What is a caesarean section?
A caesarean section or c-section is where the baby is delivered via surgery. The surgeon cuts an incision through the stomach and uterus wall and the baby is delivered via that incision (as shown above).
It is called a ‘caesarean’ because it derives from the Latin word ‘caedare‘ which means ‘to cut’. There is some debate as to whether it stems from Julius Caesar being the first person delivered this way or if this was a practice that was done by the ancient Romans. But it is hard to be definitive about this.
Being cut through the stomach wall and uterus sounds painful. So before we get there, let’s talk –
Why its good to see your anaesthetist before giving birth?
Your are entering the great unknown and whilst you are an expert in your own field, you may not know as much about your options when giving birth. We always recommend where possible to educate yourself and understand your options as much as possible.
In the video below, Donna (our midwife) and Dr. Nathan Judd (Anaethetist at Adelaide Anaesthetic Service) discuss this very fact at length. Have a listen to get some great insights into certain risk factors which may further drive your decision.
This doesn’t just refer to caesarean sections, but also epidurals or an induced labour.
Donna: Why would someone maybe need to see an Anaesthetist before birth? What would you say before birth?
Nathan: We do see quite a lot of ladies nowadays just to talk about their options for labour analgesia so either epidurals or anesthetics for cesareans, so spinal or general anesthetics.
We don’t see all ladies, but there are some that we’re particularly keen to see. And there are some people who perhaps can’t have an epidural for their labour, we do like to sit down and talk to them about what their options might be. And that would include people who have had previous back surgery. Or people whose blood doesn’t clot properly, for example – with very low platelets. Happy to talk to anybody who’s had a previous unsatisfactory experience with an epidural or a caesarean. Or is just worried about what might go on during labour or cesarean. We’re increasingly wanting to talk to bigger girls, so obese girls. And it’s just practical implications of getting a spinal or an epidural in for labor or cesarean, just it’s just harder.
And so to be able to plan that a little bit more and talk about the options, getting a timeline in place is particularly useful. And so if your obstetrician or midwife thinks you should see an anesthetist make an appointment, we’re happy to talk to you about it.
You get the bill from them, but what does the anaesthetist do for you during birth?
You listened to Dr. Nathan and when and spoke to an anaesthetist. And they spoke to you all about the risks and considerations with the painkillers and procedures you may need during birth.
But don’t be put off, be rest assured, it is still all your decision about how all these things happen. Watch Donna and Nathan speak about consent and how you are very much in control of your own destiny.
Dr Nathan also speaks about some great strategies to over come anxiety or hesitation about medication during childbirth. It is your body and your care, make sure they care caring for your health – whether that is emotional, physical or mental health. You aren’t putting them out, that is their job.
There’s a bit more to anaesthesiology than I thought, even the sneaky photographer role:)
Donna: So you always need, in say something like a caesarean, you always need an anesthetist and obviously surgeons. As well as all of the other support groups. And so the anesthetist’s role in something like that is to offer pain relief?
Nathan: So during a cesarean, our role is to make the procedure comfortable and tolerable for you. And there are only really three ways we can do that. The other thing that we do is sort out your pain relief afterwards. So for the first two hours, days, weeks. We’ll chart all that.
Donna: So you’re in charge of that as well?
Nathan: We’re in charge of starting the ball rolling, talking to you about it, and having a plan. And often if there are problems later on with pain relief, you guys might give us a call at home and sort something out for you.
Donna: OK. And you obviously make sure that the bloods are OK as well? So the doctor might have done the bloods, but it’s your role to interpret that in terms of the medications.
Nathan: Yes, yes. So whoever requested it should be following up as well, but we’ll be having a look at those. And making sure that it was safe to go ahead with your procedure and safe to have whatever pain relief afterward you need.
Donna: And I guess also for mums to know that before they have any procedure, they always have to sign a consent. So sometimes the mum’s a bit nervous about a spinal anesthetic, for example, for a cesarean, then maybe they see the anesthetist beforehand. So they get all that information. And there is this part that they sign, that they understand what you said.
Nathan: Yeah, that’s right. So we’ll certainly talk about the pros and the cons and make a suggestion about what anesthetics are best for you and then ultimately the choice is yours. And as a patient, you can choose to accept or choose an alternative. And then we’ll normally get you to sign to say that we’ve talked about it and are happy to go ahead.
Donna: So it’s always completely your choice and a great discussion to have with your care provider, whether it’s the midwife or the doctor. There are some people, I find that are very anxious about anesthetics and maybe they don’t like needles or they’ve had a bad experience before. And having a chat with you on a nice bright sunny day and not stressed and anxious, they can get lots of good information so that it doesn’t seem as scary.
