10 Caesarean Section Facts
You may have heard of a caesarean section (or c-section) before. Your mother may have had one, or maybe you or your partner expect to have one. But there is a lot that most people don’t know about this surgery, and a lot that might inform you in the future. Read on for Dr Skinner’s 10 interesting things about caesarean sections.
Safety Note
Every caesarean is performed based on the individual clinical circumstances of the mother and baby. The exact surgical technique, number of layers closed, and use of instruments such as forceps can vary between patients, hospitals and surgeons, and your own obstetrician is best placed to explain what applies to your specific procedure. This article is general information only and does not replace advice from your obstetrician about your own care.
1. Caesarean section is one of the last major incision surgeries still performed today. Most other surgery is performed through a small hole or small incision. In many cultures a caesarean is considered to be dangerous, but in Australia the risk has been drastically reduced due to new technology, improved surgical techniques and medicines.
2. Several separate layers of the abdominal wall and uterus are opened during the procedure. The exact number can vary depending on individual anatomy and surgical technique, but commonly around six layers are opened in sequence to reach the baby. Once the baby is delivered, the uterus is typically closed in one or two layers of stitching, depending on the clinical situation and your obstetrician’s judgement — current evidence has not settled on a single “correct” approach, and both techniques are considered safe. The remaining layers of the abdominal wall are generally closed individually, though your surgeon may choose not to separately re-stitch every layer where this is not clinically necessary for healing.
3. No muscles in the abdominal wall are cut during a standard caesarean. In fact the obstetrician goes between the muscles, separating rather than cutting them, to reach the uterus.
4. Some people are concerned about the pain relief during a caesarean. Less than 1% of caesarean sections are performed under a general anaesthetic in a private hospital. A general anaesthetic is only performed when the woman can’t have a spinal/epidural or if the spinal/epidural isn’t working or cannot be successfully inserted.
5. One question we get asked quite a lot is, “Can I have a normal delivery following a caesarean section?” The answer is that a reasonable number of women can have a normal delivery after having one caesarean section if they desire it, provided the same problem that caused the initial caesarean does not occur again. You can read more in our guide to vaginal birth after caesarean.
6. Some women choose to have an elective caesarean section, and many women feel concerned about making this decision – but this should not be the case. Many women require or request a caesarean due to not only obvious maternal or baby health reasons but also psychological issues. Some women have mental health concerns that also need to be taken into account. It is important that these issues are managed just as carefully as the physical issues.
7. Caesarean section is major surgery, and recovery takes time. Post-surgery, women commonly require tablet analgesia for up to 2-3 weeks, and this is very normal and necessary. Full recovery generally takes several weeks, and most women stay in hospital for around 3 to 5 days after the birth. Keeping the wound clean and dry, wearing loose clothing, and watching for signs of infection such as redness, swelling or discharge are important parts of recovery — contact your obstetrician, midwife or hospital promptly if you notice any of these signs, or if you have concerns about your wound or recovery at any stage.
8. There are eleven people in the surgical theatre room during a caesarean section. Firstly there are the parents, your obstetrician, an assistant surgeon (also an obstetrician), anaesthetist, anaesthetic nurse, paediatrician, midwife, scrub nurse, scout nurse (assists the scrub nurse) and an operating technician (who manages all of the electrical operating equipment). It is a busy place!
9. Forceps are sometimes associated with the delivery of a baby in a vaginal birth. However, sometimes the obstetrician will need to use forceps to help deliver the baby’s head during a caesarean section. This is because the incision is barely wide enough to ease the head out, so forceps are needed to safely assist this process.
10. The spinal/epidural takes approx. 3 hours to wear off. This is replaced with tablet analgesia. It is important to remember to maintain your analgesia as prescribed and not try to wean yourself off it early. The spinal anaesthetic risk of a permanent partial paralysis is 1:10,000. This risk is low compared even to the yearly risk of being the driver of a car on the road.
This article reflects general Australian clinical practice and current evidence on caesarean technique, including guidance from the Australian Government’s Pregnancy, Birth and Baby service on caesarean birth and recovery. It is general information only; individual procedures and recovery can vary, and it does not replace advice from your own obstetrician about your specific care. For more information, see our pages on pregnancy care, vaginal birth after caesarean and choice of hospitals.
