UK Midwifery Archives
These archives contain extracts from discussions held on the UK Midwives and Consumers email list, a discussion group for people interested in midwifery in the UK. Open to midwives, students, mothers, and anyone interested in improving maternity services in UK. Posts in these archives express the views of the individual authors, and not those of the Association of Radical Midwives.
Planning a Good Caesarean Section
This page contains ideas for both mothers and midwives. When a caesarean section is scheduled, or even when it is just a possibility, mothers can still make some choices about the way their child will be born, and supportive midwives can make a great difference to the mother’s feelings about the birth.
- Suggestions from Mothers and Midwives
- Caesarean Experiences
- Caesarean Section under General Anaesthetic
- Questions and Answers
- Links to sources of more information
Claire had her first baby by elective caesarean after she developed pre-eclampsia. Here are her suggestions based on her own experience:
- Don’t have a caesarean, if you can avoid it.
- Try to get a thorough consultation with both the obstetrician and the anaesthetist beforehand. The anaesthetist’s role is very important and you may well find that you are talking to her/him a lot more than the surgeon during the op.
- Prepare lots of questions beforehand (and get lots of information!).
- Check who will be operating, and who the anaesthetist will be, on the day the operation is scheduled. It would be a shame to spend hours talking to a consultant and an anaesthetist about your preferences, only to find that they are off-duty on the day, and the doctors on the team have only your notes to go by.
- Book an early morning appointment if possible, then there is less risk of your operation being postponed as emergencies/delays crop up through the day. Claire chose 7AM!! You will also have, hopefully, experienced staff on hand to look after you in the immediate recovery period.
- Discuss relative merits of spinal vs epidural anaesthesia with the anaesthetist, and find out what options they offer for caesareans. Spinals are apparently associated with fewer side-effects and less risk of dural tap.
- Having a catheter is not mandatory during a caesarean. You can refuse to have one. Claire chose to go to the loo lots beforehand instead, on the grounds that the whole experience was going to be demeaning enough without catheterization too… avoiding a catheter also reduces the risk of infection and postop discomfort.
(Note: But see also Questions and Answers. Many midwives would advise against this as refusing a catheter does carry risks; catheterisation helps to avoid accidental bladder damage where, for example, a full or partially full bladder is ‘nicked’ during the operation.)
- Walk to the operating theatre and put yourself on the table; you don’t have to be wheeled in as if there was already something wrong with you.
- Think about whether you want the surgeon to talk you through the operation or not, and make sure she/he knows your preference. Some people find it reassuring to be told exactly what is happening, others just do not want to know when the first cut is being made.
- Make sure birth partner has a camera in the operating theatre so they can take pictures of anything mum might not be able to see, eg baby being weighed.
- Cuddle baby while you are being stitched up, if possible.
Emma has had both an unplanned and a planned caesarean:
With my first son I planned a home birth, but he was 3 weeks late and I wasn’t dilated at all so I was induced, rightly or wrongly, and after 36 hrs in labour I had an emergency c/s under GA (general anaesthetic)(as a teenager I had spinal surgery which altered the flexibility of my pelvis and prevented an epidural). I was 3 cm dilated and his head was swollen. Apparently he was in the perfect position for a normal delivery, but was just too big – he had a head circumference of 40cm!
The CS was the worst, most violating experience of my life. I suffered post-traumatic stress disorder and found it difficult to bond with my son. This wasn’t helped by the huge sanitary towel-like bandage across his face where the scalpel had cut him from cheek to ear. It took six years for me to risk another pregnancy – I was so traumatised.
I was determined to VBAC (vaginal birth after caesarean), but right at the last minute, my baby went breech. We turned her using Acupuncture, but she turned back. I knew my pelvis was not perfect so a CS seemed the only option.
(Some caesarean mothers) really fight the procedure, and initially that is how I felt too, but then I changed. I didn’t want to hate the birth; I wanted to make the best of it. I decided to make it positive.
Firstly, I begged them to let my partner stay, which was not normally allowed (if the mother had a general anaesthetic), but luckily this battle became unnecessary as an anaesthetist who could do special epidurals promised to help me. I then thought about the things that had upset me the first time: not being close to my baby, and feeling out of control. These are things that helped me deal with it all:
- I made a blanket for baby and slept with it the night before the CS. I insisted that babe was wrapped in it when she was born, so she could smell me and we could be sort of together.
- I chose music for the occasion (‘Close to me’ by Burt Bacharach!)
- My husband and the medics took loads of pics (I recommend a matt polaroid film for a less gory appearance)
- I retained some control over sexing and weighing the babe. I also specified that she wasn’t cleaned up until I was comfortable, and (in a morphine-induced haze) ready to be part of things.
- I used all the painkillers going! This way I could concentrate on her, not the pain.
The birth of my daughter (by planned caesarean) was in contrast the best thing that has happened in my life, even though it was a CS when I really wanted a natural birth. Because I accepted the CS, I could sort of enjoy it, and I didn’t feel cheated like the first time. That isn’t to say I am a convert – babe 3 will definitely be a VBAC/HBAC (vaginal birth after caesarean/home birth after caesarean) if I can find a midwife willing to encourage me!….
