Maternity : Planned Caesarean Section

Having a planned Caesarean Section 

•  Your ‘pre-operative assessment appointment’ (Pre-Op) will be on your App
•  Your Caesarean section date will be added as an appointment on your app

•  What to expect at your ‘pre-operative assessment appointment
• Preparing for your caesarean section 
• On the day of your caesarean section
• What happens after your caesarean
• Frequently asked questions

 Your Pregnancy notes also have lots of information but if you have any questions, please contact the antenatal clinic during normal working hours.      

What to expect at your pre-operative assessment appointment

The Pre-operative assessment appointment. This is one of the safety checks that we do before your caesarean section. You will be seen by one of our midwives or maternity support workers. During this visit, they will; 

• Complete a health check
• Check what medication you are on, if any.  Please bring your medication with you since this helps to write down exactly what dose and times you take your medication
• Check your weight
• Take blood tests or other tests that may be needed, e.g. Covid-19 swabs, MRSA swabs
• Check you have your Omeprazole tablet (This is to reduce the acid in your stomach)
• Check that an interpreter has been organised if needed
• Answer any questions you may have about the procedure
• Give you a time to come into the hospital on the morning of your operation

Section 2 - Preparing for your caesarean section 

Day before admission:

•  Please take your Omeprazole tablet at 10pm on the night before your Caesarean. This tablet will be provided at your pre-op appointment.
• Please remove any nail varnish from fingers and toes.
• Please remove any body piercings and leave all jewellery at home

  Section 3 - On the day of your caesarean section

•  Have a good wash, paying particular attention to skin folds or creases that may be near the planned site of surgery
• You can eat and drink normally up until 2am on the morning of your operation. After 2am please do not eat any solid foods
• It is important that you do not become dehydrated before your operation, please continue to drink plain water until 6am
• Your midwife will complete a check list, check you and your baby and give you a gown to wear.  
• If you are due to take any tablets prescribed by your GP or hospital doctor, take these at your normal time with water, even if this is within the two hours before your surgery
• You will meet the obstetricians who will be performing your operation

  Anaesthetics

• You may be asked to attend a pre-operative appointment with an anaesthetist prior to the day of your caesarean section to discuss the different sorts of anaesthetic that can be used.
• Before you come to the operating theatre, the anaesthetist will discuss the anaesthetic with you. Most women (19 out of 20 women) choose to have a spinal anaesthetic which means they are awake for the operation as this is usually the safest option for you and your baby.
• Further information on your anaesthetic choices is available at www.labourpains.com

 The Caesarean section operation

•  Your midwife will take you around to the operating theatre
• Only one birth partner can accompany you to theatre.  If you require a general anaesthetic your birth partner will unfortunately not be able to be present in theatre.  If you required a general anaesthetic during the operation your midwife will take your partner out of the theatre and show him/her where to wait
• There will be several people and a range of equipment in the operating theatre to ensure your safety
• You will have a drip put in your arm to give you fluid and antibiotics.  You will also have a tube (catheter) put into your bladder, usually just after the spinal anaesthetic is completed

 Section 4 - What happens after your Caesarean?  

• Once you are ready to be moved from ‘Theatre\Recovery’ you will be transferred back to your bed.  You will remain there for the rest of the day before being transferred to the postnatal ward in the evening
• A few hours after your operation, you will be encouraged to eat and drink
• Once the strength has returned to your legs, the staff will help you to sit up out of your bed
• Your catheter will normally be removed the day of surgery if your baby is born before 2pm.  If your baby is born after 2pm, your catheter will be removed on the postnatal ward the day after your surgery
• The midwife will be there to help you feed your baby
• You will receive an injection of Clexane to thin your blood to reduce the risk of a blood clot forming in your leg veins 

 The day after surgery  

•  If you have had a spinal or epidural anaesthetic, you should have fully recovered the feeling in your legs by the following day.  You should try and walk around as this reduces this risk of blood clots in the legs, helps prevent chest infections and encourages your bowels to return to normal function.  
• You should expect to feel some pain after a caesarean section.  It is best to take the pain killers you have been prescribed regularly for the first 2 days.  If you have any pain, you can be given additional painkillers so please tell the Midwives if you are uncomfortable
• You may feel sick after your operation, but you may be given anti-sickness medication to help with this.  Please let the Midwives know if you feel sick
• Your risk of developing a clot in your veins (deep vein thrombosis or DVT) will be assessed at the time of your operation.  You are likely to be advised to have an injection of Clexane every day for 7 days but women at high risk of developing a clot will be advised to continue this for 6 weeks after their baby is born.  Whilst you are on the postnatal ward, you will be shown how to do this yourself

