Childbirth: elective Caesarean
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| Baby Isabella: born by Caesarean section |
For many women, the act of giving birth to a child is as close to nature as a modern woman can get. For others, the idea of labour and childbirth is almost a deterrent to having a family. myDr talked to one woman who overcame her fears of childbirth by having an elective Caesarean section to give birth to her daughter, Isabella.
‘I believe that we live in a civilised society and, as a woman living in a civilised society, I have choices.’
That’s the opinion of Snezna Stojkovski, a 36-year-old public relations executive who lives in Sydney with her husband, George. Snezna opted to have an elective Caesarean rather than worry and fret about the pain associated with conventional vaginal childbirth.
Snezna said: ‘Even before I fell pregnant, I always felt that I’d rather have a Caesarean because the normal birth process was too painful for me to contemplate. I liked the idea that you could book in on a certain day, you would know what to expect, and there would be no surprises or agonising pain for hours or days on end. It all seemed very civilised to me.
‘But when I did fall pregnant, I started to think that maybe I would have a "normal" birth after all. I’d been having a good pregnancy, I hadn’t been sick, I hadn’t been overtired, and I felt fit and healthy. I really felt that I could cope with it. I was mentally going down the path of having a conventional childbirth so it was actually quite late in my pregnancy that I finally made the decision to have a Caesar.
‘I didn’t research the birth process for quite a long time: I just didn’t want to know. Other mothers I knew had read all the books and talked to other mothers about their experiences of birth as soon as they found out they were pregnant. For me, I felt ignorance was bliss! A friend of mine became pregnant a couple of months before me and I actually told her not to tell me what she had found out!‘
It wasn’t until about the 6 month of her pregnancy that Snezna began her research into childbirth options.
She said: ‘At that time I started listening to other mothers, and their horrendous stories really made me wonder if I could really go through with a conventional childbirth. I have absolutely no tolerance for pain and what I heard really scared me: I know what a coward I am.
‘Several women I talked to told me their sex lives were never the same again: some had what they described as "no feeling down there" after having an episiotomy [where the area of tissue between the vagina and the rectum, the perineum, is cut to enlarge the vagina and assist childbirth] and others said their insides were so stretched and loose after the birth that sex just didn’t feel the same for them or their husbands.
‘About 5 mothers told me about the excruciating pain they felt when they urinated, and said they weren’t able to sit down comfortably for weeks. So when I finally started researching about birth methods it seemed to me that there was more chance of problems with a normal birth than under controlled surgical conditions with a Caesarean.’
Another factor was that Snezna had placenta praevia (where the placenta covers the opening to the birth canal) so there was a chance she would have needed a Caesarean anyway. As it turned out, the placenta moved so it wasn’t compulsory for her to have one.
Making the decision
Snezna said: ‘Of the 3 women I knew who had had a Caesarean, one had had her first child vaginally and her second child by Caesar and she told me that if only she’d known the difference first time around, she would easily have chosen a Caesar over vaginal birth. Even more convincing for me was the fact that that particular woman was a locum obstetrician who decided to tell me this news only after I’d told her that I had decided to go ahead with the Caesarean. So not only was she a mother, she was also a professional in the field. That really helped convince me my decision to have a Caesar would be the right one.’
There were those who disagreed, however. Snezna said: ‘No one came out and told me that I was not a good mother but people did ask if I’d feel upset because I would miss out on the most beautiful experience of motherhood, giving birth "naturally".
‘My husband, George, felt that whatever was best for me was fine with him so he supported me no matter what I chose to do. But he was keen to research as much as we could about each option and find out the pros and cons of each in terms of risks for me and the baby.
‘At about 7 months I was still deciding and I asked my obstetrician about the pros and cons of an elective Caesar. I was worried he’d think I was a wuss but he was very non-judgemental.’
There are risks and benefits with every childbirth option. When Snezna weighed up the options she considered:
- being in labour for a long time;
- her own low tolerance for pain;
- the risk of the baby becoming distressed during labour;
- the idea that the umbilical cord could be wrapped around the baby’s neck;
- the idea of a possible forceps delivery or emergency Caesarian;
- the fact that she would not be able to control the timing of the birth or the procedure; and
- the idea that there could be more distress for the baby as it has to go through the birth canal, rather than being gently lifted into the world.
She said: ‘With a Caesarean, it’s more controlled and usually there are no surprises. However, it is major abdominal surgery involving an epidural, so there are risks involved as with any surgery. Another downside to consider was that because the baby has no transition phase and is simply lifted into the world, it could have difficulty getting used to the relatively cold air of the environment after being in the womb, which could cause breathing problems for the baby. So there were some big decisions to be made.’
