incision is the low transverse incision. It is critical to know what type of incision. The type of incision plays a crucial role in deciding if your provider will give an okay a VBAC in the future.
The baby’s head is most often delivered first so that the OB can suction the mouth and nose. Unless there is a complication, the OB will lift the baby so that you and your partner can see her. (Be on the lookout for my suggestions on making this a family-centered event and not only a sterile procedure)
The nursery nurse will take your baby to the warmer for an assessment.
Pro tip: ASK FOR SKIN TO SKIN IN THE OR PRIOR TO ENTERING THE OR!
Many hospitals then take the baby to the nursery while you are stiched and cleaned. Your partner can accompany the baby. But be sure to ask if they can keep the baby with you. IT’S YOUR BABY! Be sure to understand how vital the golden hour after birth is and to do everything you can to protect it.
Read this: The Essential Cesarean Guide
After the Surgery
Once cleaned, your CRNA and primary RN will transport you to your labor room or PACU. This depends on the facility.
You can expect to feel a few things (everyone experiences them differently or not at all) after the surgery:
- trembling or shakiness (from a drop in adrenaline and medication)
- Pain (not usually until a bit later but your nurse can be preventative in this) Key to pain control is a binder and being medicated around the clock.
Your RN will massage your fundus, which is the top of your uterus, every 15 min, while in the PACU. Fundal massage helps prevent hemorrhage and to assess your bleeding. Next, we clean you, put pads, and panties on you and transport you to the postpartum unit.
PRO TIP: This is a hardcore pro tip for you to take as you will. I highly suggest you bring a binder to the hospital and ask your PACU RN to place it on you before your spinal wears off. Girl, a binder is the number one way you can reduce your pain during the recovery process. I promise!
I hope this guide to a cesarean section painted a thorough and clear picture for you to understand what is happening during this massive event in your pregnancy/birth.
As always, comment and share what you experienced during your cesarean section. Did you feel that everything was adequately explained to you? Did you have enough education beforehand?