Elective caesarean

A caesarean is defined as “a surgical procedure, in which incisions are made through a mother’s abdomen and womb to deliver one or more babies. It is essentially an alternative to natural birth. An elective is a medically unnecessary caesarean section, where the caesarean section (CS, or c-section) is requested by the pregnant patient or her doctor.”

The procedure is increasingly becoming more popular in Kenya many more mothers choosing to have a Caeserean section. Most doctors will recommend that you have your elective caesarean (also known as a patient choice c-section) at around 39 weeks of pregnancy. If you go into labour before 39 weeks, you may have a regular caesarean if you so choose. Studies done by Turnbull, Raheem and Salloum indicate that roughly 1 in 3 women will choose a repeat elective caesarean section in preference to natural birth after a previous caesarean section.

Main reasons some women choose to have an elective caesarean:

• If your baby is large and might damage the cervix during labour
• If your baby is deemed to not be in an optimum position for birth
• If you have some kind of medical condition that might make natural birth difficult or complicated
• Anxiety or worry from previous births that may have been difficult

• To avoid having an Episiotomy (a surgical incision through the perineum made to enlarge the vagina and assist childbirth)
• Personal choice - some women may choose to have an elective caesarean so they can pick the birth date or have it during a period that is convenient in terms of taking parental leave
• To avoid the pain of natural birth and the damage to the vagina that it may cause
• You are expecting triplets, quadruplets or more

Elective Caesarean is a surgical procedure and is sometimes done under local or general anaesthetic or with an epidural and, as with all surgeries, it carries with it some inherent risks to mother and baby. Some of these risks may include:

• Risks stemming from the use of and possible allergic reaction to anaesthetics
• Unplanned prematurity of the baby if the dates are wrong, which may increase the risk of the baby having breathing problems
• Respiratory distress syndrome, where the baby retains fluid in his/ her lungs (natural birth assists the baby to clear this fluid, which normally fills the lungs when your baby is still inside your womb, whereas some of it can remain after a caesarean)
• Increased risk of maternal death is almost 4 times greater than for vaginal delivery).

These risk factors are something to consider, but remember that with any kind of procedure of this nature there are risks. It’s best to get your hands on all the information you can and then make an informed choice about whether to have an elective caesarean or not.

What actually happens in an Elective Caesarean?

You may be given a pair of surgical stockings to wear, which will help stop the formation of blood clots. Nail varnish and jewellery will be removed, and your pubic area will be shaved. In theatre, you’ll be given a local/ general anaesthetic or your epidural will be topped up. Your partner will be asked to wear a surgical gown, but will generally be allowed to stay with you.

The anaesthetist will ensure you cannot feel anything before the operation begins. A screen is clipped up so you can’t see what is going on, a catheter will be inserted to drain your bladder, and an incision made just above your bikini line giving the surgeon access to your womb. You may feel a tugging or rummaging sensation, but no pain. The baby will be delivered within 3 to 5 minutes of the incision, he/ she will be lifted out, checked and the cord clamped and cut.

If everything is OK, you will be able to hold your baby on your chest while the placenta is delivered and you are stitched up. You may prefer your partner to hold the baby while this is completed. The whole operation takes around 30 minutes. You will then be removed to a recovery bay or room, and then onto a ward. A midwife will encourage you to breastfeed your baby as soon as possible.

There are a couple of things that you might want to bring with you to the hospital to make things a little easier and more comfortable for your stay in hospital and the elective caesarean procedure:

• Comfortable clothes and sleep-wear, bearing in mind you may be breastfeeding after the elective caesarean, so bring clothes which that allow for this
• Slippers or other comfortable footwear
• Underwear that sits high on your body so that they don’t irritate the scar from the procedure
• Toiletries
• A set of clothes for your newborn to wear on the trip home
• Your own choice of snacks and refreshments, especially if you are a picky eater
• Bring in some high fibre foods and fruits, such as prunes, so your digestive system can get back to working order as soon as possible after the elective caesarean
• Your Medical Aid card and identity document
• Some massage oil that your partner or member of family can use on you in the days that follow the procedure to aid recovery
• Extra pillows and blankets to better support you in the recovery process
• A car seat for your newborn’s trip home

After the Elective Caesarean

Your catheter will usually be left in place until the morning after the operation. You will also have a small drip running into an arm vein, and if you are wearing surgical stockings they will be left on. You will be given painkillers, but your midwife will encourage you to get out of bed as soon as possible to promote circulation and help prevent clots. Expect to stay in hospital for around 3 days and arrange to have extra help at home, as you may find getting around difficult at first.

It may take some time to recover from the Elective Caesarean, and it can take between 8 weeks and 4 months to completely recover from the procedure (this is dependent on a number of factors including how many children were delivered, your health before, and if any complications arose during the procedure). The good news is that, if you had a relatively hassle-free surgery, you should be able to choose whether to have your next baby by natural birth or via c-section, although it is recommended you give your body at least a year to heal completely before trying for another baby.

There are a few things you can do once you have come home from the hospital to aid your recovery from an elective caesarean including:

• One of the most important things you can do to ensure a speedy recovery is to rest. Try limiting the amount of visitors you entertain and your physical activities, just relax and try to get as much sleep as possible.
• Drink plenty of fluids to replace those lost during the operation.
• Avoid stairs as much as possible – even moving to the ground floor of your house for a week or so following your procedure will help.
• Make sure you have many pillows to support you during your recovery period. They can also support your back when you start breastfeeding.
• Avoid sexual activity for at least 6 weeks following your elective caesarean.
• When your bleeding has stopped and your scar completely healed, try out swimming. It is one of the best exercises you can do to aid your recovery as it is very gentle on your body.

There is a fair bit of controversy around elective caesareans, with many people feeling that it’s not something that should be pursued. You should do whatever you think is right and not let the negativity around the subject influence you. In order to make the right decision, you need to arm yourself with as much information about elective caesareans as you can to make an educated decision.