If you decide to go for an elective section, which is hard when you want a natural delivery, all I can say is that it is a very different experience to an emergency, and it can be very special; mine was wonderful. I recovered very quickly, very different to the emergency section, and breastfed well.
I’m Karen, I’m 33 and have one daughter who is nearly two. I had a difficult last few months of pregnancy which ended in an unplanned, rather rushed caesarean and when I saw that this group was for mothers as well I thought I’d join it as I thought maybe my experiences and feelings after my unwanted c-section (but appreciated now since I have my daughter and apparently she wouldn’t have survived labour and delivery by normal means) may be of interest to somebody.
Things I found helped:
- Being given the choice of whether or not I was told the baby’s sex – given that this was the only choice I was able to make I wanted to find out for myself and not just be told.
- Being able to hold my daughter, albeit briefly, before she was whisked off to be checked by the paediatrician
- My determination to get up and out of bed and down to SCBU (Special Care Baby Unit) ASAP and the midwives’ willingness to help. I was down there that night breastfeeding.
- The midwives’ wonderful help in getting breastfeeding established when faced with a newborn who just did NOT want to breastfeed. They were great and spent hours (and I mean hours) each day helping out to try and get it working [as aside, we’ve just stopped breastfeeding at 23 months].
Things that didn’t help:
- Not being given the choice to see my daughter being born. I would have liked the screen to be down so I could see but this wasn’t offered – and at the time I was too concerned for my daughter’s welfare to even think of it but would have said yes if asked.
- When she ended up in SCBU, not being given a photo of her
- Not being told what was wrong with her (I later found out when her notes were left on my bed and I read them – hypothermia, RDS (respiratory distress syndrome), Strep B)
- Despite having insisted that she did not have formula, her being given formula on her first night without me being asked. I only found out because I overheard two midwives discussing her. When I questioned it they said that they didn’t want to disturb me.
- Being put on a ward with 3 other women who had their babies with them when there were 3 women in the next room who also had babies in SCBU. I lost count of the number of times I cried because my baby wasn’t with me when the others were all there.
- When considering my birth plan, I completely closed my mind to the idea that I may need a c-section. With hindsight, I should have a least given it some thought, but I only considered the drug-free water birth I was hoping for – and which was still possible until the last minute when we both had problems with high heart rates.
- Being shaved for the section …yeuch, not a nice experience. There is a tip for you – tell Mum where to shave and give her a mirror – if only they didn’t have a bump in the way! But it was the most embarrassing thing, I just hated it.
Karen’s birth story is online.
A couple of things spring to mind from when I had my “unplanned” section. The biggest thing being that because I was under community team midwifery care, I had my primary midwife with me when it all went to pot. Just being able to find someone in that theatre, before my husband was allowed back in, someone who I knew very well, made a scary situation much more tolerable. Not sure how this fits in though with the current (midwife) shortages! Also that she shared my sadness, she shed a tear in theatre, as I did; she didn’t say, “Well at least the baby will be OK” etc.
Other points are all around the issues of control really. When the birth you had hoped for suddenly is not possible, you lose that element of control. My midwife skilfully gave me back simple elements, despite some battle with the permanent hospital staff. Those included:
- Would you like to be catheterised now, in the delivery room, or after the spinal is sited, in the anaesthetic room?
- Would you like to wear your own birthing clothes?
- Would you like your own pillow?
All very simple, but gave a little bit of choice back to me. I know we were fortunate as we had some time to spare. But it made that operation into a birth with good memories for me.
I had TEDS on (surgical stockings – see below), not the inflatable booties, and no, my arms weren’t tied down.
I read a magazine article about a woman in the UK who birthed her own baby with a C/S! The surgeon asked her to reach down to feel the baby’s head, and she just started to pull, and he let her! There’s active involvement.
Laura had a caesarean under epidural after transferring to hospital from a planned home birth. Her birth story is online.
The nicest thing through the experience was encounters with midwives. Firstly there was a lovely student midwife present at the end of my labour who also came to the c-section. I had my labouring with my mother and partner as birth partners but, after a bit of debate, my mum was refused admittance to the operating room (we were all quite upset by this). Once baby was out and safe I was desperate for my mum to be told and the student midwife very kindly rushed straight out to pass on the good news. I realise now she may have preferred to stay and watch so it was so kind of her to leave.
Other good things including a midwife managing to wrangle me a single room on my second night as I was desperate for sleep. And my home birth team midwife who had been such a support to me in labour made a special detour to the hospital to come and see me and that was lovely to see a friendly face in hospital. I felt ‘followed-up’. I especially liked this as after all my feelings of failure she said I looked like a natural at breastfeeding as I was lolling on the bed breastfeeding, reading ‘Hello’ and dropping chocolate chip muffin all over my newborn daughter.