It was a final discussion with her midwife that finally cemented her decision. Snezna said: ‘I started having antenatal lessons with a midwife who came to our home. I told her I was thinking about having a Caesar and she advised me not to make up my mind completely until closer to the time and to keep an open mind. Part of the birth class was a video of both a vaginal delivery and a Caesarean section and that really made up my mind!
‘My recollection is that the 2 videos couldn’t have been more different. With the conventional delivery I remember the look of pain on the woman’s face as she panted, sweated and crawled around on all fours during labour. All I saw was excruciating pain for a long, long time, compared with the other video where the woman went into hospital calmly, had the Caesarean section very calmly, and then came home again with the baby. When I saw those videos, I was 100 per cent convinced! I think the midwife was a little disappointed that the videos hadn’t had the desired effect!’
For Snezna, surgery was less terrifying than childbirth. She said: ‘I wasn’t at all fearful of being cut open and having major surgery, compared with the fear of going through hours or even days of what seemed like unbearable agony. My thinking was that I didn’t need to go through excruciating agony to have a child. I had access to a good hospital, a good obstetrician, and established surgical procedures. I felt confident that nothing would go wrong. My main fear in the run up to the due date of the Caesarean was that the baby would come early!’
She added: ‘Once I’d made the decision and had booked the date and time for the hospital appointment I felt much more relaxed. It really reassured me in the run-up to the birth. I felt no stress at all and was totally comfortable. I think that is another consideration: sure, some people did mildly criticise my choice by asking if I was sure I was happy missing out on what motherhood was all about, the joy of natural childbirth. But I felt that it would cause me and my baby more harm if I was stressed out and terrified of the birth process.
‘As it was, I was really looking forward to it and, as anyone who’s been pregnant will tell you, by 9 months you’re just dying for the baby to be born. Plus, we were really excited and very keen to meet her.’
Snezna and George had also decided that they would find out the sex of the baby as early as they could. She said: ‘Neither George nor I can understand why you wouldn’t want to know. Until I had an ultrasound at about 20 weeks she was an "it"; afterwards she had an identity. And it definitely made life easier in terms of buying clothes and decorating the nursery.’
Scheduled and emergency Caesareans
Having a Caesarean is not always planned. Sometimes an emergency Caesarean has to occur during childbirth if a vaginal delivery is problematic. For example, your baby may be in distress, your labour may have halted even if you have been given drugs to speed up the process, or your own health may be at risk.
In some cases, your doctor may schedule an elective Caesarean because of known problems.
- The baby’s head may be too big for your pelvis, making a vaginal birth almost impossible.
- Your baby may be in breech position, where its bottom, rather than its head, is due to emerge first.
- The baby may be in an awkward position where it is lying across the vaginal opening.
- You might have an existing medical condition, such as pre-eclampsia or diabetes, that may prompt the doctor to recommend a Caesarean.
- You may have problems with the placenta such as placenta praevia where the position of the placenta blocks the outlet of the birth canal.
Preparation for a Caesarean
A Caesarean section is major abdominal surgery. Before the Caesarean you will have your pubic hair shaved and a catheter put into your bladder to make sure that it’s empty and doesn’t interfere with the operation. Nutrition comes from a glucose drip.
Snezna said: ‘Bella was scheduled to be born at 3 pm on 6 July 2001. On the day, we were told to go into hospital at about 11 am. As it turned out, that was about an hour earlier than we needed to get there so it’s probably a much shorter wait for most people. We were registered and then were put in a temporary room. The anaesthetist put a local anaesthetic patch on my hand so it was easier to put the glucose drip into my hand. You can’t eat from about 7 pm the night before until well after the operation.’
The epidural
Unless the Caesarean is an emergency and there isn’t enough time, usually you are not given general anaesthetic, which makes you completely unconscious. Rather, you are more likely to be given an epidural anaesthetic.
The name ‘epidural’ comes from its place of delivery into the body, the spine. The spinal cord is surrounded by cerebrospinal fluid which helps protect and cushion the brain and spinal cord from damage. The fluid is held within a tough sheath called the dura, which means ‘hard’ or ‘tough’. However, the spinal cord and the dura do not run all the way down the entire length of the spinal canal: they come to an end at about the first lumbar vertebra (bone).
An epidural is delivered to the area of the spinal canal that is not protected by the dura, known as the epidural space. This space contains the spinal nerves which then pass through the dura to the brain. Epidural literally means ‘above the dura’, so some doctors prefer to call it an ‘extradural’ which means ‘outside the dura’.
After cleaning the skin with antiseptic, the anaesthetist will inject some local anaesthetic into your back before inserting an epidural needle in to the space between the vertebrae (bones) of the spine to find the epidural space.
