Caesarean birth: expect the unexpected

Caesarean birth is a surgical operation where a baby is delivered through an incision in the mother’s abdomen. This procedure may be recommended by your doctor or can be an elective mode of delivery. We want to provide you with some information to help you make informed decisions in your birth.

Caesarean birth procedures have saved the lives of many mothers and babies. A caesarean birth might be needed when a vaginal birth is not possible. Here we describe some potential reasons relating to your or your baby's health.

Reasons related to your health:

• This is obstructed labour which occurs when the baby cannot exit your pelvis during childbirth even though your uterus is contracting normally: Dystocia

• Fear of labour pain: Tokophobia

• The placenta is implanted very low in the uterus that the baby’s path through the vagina is obstructed: Placenta previa

• The mother has had an infection that can pass on to the baby as it goes through the birth canal and vagina, e.g. active herpes or HIV

• Serious medical or health conditions

• The mother has a previous caesarean birth

• Concern about current or future maternal pelvic floor problems

• Finding it more convenient to have a planned date of birth and other psychological factors like personal control

Reasons related to your baby's health:

• If the baby is not getting enough oxygen: Fetal distress

• The baby’s position in the uterus is not ideal for vaginal birth: Malpresentation

• Rarely, if membranes rupture in a gush, the cord can be carried along and become caught between the baby and your pelvis. If this occurs, every contraction compresses the cord and decreases the blood supply to the baby: Cord prolapse

• If the baby is too large to pass safely through the mother’s birth canal

• Multiple births (twins or triplets)

While caesarean births are a relatively safe procedure, it is still a surgical operation. With any operation comes possible complications which could impact you or your baby's health.

Complications related to your health:

• A longer hospital stay and longer recovery

• Decreased bowel function after the surgery

• Increased incisional pain following the surgery

• Needing extra breastfeeding support

• Heavy blood loss up to twice as much as vaginal delivery - this is to be expected

• Risk of infection to the wound and the uterine lining

• Reactions to anaesthetics such as nausea, vomiting, and severe headache

• Increased likelihood of a repeat caesarean birth in future pregnancies

• Blood clots in legs or lungs

• Long term impact on bladder functioning

• Placenta previa or placenta accreta: Problems with how and where the placenta attaches itself to the wall of the uterus in future pregnancies

Complications related to your baby's health:

• Breathing problems, especially in preterm babies

• Admission to the neonatal unit

• Accidental nicks or cuts to baby’s skin during surgery

• Babies are exposed to more short-term risks, which range from altered immune development, allergy, asthma, and reduced diversity of the intestinal gut microbiome, compared with those born vaginally

There are also some benefits to having a caesarean birth. In emergency situations, a caesarean birth can save the lives of you and your baby. Even in non-emergency situations, there are still benefits to this procedure.

• Reduced injury to your vagina

• Minimal or no vaginal pain during birth

• Less risk of urinary incontinence/bladder control

• Resolving medical emergencies

So how can you prepare for a potential caesarean birth? Answer these questions along with anyone who you want to be involved in your birth from preparation to postpartum support.

1. Who will make up my support system?

2. When and how will I communicate with them?

3. What are some ways that I can help them prepare for the possibility of caesarean birth?

4. What are some areas that I can ask for help in (e.g. chores, driving, caring for children)?

5. What are some ways that people may respond to my caesarean birth experience?

6. What are some ways that I can respond to people who may react negatively to my caesarean birth experience?