Nathan: I think so. I think importantly as well, if you have a chat early on, you can put in place some other plans if you are needle phobic, hypnotherapy might just be magic for you. So go and see a hypnotherapist early on and spend some time with them. You’re not going to lose anything and it may well make a massive difference to the rest of your life, not just your labour and delivery. We can also do things like numbing cream if we plan ahead long enough to get you more comfortable with needles. And just to inform you about what’s going on so you can be relaxed.
Donna: Nathen had got lots of chit-chat to get you through a cesarean no problem, so you can talk about anything.
Nathan: I love taking photos of your baby as well once it’s done.
Donna: Yeah, he gets quite particularly with the angles, actually.
Wait a minute, what are the three options for anaesthetic during a caesarean operation?
That off-hand comment in the previous video caught me off as well. I thought there was only a spinal anaesthetic but apparently there is more! Hear Dr Nathan talk about the 3 options facing you when you are about to have a caesarean.
If you are interested in epidurals, we talk more about that procedure here.
Nathan: Well, if you don’t want to have a spinal anesthetic, you can go up to sleep. So there are only three alternatives to get through a caesarean. So you have a spinal anesthetic. If you’ve got an epidural in for your labor and you need to have a cesarean, we can put some stronger medicine through that to use it. Then there’s a general anesthetic. We won’t ever suggest a general anesthetic as your primary anesthetic because it’s not as safe for mothers. We’re principally looking after the mother. General anesthetics are very safe nowadays, but a spinal or epidural is safer again. So it’s always the suggestion, if you just won’t have a spine or an epidural, then a general it is. If there’s a reason you can’t have a spinal or epidural then you may get a general as well. But always suggest for your safety a spinal anesthetic or an epidural anesthetic.
Before we go to much further, we need to talk risks. What are they?
It is important to have a really good understanding of the risks associated with taking medications during labour, birth and beyond.
We have all heard of the horror stories about permanent nerve damage, back pain or persistent numbness, Dr Nathan helps put that in perspective. He also details some of the lesser know side effects and their potential impact on your life style.
Some great insights into safe medication use and storage – worth taking note of. Not just with regards to pregnancy medication, but all medication that we might have in the house.
Donna: And to demystify some of the information that comes out there, like one bad, terrible outcome can make media all around the world. And the percentage of that can be incredibly small like something like permanent nerve damage.
Nathan: Yeah, so that’s fabulously rare. As far as permanent nerve damage goes to put it into context, there is a chance with an epidural in particular, also with a spinal, but less so. But your chance is something akin to your chance of dying in a car crash in Adelaide every year, right? So amazing low, if you’re getting into your car to drive around, you’re not petrified about that.
Your anesthetic, your spinal, or your epidural is essentially safer to manage from a permanent nerve damage point of view. So we’re talking 1:50,000 to maybe 1:100,000, something like that. So amazingly rare but it does happen.
Donna: And that’s the part of that information. Sharing them so that they understand a lot of medicine especially is just treating one bit and then going away. At least this one you can see it from the start to the end.
Nathan: That’s right. Do one job, do nothing else. Until that’s finished, do it properly, move on to the next job. It works for me.
So one in 200 ladies will get a bad headache, like a migraine after an epidural and sometimes that will need to be fixed with another epidural in a couple of days. Blood patch, that’s about one in 200 and that’s really just an irritation for those 1:200 because it will lay you flat for two days to a week even. But once again. 199 out of 200 won’t get that.
Donna: And if you think about that in a normal-sized maternity unit that’s about one a month, if that.
Nathan: Yeah, 1:1000 ladies will have a temporary irritation of the nerve in their back-
Donna: Like a back ache?
Nathan: No, causing some numbness or weakness in the legs for example. Or a tiny little patch in your legs perhaps.
Donna: Ohh like there are some people that go, this bits numb.
Nathan: Yes, that’s right. So 1:1,000 will have that. That gets better, but it takes days and weeks to get better. So it’s 1:1,000, as I said before, no significant damage it’s only going to some numbness and weakness. Thats fabulously rare, but not impossible.
Donna: And it’s not like the risk of having a car accident once a year in Adelaide doesn’t stop you from driving around?
Nathan: Absolutely not, no.
Donna: So you’d have to really put that in perspective as well. And reactions to epidurals and spinals, are there very many?
Nathan: Well, with regards to epidurals, most work really well. As far as reactions go, both an epidural and a spinal will cause your blood pressure to go down, to a certain extent. So we’ll measure your blood pressure often after they both go in. And if you don’t feel fabulous, just yell out. It’s usually quicker for you to tell you’re anesthetist or midwife you’re feeling a little bit lightheaded than it is for a blood pressure cuff to think about it and tell us the same.
