Considering a Caesarean Birth

Considering a Caesarean Birth 

This information is for you if you are considering a planned (elective) caesarean birth for your baby. It may also be helpful if you are a partner, relative or friend of someone who is considering a caesarean birth. This information is not for you if you have already been offered a caesarean birth because of specific reasons in your pregnancy, as the benefits and risks will be different. If you are in that situation, your healthcare professional will discuss your options for birth with you. Our role as maternity health professionals is to ensure that women have choice and control over their care which is planned and received based on ‘what matters’ to you to include your individual needs and preferences. If you are considering a caesarean birth, we will book you in our birth options clinic to discuss this.

What is a caesarean birth and why isn’t a caesarean offered to every woman?
A caesarean birth is a surgical procedure in which your baby is born through a surgical cut in your tummy and your womb. The cut is usually made across your tummy, just below your bikini line. Around 1 in 3 pregnant women in the UK has a caesarean birth.

The majority of women in the UK give birth vaginally, recover well and have healthy babies. Most women who have a planned caesarean birth will also recover well and have healthy babies. However, there are risks for both you and your baby if you have a planned caesarean birth and it may take longer to recover after your baby is born. Having a caesarean birth is a major operation with risks that should be compared with your risks of a planned vaginal birth.

Why do some women consider a caesarean birth?
Women consider a caesarean birth for many reasons. Your thoughts and feelings about giving birth will be influenced by the culture you grew up in, your previous experiences, and the experiences of the people around you.

• You may have had a difficult vaginal birth in the past.
• You may have concerns about damage to your pelvic floor during a vaginal birth.
• You may think that a planned caesarean birth is safer for your baby.
• You may have anxieties about having a vaginal birth for the first time, including about
  how you might react to vaginal examinations and labour pain.

• You may want to avoid the chance of needing an emergency caesarean or an assisted
  vaginal birth.
• You may want to avoid having an induction of labour.
• You may feel that a planned caesarean birth gives you a better sense of control.
• You may have had a previous traumatic experience or sexual abuse.
• You may be concerned as many of your family members have required emergency caesarean births.
• You have considered the benefits and risks and have decided you would prefer a caesarean birth.

We may offer you support from specialists with experience supporting women with anxieties and
other mental health issues in pregnancy. If you had a difficult vaginal birth previously, discussing your birth with us to help you understand what happened may help. Many complications that happen
during one birth do not, or are unlikely to, happen again. Even if you had a complicated assisted
vaginal birth in your first pregnancy, your chance of having a vaginal birth with no assistance is more than 4 in 5 (80%) in your next birth.

Discussing your options for pain relief might be helpful. Safe and effective options for pain relief including epidural analgesia are available. For more information about pain relief during labour seethe Labour Pains website. Labour Pains - Information on pain relief choices during labour You may wish to talk about your options with an anaesthetist.

If you are anxious about the need for vaginal examination or about any other aspect of birth, your healthcare professional may offer ways of caring for you in labour that may be more acceptable to you and offer referral to a specialist to explore the underlying reasons for your anxiety. There are tools available to help you feel more in control when you are in stressful situations (during birth and beyond). There is a chance that vaginal examinations may be needed even after a caesarean birth (for example if you have heavy bleeding afterwards).

If you are concerned about the timing of labour and its unpredictability (for example, if your planned birth partner is going to be away for work or if you need childcare for an older child), you can ask to have your labour started in a controlled way. This process is called an ‘induction of labour’. If you would like to discuss this option alongside the option of a planned caesarean birth, then please let us know.

What are the outcomes of having a planned caesarean birth compared to a vaginal birth?
The figures quoted in this information are based on the best available research, which is limited. When considering the benefits and risks of your different options, it is important to bear in mind that we have to rely on studies of variable quality, including some that compare planned caesarean births for all reasons (including caesarean births for women who have medical factors) with vaginal births, or emergency caesarean births with vaginal births. For some women who plan a vaginal birth, an assisted birth with forceps or ventouse (suction cap) or an emergency caesarean may be recommended in labour. This information will be discussed further with you at your birth options appointment.

