An Obstetrician's View (Caesarean Section)

Member Name: drdel

Product:	Caesarean Section
Date:	15/08/01 (514 review reads)
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I haven't written any medical ops for a while so I thought I would do one on caesarean section since it is in my chosen speciality.

There have been several ops about childbirth and caesarean sections and they have understandably been from ladies who have personal experiences to share. I hope this op, from a professional point of view will be useful to some women who are about to have a caesarean or thinking about it or are afraid that they might have one.

Firstly some boring facts. The procedure: Basically, a cut is made just below where your bikini line would be and your baby is delivered through this opening in your tummy. You don't have to push, and the delivery of the baby takes only a few minutes. The rest of the operation is sewing you up. The whole thing can take from 20 minutes to an hour assuming no complications have occured. You can be awake during the procedure by having an anaesthetic into your spine which numbs you from below your rib cage downwards. This doesn't mean you won't feel anything, you will still feel pulling, but you should not feel pain. What are the risks. It is generally accepted that the risks to the baby are less than in normal delivery, but the risks to the mother are higher. Because it is an operation you have the risk of infection, this is very small, there is a risk of bleeding which rarely leads to you needing a blood transfusion follwoing, there are risks to damage to structures around the womb such as bowel or the ureters which are tubes leading from your kidneys to your bladder. These risks are all small but risks that you should be aware of.

That's the procedure but I want to add some comments of my own and hopefully dispel some myths along the way. Firstly, and I know different labour wards have different staff, but by and large, we do not perform caesarean sections unless it is necessary. So, what does that mean? It means that the risks of not doing the caesarean are greater th
an doing the caesarean. This is generally true of all medical treatment. If your doctor suggests to you that you need a caesarean, it usually means that he feels you and your baby will be more at risk continuing the labour naturally. If this is not the case, he shouldn't be advocating a caesarean. This is the contentious issue. When is it safer to have a caesarean? This really depends on the individual case and you will hear varying opinions on this, but the important message I want to give out is that generally if we advise a caesarean, it is not so we can get a good nights sleep, or because we want to ignore your birth plan, it is in our opinion in your best interests. My personal preference is for all women to deliver normally, but we all have to accept that pregnancy and labour carry risks to mother and baby and to assume that all women can deliver normally if given enough time, is simply not the case.

Now, there are some women who want to have a caesarean. They do not want to go through normal labour. There has been recent press about this. My personal feeling is towards mother's having the choice about how their pregnancy will proceed. There are financial constraints that I appreciate, but if the prospective mother and father understand the risks and future implications then I believe it should be their choice. Whether they should have to pay or not is a debate I would rather not indulge in.

Many women ask me if they can deliver normally following a caesarean section. My answer is always, it is your choice. If you have one caesarean section then you have about an 70% chance of delivering normally following. The concern is that the scar over the womb is a weak point during contractions and there is 1% chance it may rupture. If the mother is aware of this then she should be allowed to attempt a normal delivery. The other thing to say is that if she fails in her normal delivery she will end up having another caesarean section. Women who
have previous caesareans rarely have ventouse or forceps deliveries. Once you have had two caesarean sections, the evidence and the strong advice is not to attempt a normal delivery. The scar area will be weak and attempting normal delivery is more hazardous.

Finally and probably most importantly, and I know I have said this before in other ops, but it is worth reinforcing, whatever method you deliver your baby, remember two things.
One, you should not feel shame or a sense of failure if you do not deliver normally. For some women it is difficult, and also different babies handle the labour better. If your baby is becoming distressed by the contractions this is not your fault, it just happens.
Secondly, the object of the exercise is to have a healthy mother and baby at the end of it. We as professionals and patients should never lose sight of this. If this is achieved in the way you had not hoped, then it can be a disappointment but when you have seen the distressing occasions when a mother or baby's health is compromised then I am sure we would all agree that we would not want that to happen to us. I have seen a baby emerge from a normal delivery brain damaged because the parents were adamant they did not want a caesarean section despite signs that the baby was in distress. I know this is an extreme case, my point is, never lose sight of your own health and your baby's, as this is what we are all striving to do above all, as well as make pregnancy and labour the most pleasurabe experience possible for you and your partner.

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