And that’s easily fixed. You’ve always got a drip in a vein with some fluids or some medicine going in. And you’ll feel better straight away. So that’s common, it’s temporary, you know it’s not the end of the world,
Donna: And we’ve kind of already had a bit of a chat about the postnatal medications and the fact that you might start off stronger. And then certainly when you go home you get some education and some awareness about how to wean down on those things.
But it’s not like maybe when a doctor prescribes you a course of antibiotics and you think I better take them all. Certainly, postnatal medications and inflammatories have certainly got side effects. Paracetamol was fairly safe, but you’re stronger painkillers if you don’t need them, you don’t keep taking them because they got prescribed to you. You just wean them down.
Nathan: You take them when you need them, and if you don’t need them, don’t take them. That’s quite right because they do have their side effects. You’ve got no real chance of getting hooked on them if you’re using them as suggested, and stop using them when you don’t need them, they’ll disappear from your system pretty quickly.
Donna: And if you feel uncomfortable having some of those, more narcotic-based medications at home and you’ve still got some left. You can always take them back to your local pharmacy and they’ll dispose of them safely. Certainly the strong painkillers, we don’t encourage you just to put in the bin because you don’t want someone to come across them. So, you know, safe disposal of your medications.
Nathan: Yeah, you don’t want to leave things like that laying around in a cupboard for a kid to find them. So once you’re finished with them, take them back to your pharmacist to get disposed of properly.
Donna: And they’ll do it properly. Or even think, ‘Ohh, I remember those drugs I had when I had a baby. Four years later I’ve got a sore neck. I might take some endone’. It’s probably good to go back to the doctor and get that checked up and don’t share them as well. I do find that there’s a bit of a climate of medication sharing amongst some friends that is quite worrisome. Actually, because what did I have the other day, someone said ‘Ohh was feeling a bit anxious’ so my friend gave me her antidepressants and I’m like, Oh my God don’t. Just don’t.
Nathan: That’s not safe. It’s not sensible. It’s probably not legal either. So just don’t do it, just go to the GP,
Donna: Yeah, absolutely. And get that advice just for you, especially with the pain relief medication postnatal.
How are spinal anaesthetics is given?
We have given consent and now are at the stage of getting an epidural or a spinal anaesthetic. But what does that process look like and how does it work?
Donna and Dr Nathan go into some depth about how they insert the anaesthetic, some risk factors associated with inserting the canula, what you can expect to feel and what impact this anaesthetic will have on your body.
Donna: So in terms of an epidural and a spinal, so we know that we can see you beforehand, but if not, we’re going to come in and get it done. How long would you expect that a spinal for a cesarean would go for?
Nathan: Alright, so the process for a cesarean and spinal will be you’ve come into the operating theatre and have a drip put in the vein, and for a lot of ladies, that’s the most unpleasant bit of the whole process. Unfortunately, it’s a little more unpleasant than even the spinal anaesthetic. So pop that in.
Then we want to clean your back with antiseptic, going to get you to sit up and curl up a little bit over the bed like this. It’s also a curl of the back, not really a lean from the hips, a curl. We’re going to put a little bit of local anesthetic in the back, just another patch of skin about level with the top of your hips. And then through that with a little really, really fine needle many times finer than on a blood-taking needle. You’ll hardly know about that.
Pop some medicine in and take the needle out and it starts working straight away. Probably takes about 5 minutes to work fully, in which case you’ll be comfortable up to about here, about your chest and you won’t be able to move your legs.
Ok, so we got the spinal anaesthetic. Now what?
OK, so consent is given – we are good to go. So what should I expect to feel during the caesarean operation, (also commonly called c-section or caesarean section). Whilst the operation is largely safe these days, a typical vaginal birth is generally considered safer.
Typically a caesarean is only recommended when
- Your baby is in the wrong position (such as breech or transverse).
- You previously had a caesarean (although vaginal birth after caesarean (VBAC) is certainly possible).
- Placenta previa, the placenta is blocking the cervix.
- You are having an at-risk pregnancy (i.e. multiple births or some other medical condition).
You might be interested to know, induced labour does not increase the chance of a caesarean section. Click the link to read more about it.
Donna and Dr Nathan delve into how long a caesarean operation normally takes. What you can expect to feel during the caesarean section and how much you can move.
I like the idea that it will just drift away. Not sure, it is totally that dreamy though.
Nathan: For the ceasarean, you won’t feel any pain, but you may feel pushing and pulling and pushing. In fact, I think most ladies will feel some sensation. But you should never feel pain. If you’re not happy with what’s going on at any point in time, just tell us and we’ll stop and sort it out. They will always have the time to stop if you think you’re in pain.