What anaesthetic will I have during a planned caesarean birth?
A spinal anaesthetic is the most common way of ensuring your comfort for a planned caesarean birth. However, in uncommon individual circumstances, a caesarean can also be performed using an epidural, combined spinal and epidural or with you asleep under a general anaesthetic. If any of these alternative techniques are being planned for you it will always be explained and discussed with you in advance before your caesarean.

A local anaesthetic drug is injected through a needle between the bones of your back into the fluid that surrounds the spinal cord. The anaesthetic acts to numb the nerves that supply sensation to your body from the level of your chest down to your feet. It will make you numb for at least 2-3 hours. Furthermore, painkillers added to the injection that will provide additional pain relief for several hours beyond this.

If I choose to give birth by caesarean, when will it be done?
You will usually be offered a date at or soon after 39 weeks of pregnancy. Babies born by caesarean earlier than this are more likely to need admission to the neonatal unit for help with their breathing (1 in 24 babies at 38 weeks compared to 1 in 56 babies after 39 weeks). Even a short stay in the neonatal unit can be very stressful for new parents, and rarely babies can be affected in the longer term as well. This is why we recommend planning for your caesarean to take place after 39 weeks, unless there are other reasons why your baby may need to be born earlier.

Your caesarean is a planned operation and there may be one or two planned for that day. In exceptional circumstances we may need to move your caesarean date prior to the day or may need to delay it on the day due to emergencies from the labour ward arising which do take priority. We will inform you of any changes and may be able to offer you a drink or snack while you are waiting. You can continue to drink 250ml per hour of clear fluid up until you go to theatre.

What happens if I go into labour before my caesarean date?
There is a chance that you may go into labour before the date of your planned caesarean (approximately 1 in 10 women). It is important to discuss your preferences should this happen. Complication rates for caesarean birth are higher when they are performed during labour (about 1 in 4 women experience complications) compared with during a planned procedure (about 1 in 6 women experience complications). Complication rates are higher when a woman is in the active stage of labour where contractions are regular and the cervix is dilated (1 in 3 women may have complications) compared with when she is in early labour and the cervix has not dilated much (1 in
6 women may have complications). If you do go into labour before the date of your planned caesarean you will be offered a choice of continuing with labour or of having a caesarean birth as planned.

In the event that you arrive in advanced labour (e.g. end of first stage of labour or in second stage of labour) the doctor may advise that a vaginal birth is safer than an emergency caesarean. An emergency caesarean at the end of labour can result in difficulty in delivering the baby due to the baby’s head being lodged deeply in the pelvis, particularly in babies over 37 weeks gestation. This can result in complications for yourself including tears in your womb and serious bleeding. For your baby, the complications can include damage to their head and face, lack of oxygen to the brain, nerve damage and in rare cases death. Having a caesarean when you are fully dilated also carries an increased risk of preterm birth in any future pregnancies. We would advise you to call maternity straight away if you have any signs of labour prior to your booked caesarean birth including
waters breaking or any contractions.

What does my intuition tell me?
Midwives and doctors have a professional duty to recommend evidenced based care; to treat women as individuals and work in collaboration with you. Our role includes listening to your individual preferences, to have an informed discussion regarding your birth options, and to agree a plan of care needs based on your own personal wishes, bearing in mind a risk assessment of your medical, social, psychological and obstetric needs. It is important to consider the benefits and risks carefully. People view risk differently and how you view risk depends to a large extent on your own preferences and experience.

We will not usually recommend a caesarean birth unless there are specific issues complicating your pregnancy. However, there are many factors that can influence how you feel about the way you give birth. The risks of caesarean and vaginal births will also depend on your individual circumstances. Your personal feelings, concerns, interpretation of risks and opinions are all important and will be respected when you speak with us about your birth plan.

What are the next steps if I wish to book a planned caesarean birth?
If you already have an appointment in the antenatal clinic with a doctor then they will discuss your consent for the caesarean and book this in for you following your appointment with the birth options clinic.

If you have been seeing a midwife throughout your pregnancy then the birth options clinic will refer you for a review with the doctor who can discuss your consent and book your caesarean.

This leaflet is to give you general information about your birth options, most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and your midwife or doctor but may act as a starting point for discussion. If after reading it you have any concerns or require further information, please discuss this with a midwife or doctor.

If you wish to read further information about the caesarean procedure itself then please search for the Planned Caesarean Birth leaflet in the library on your Badger app or ask your community midwife for a copy.