What is a caesarean section?
A caesarean section (CS) is an operation to deliver a baby when a vaginal birth is not possible or is not safe for the mother or child. In the operation, a cut is made in the mother's abdomen and uterus (womb) to deliver the baby.
Caesarean sections have become fairly common, due to better screening tools. These allow the doctor a more accurate assessment of the safety of vaginal delivery for the mother and the baby.
When is it used?
A caesarean section may be performed by choice (elective CS) or in an emergency. Elective CS is done when the birth passage is not adequate or when the baby cannot tolerate a vaginal delivery.
An emergency CS may be done when certain problems occur during labour. The position of the baby in the womb at the time of delivery could be abnormal. The baby could develop problems causing its heartbeat to slow down, showing that the baby cannot tolerate further labour. Under these conditions, a CS may be necessary. It could also be done if the cervix, which is the opening of the uterus, does not get fully dilated during labour, or the baby is too large for the mother's birth canal.
It is done when there is:
Danger to baby (foetal distress)
- Increase or decrease in baby’s heart rate
- Problems with the uterus - too small, scarred, or deformed; or multiple babies in the uterus
- Problems with the cervix - too loose or relaxed or active genital herpes infection of the mother
- Problems with the placenta and umbilical cord - attached too close to the cervix, incompletely attached to the uterus or abnormal development.
Danger to mother (maternal distress):
- Baby’s head is too large to pass through mother's pelvis.
- Prolonged labour.
- Abnormal position of the baby’s buttocks (breech), face or shoulder presentation; crosswise (transverse) position
- Pregnancy in mothers over 40 years
- Extreme illness - toxaemia, pre-eclampsia, eclampsia, hypertension
What preparation is needed?
Plan for care and recovery after the operation. Allow for time to rest and try to find other people to help with the daily duties. Follow instructions given by the doctor. Contact the doctor when labour starts.
What happens during the procedure?
Surgery is usually done under regional or general anaesthesia. A regional anaesthetic numbs the lower half of the body, preventing pain while the mother remains awake. A cut is made across the abdomen below the belly button. The uterus is opened, the amniotic fluid is drained, and the baby is delivered. The baby's mouth and nose are cleaned of fluids and the umbilical cord is clamped and cut. The child specialist or nurse looks after the baby. The uterus and abdomen are closed with stitches.
What happens after the procedure?
The average hospital stay is 2 to 4 days. Recovery takes longer than a normal vaginal delivery. Pain can be managed with oral medicines. Avoid exertion for 6 weeks. Begin exercises after 6 weeks, to regain abdominal muscle tone.
What are the benefits?
Caesarean sections can save the lives of babies and their mothers and prevent complications. Delivering the baby by CS is safer than risking normal vaginal delivery when there is foetal or maternal distress.
What are the risks?
CS is a very safe operation, and that is the reason why it is preferred in complicated cases. However, apart from a small risk of anaesthesia, there may be internal bleeding, infection, clot complication (embolism) or a weakening of the uterine wall in a small percentage of cases. Call the doctor immediately if the patient develops a fever, nausea, vomiting, becomes dizzy, or has shortness of breath, after a caesarean section.