Your cesarean takes about an hour, give or take a bit. And your spinal anesthetic will start to wear off at about 1.5-2.5 hours, it will just drift away.
Donna: Goes downwards.
Nathan: Yeah, it’ll just drift down so you’ll get feeling back. Eventually, your leg strength will come back. That’s probably 6 to 12 hours until it’s fully gone.
Phew, its over! Now for recovery and loving this baby.
Finally after 9 long months, it is over! Congratulation’s and great work mum.
Now for the recovery side of things. Often this is missed and all the focus goes to the baby. But a healthy, well mum makes for a health and well baby. This recovery stage is every bit as important as the 9 months you have spent growing this baby.
Take careful note of what Dr Nathan speaks about of particular note, make sure you are feeling pain free enough to get up and about. I found particularly interesting the conversation about pain medications and the impact of that on your ability to function and breastfeed. Well worth a watch.
Generally the stitches and wound should heal over a 6 week period post caesarean.
Nathan: Your spinal anesthetic will start to wear off in about 1.5-2.5 hours. It will just drift away.
Donna: Goes downwards.
Nathan: Yeah, it’ll just drift down. So you’ll get your feeling back. Eventually, your leg strength will come back. That’s probably 6-12 hours until it’s fully gone.
So enjoy the first day after your cesarean and rest in bed. Put your feet up and then the next day you have to be up and about, out of bed. Enough pain relief to be comfortable to move. And get moving. Get out of bed. Otherwise, you’ll potentially run into some risks if you don’t get moving.
Donna: Yeah, yeah. It’s quite important to keep all that blood moving and deep breaths.
Nathan: And be comfortable doing that. So take some pain relief for the first couple of days at least and get moving.
Donna: And I guess, thinking about what your body does, if you accidentally got your foot stuck under a chair leg, you would get this instant message to your brain saying, ‘Your foot’s stuck, get it out’. And so that doesn’t alter the pain message when you’ve had a caesarean because your body’s like, excuse me?
Nathan: Yeah, that’s right. So you will have some discomfort afterwards. That’s just a fact and everybody responds to that differently and the amount of pain relief will vary depending on what you need. What your experience is and how you’re coping.
There’ll be options out there, but you just got to take something for the first few days at least. Certainly, Panadol four times a day. Plus some anti-inflammatories. These are the bare minimum. On top of that there will be some stronger options just ask your midwife for them if they are available.
Donna: There’s always good and bad with all of our stuff. It’s always a balance, sometimes really strong narcotics can make you feel really sleepy. And some people don’t like that feeling. Or some people really love it, a little bit too much and we’re like, you can’t be on them forever. But it’s about knowing that it’s more important that you’re moving about and you can’t expect to do that without some sort of medication.
Nathan: That’s right, for at least the first couple of days, you really need to be taking something decent to get up and get moving. And after that, you can start winding back a bit. And the stronger stuff has the potential to come out in your breast milk a little bit. But really the amount in your mind or in your brain is similar to the amount in your breast milk. So if you’re taking it and you’re not drowsy and semi-conscious, then there’s not enough in your breast to affect your baby. So if you’re taking sensible amounts of pain relief such that you’re comfortable but not sedated, you’re OK to breastfeed.
Donna: Perfect. And knowing that at that stage you’ve actually got very small amounts of colostrum or breast milk as well. So then you think of the relative percentage to that as well, it’s really risk-benefit, but the amounts are very, very small and you know if you weren’t moving because you weren’t taking pain relief, the risk to you for that. Is actually worse. So we’re always balancing.
And people explain that to you because you spend the whole pregnancy avoiding medication. All of a sudden we’re saying ‘here, you go’, But in that cesarean situation, there is a reason why we need to tell that message that your body is saying ‘this is really sore,’ to just calm down a bit.
Which is why we use that combination of paracetamol, which is going to make everything last longer, and anti-inflammatories we can’t use in pregnancy because it can affect that little hole in the baby’s heart that we want to keep open. But once the baby’s out, we don’t worry about that anymore. So unless you’ve got a medical condition where you can’t take an anti-inflammatory, we would use it certainly post birth.
Nathan: As a matter of routine, in fact, it’s one of the best pain reliefs.
Donna: Because there’s lots of muscles involved, so you want to just calm them down a bit and then maybe some sort of a stronger painkiller to balance everything up. Which is great.
And some people, even after a normal birth, use a combination of those painkillers. Because there’s lots of soft tissue e.g. the perineum, that can be quite tender and so and in terms of postnatal medications that’s kind of the three types that we tend to look at using.
Have questions about looking after your baby?
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Disclaimer: This article is for general information only and not intended as a substitute for medical advice. All information provided on this website is not intended to diagnose or prescribe. In all health-related matters we recommend consulting with your local healthcare professional