  Day two onwards

•  It is important to continue to walk around.  You should spend at least eight hours out of bed and aim to walk a little further each day
• Your pain control medication will be reviewed daily and your dose will be adjusted to give you optimal pain relief
• You should be able to leave hospital about one or two days after your operation.  However, we will not discharge you from hospital until we are sure that you and your baby are ready.  This means that we will make sure that:  
• Your pain is well controlled, you are able to eat and drink, you are able to pass urine and your baby is feeding well You are given painkillers to take home with you  
• If you have any severe abdominal pain that does not go away, vomiting or temperature at home, it is important that you contact your Community Midwife or the Maternity Ward on WCH 01946 523260 CIC 01228 814269  

 Contact details:

 Should you have any questions about your operation, or any other aspect of your care, please contact the Antenatal Clinic on WCH 01946 523484 CIC 01228 814506 

 Section 5 - Frequently asked questions

 What are the complications of caesarean section?

 You will have been offered a caesarean section because it is considered that the overall benefits of the operation outweigh the risks.  The majority of caesarean sections are performed without any complications.  

The actual complications and how often they occur depends on your individual circumstances.  For example, the risk of damage to your bladder is higher if you have had previous caesarean sections.  Your Doctor should discuss the following risks with you and provide you with the figures based on your individual circumstances:

•  To reduce the risk of heavy bleeding, you will be given a hormone (oxytocin) through your vein to help your womb contract
• To reduce the risk of infection, you will be given antibiotics through your vein before the operation starts
• To reduce the risk of blood clots, you will be given some elastic stockings to wear.  It is important to use these stockings until you are fully mobile.  You will also be given blood thinning injections.  If you have a higher risk of blood clots, you will need to have these injections for longer.  Finally, it is important to get up and about as soon as possible and drink plenty of fluids
• To reduce the risk of bladder injury, a tube would be passed into your bladder before the operation.  This would be removed once you are mobile

 When can I start walking after a caesarean section?

 You will be encouraged to walk as soon as the feeling in your legs is back to normal.  Walking around reduces the risk of blood clots in the legs, helps prevent chest infections and encourages your bowels to return to normal function.

 When will I be able to go home?

 Most women are in hospital for 1-2 days after a planned caesarean section.  

 Can I drive after a caesarean section?

 You should not drive until you are confident that any discomfort would not distract you or prevent you from stopping in an emergency.  If you are in doubt about driving, contact your motor insurer so that you are aware of your recommendations.

 Is there a limit to the number of caesarean sections I can have?

 No, however, with each caesarean, your risk of certain complications during pregnancy and birth increases.  Some of the main complications of repeated caesarean deliveries include:

• Injury to your bladder or bowel
• Heavy bleeding
• Needing to have a hysterectomy
• Placenta praevia – the placenta is attached on or near the neck of the womb
• Placenta accreta – the placenta grows through the lining of the womb and into the muscular layer
• Uterine rupture – a very rare complication where the scar on your womb from your previous caesarean tears open

 If I get pregnant again, will I need to have another caesarean delivery?

 Not necessarily.  It this is your first caesarean, then most women will be offered a vaginal birth after a caesarean (VBAC) in a future pregnancy

 Can my birthing partner be with me during the operation?

 Yes, it’s very likely that your birthing partner will be able to stay with you during the operation if you would like them to be present.  In the small number of cases where general anaesthesia is needed, we will ask the birth partner to leave the operating theatre.  They will be allowed to wait in a room close to the operating theatre and we will keep them informed of the progress of the operation. 

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Information.Governance@ncic.nhs.uk | 01228 603961

Feedback

We appreciate and encourage feedback, which helps us to improve our services. If you have any comments, compliments or concerns to make about your care, please contact the Patient, Advice & Liaison Service:

pals@ncic.nhs.uk | 01228 814008 or 01946 523818

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complaints@ncic.nhs.uk | 01228 936302