A catheter is then inserted through the needle before the needle is taken out. The catheter, which is taped to the skin, then allows the anaesthetist to deliver the anaesthetic and top it up to keep you numb. The exact procedure for an epidural may vary from hospital to hospital. An epidural may take about half an hour to be administered and to take effect, depending on the strength of the anaesthetic delivered. You are still conscious but cannot feel any pain.
Snezna said: ‘The anaesthetist talks you through the epidural so you know what to expect. I hunched over a pillow, leaning forward, sitting up on the side of the bed so my spine was rounded to open up the spaces between the vertebrae. It’s important not to move. Then I felt, as I’d been warned, intense pressure on my spine. It wasn’t painful, just pressure. The effect was very quick. Within about a second I started to lose feeling in my lower half. I tried to lift my legs and found I couldn’t move. It was a really weird feeling: you think that you can do things but you simply can’t move. I was then hoisted on to the operating table.’
What happens during a Caesarean?
During the operation, surgical drapes are put up to shield you from what’s going on with your lower half: your partner will most likely stay by your head.
A small horizontal cut, usually 12-15 cm long, is made very close to your bikini line, through to your uterus.
The fluid that helped cushion the baby in the womb, the amniotic fluid, is suctioned away and the surgeon then lifts the baby out through the opening.
The feeling is not painful but there is some pulling and prodding at your abdomen as the procedure is carried out. It takes about 40 minutes to an hour for a Caesarean section. About 10 minutes of this is the actual delivery of the baby, the cutting of the umbilical cord and the removal of the placenta; the rest of the time is spent cutting and then stitching up the various tissue layers of your abdomen.
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Snezna said: ‘Through the operation, I was chatting to George: I didn’t feel a thing but I could hear and smell the laser "cutting" through my skin. It was all so quick. Before I knew it, the obstetrician told us to have a look, and there was Bella’s head coming out of the cut in my abdomen. When she was completely removed, she was wrapped up and given to me to hold in my arms to bond with her. ‘After the umbilical cord was cut, George went off with the nurse to give Bella her first bath while I was stitched up. I then spent half an hour in post op. Occasionally a nurse would come to change the absorbent pad that I needed as I still couldn’t move: that was quite humiliating. You do still bleed through your vagina like you do after a conventional birth. At first it’s very, very heavy but after about a week it’s like a normal period, though I still had some bleeding for about 8 weeks after the birth.’ |
After the Caesarean
Snezna said: ‘I wasn’t tired at all: after all, I hadn’t done anything! I was numb from the waist down until late into that night. I could move my legs a little by about 10 pm and by the next day I woke up feeling absolutely fine. I fed the baby, got up, had a shower, got dressed, blow-dried my hair and put my make-up on, ready for the grandparents’ visit!’
With a vaginal birth, recovery can vary widely depending on the kind of childbirth experience, how prolonged it was and how difficult it was. For a Caesarean section, the average recovery is about 6-12 weeks.
Snezna said: ‘On day 3 in hospital I was visited by a friend who had had her baby conventionally and she was astounded at how mobile I was. She told me that after her childbirth experience she couldn’t walk properly for 6 weeks after the birth.’
While her friend’s recovery may have been longer than normal for a conventional delivery, it was enough to reassure Snezna that she’d done the right thing.
Snezna stayed in hospital for about 5 days and had her stitches removed on the fifth day. She said: ‘It wasn’t exactly stitches, more like little plastic clamps so there were no stitch marks and it wasn’t at all painful when they were removed.’
Snezna said that she was hooked up to a pethidine drip for about 3 days after the operation so she felt no pain. Whenever she felt sore, she could simply press a button on the drip and receive a new dose of the painkilling drug. This is known as Patient Controlled Analgesia. After the pethidine drip was removed, she took strong painkilling tablets for a couple of days. She then took simple paracetamol tablets twice a day for about 2 weeks after returning home from hospital.
Snezna said: ‘I had no problems with the scar at all. As soon as I got home from hospital I could vacuum, bend over, and pick up Bella: I had no problem doing anything.
‘About 4 weeks after I left hospital I went to the obstetrician and he checked my scar and said it was okay for me to start doing exercise; even jogging twice a week was okay.
‘You can’t really see the scar as it’s very low down on your abdomen so your pubic hair largely covers it. Now, 9 months later it’s still a little red but it certainly doesn’t bother me and it’s not visible.’
For Snezna, choosing surgery over conventional delivery was the right decision. She said: ‘I know some people are horrified by my decision but for me it was a case of making choices that are right for the individual. I live in a civilised Western country and, in today’s society, I can be in control of what happens to my body. I feel I chose the civilised option.’
Last Reviewed: 30 April 2002
