Caesarean Section (CS) is an operation where a baby is delivered through an incision (cut) in the uterus and abdomen. Approximately 30% of babies are delivered by a caesarean section. CS is usually undertaken when delivery through the birth canal is considered unsafe for the mother, baby or both. In most cases a transverse cut is made in the lower part of the uterus and this is known as a lower segment caesarean section (LSCS). However, in some cases (i.e. if there is extreme pre-maturity) the cut in the uterus has to be made vertical involving the upper part of the uterus (known as a classical caesarean section).
An elective caesarean section is preformed when the problem is known before the labour starts. These usually include:
Emergency caesarean sections are often only preformed for these main reasons:
If you are having a planned CS you will be booked in a surgical theatre like any other surgery. This means that a booking form will be filled in by me, you will sign consent a few days before the operation and will take this form to the Diagnostic Centre (suite 210, Level 2 in RPAH Medical Centre). You may be booked for a pre-admission consultation where various options of anesthesia and the risks and benefits may be discussed. You will also have necessary blood tests. The Diagnostic Centre will inform you about the time and date of presenting to the hospital and will complete other formalities.
However if you have an emergency C-Section, the labour ward anaesthetist will see you and discuss risks and complications.
Caesarean sections are usually preformed under epidural or spinal anaesthesia. Sometimes, particularly in an emergency a general anaesthesia may be required.
A 10 cm bikini line incision is made in the lower abdomen and various layers of skin are opened. A transverse cut is made in the uterus and the uterine muscles are divided. The baby is delivered and the placenta is delivered by a controlled cord traction. A dose of antibiotics is given. The uterus and various layers of abdomen are closed with dissolving sutures. The skin is then closed with dissolving sutures as well. There are at least 6-7 people in the theatre at any given time, including the anaesthetist and assistant, the surgeon and assistant, nurses, paediatric staff and sometimes medical students. If you have had epidural or spinal anaesthesia your partner or support person can be present in the theatre as well. You will have an IV drip, urinary catheter, and occasionally an infusion for pain relief (PCA). Occasionally a drain is left in the abdominal cavity to drain any blood or fluid that may be present.
A caesarean section is a major surgery and although it is a common operation, there is a potential for complications. With modern surgical techniques it is rare to develop any long term or life threatening surgical complications. However, it is important to consider the following list of potential risks before undergoing surgery. On an average, 5% of patients undergoing major surgery will experience a significant complication despite the best medical and surgical care.
An epidural, as it is commonly called, is an injection of pain relieving drugs in an area of the spinal cord called the epidural space. The procedure is preformed by an appropriately trained doctor (usually an anaesthetist). A special hollow needle is inserted through the skin into the epidural space (in the lower part of your back), a fine plastic tube called a catheter is threaded through it, the needle is removed and pain relieving drugs (i.e. anaesthetic) can be given through the catheter. Epidural anaesthesia is a very effective way of relieving labour pain. It can make the experience of labour and delivery more satisfying, not only for you but also for your support people. You may be in a better position to enjoy your birth experience and feel in control. However, if there is no medical indication for advising you have epidural, it would only be preformed at your request. There are medical reasons for having an epidural which include: high blood pressure, multiple pregnancies, or where an assisted delivery or caesarean section may be required. In some medical conditions, epidural may carry more risks. If you have a medical condition including heart or lung disease, back problems, blood clotting problems or have a severe infection it may be contraindicated.
Risks and complications of epidural anaesthesia - Epidurals provide a low risk method of relieving pain, however, the following are some possible side effects you may experience:
At RPA Hospital there is an anaesthetic on site 24 hours for obstetric services. However, there can be a delay sometimes if there is an emergency and they are busy with another patient.