A few things I would have found helpful to know/ or that others might like to know:
- I could see the operation reflected in the metal lights above the operating table. Obviously I couldn’t see any detail but I did see bright red (for blood) and I found this very alarming. I have since read in a good book on c-sections that other mothers have reported this.
- I felt really sick during the operation, although I wasn’t actually sick. This was made worse by being under pressure to wear an oxygen mask when I frankly couldn’t stand anything over my mouth.
- Mothers who have had a c-section need to be given extra support with breastfeeding (as everyone knows). I had great support, so much so that the midwives encouraged me to have her in bed with me as this made feeding so much easier. I would have found it more difficult if I had to ring the bell every time she needed feeding in the night (so they could lift her).
- Nobody told me that I would have such horrendous wind afterwards! It was really really painful and uncomfortable.
- arnica really helps healing
- being able to talk about it over and over again as I tried to come to terms with the outcome of my planned home birth. It was important to me not to worry about boring other people and for them to know how cathartic talking about it was.
- that you don’t always have to stay in for 5-7 days, as long as you don’t have any complications you should be able to go home sooner. This was my biggest fear of them all (irrational in some ways but partly cause I was expecting to be tucked up in bed an hour after a home birth). I was discharged 48 hours after the c-section and I was ecstatic to get home.
If I had to have another c-section (AND I HOPE I NEVER HAVE TO!!!!) there would be some things I would change:
- I would try and encourage my partner to watch the baby coming out if he could stand it. I think he would have liked to but I was anxious that he didn’t as I thought it would upset him. But now I wish that he had actually witnessed the baby coming out of me.
- photos to be taken
- I’d like to discover the baby’s sex and have it brought to me when it was all yucky – my daughter wasn’t shown to me until they had already cleaned her up a bit and wrapped her in a towel. They hadn’t completely cleaned her up though, and we left the crusty bits of blood in her eyebrows for ages as they were my evidence that she had indeed been born of my body.
If a c-section becomes necessary I think the crucial thing is that women retain as much as control over the whole thing as they possibly can.
Laura mentioned the tremendous amount of painful wind after a c/s. I agree that mothers should be told about this and that they be taught what to do about it. Having to lie in bed doesn’t help it. Knee chest position does wonders.
If the caesarian birth is planned I suggest that women and their partners consider:
- When /if urinary catheter is put in – on ward or in theatre. There are obviously pros and cons to each, such as privacy, walking up to theatre etc.
- Pain relief afterwards – being pain-free can really help get breastfeeding off to a good start, often very important for these women, to show that their bodies do work. In our unit most women opt for patient controlled analgesia and may also have voltarol suppositories, which I am told (by the women) give excellent pain relief for up to 18 hours. I think it’s really important to consider the affect of post-op pain on breastfeeding.
- What the partner will do and what he/she will wear under ‘scrubs’–it can get very hot in theatre. I point out that in our unit the partner will go to get changed while the spinal is being given, so mum will be ready in theatre when partner comes in. I think sometimes women worry that their partner won’t get into theatre on time, as she is being prepared, abdomen draped, washed etc,but they do.
- If they want photos taken who will they ask– in our unit there is often is a student midwife accompanying them–what do they want photos of?–Weighing, paediatircian check etc.
- Skin to skin contact immediately after birth, while in recovery, during transfer to the ward, and on the ward at anytime.
If a woman is coming in for an elective section then I talk it over with her the night before. I ask her what she already knows and run through what will happen over the next few days.
If it is an emergency section then I still try to inform her of who will be in theatre (ie more people than you think), explain what will happen from when she enters to going into recovery. And especially where the baby will go if she is asleep.
We always send the partner to get changed as early as possible so they can be there when the woman goes into theatre and sit with her for the spinal/epidural. Unfortunately the unit I work at still doesn’t allow partners in for a GA.
Cameras are taken in although it is usually the partner who takes the pictures as there isn’t very often anyone else spare. I don’t think I’ve ever seen anyone take pictures during a GA because there usually isn’t anyone to do it (I will try to think of this in future).
Music can be chosen and played.
Although mum’s arms are supported on extensions of the theatre table they are not strapped down. We also have gel bags for under her ankles.
I have to say we don’t often achieve skin-to skin in theatre mainly because of lack of room on the theatre table or under the sterile field. I do wrap the baby and place him/her next to mums head where she can reach him/her with one arm and Dad can help support him/her.
I ask them when do they want the baby dressed/weighed and give dad the option of coming with me to watch.
Skin to skin contact can usually be achieved in recovery if wanted.
If the woman has a GA then I try to take the baby to partner as soon as possible and weigh/dress/check baby over with them. Encouragement is given to take pictures to show mum later.
The best support for a woman and her partner in theatre is a knowledgeable person who explains every little thing that goes on and is just there for them.
If a woman is having a planned C/S, then I will take the time to run through the whole op…the prep, the staff, the equipment, timing etc antenatally. I really do “act” it out…you’re here, he’s there, that trolley’s over there and so on. If I do actually go to theatre with her, then I will take the time to introduce her to everyone (and their role), and remind her what everything is and does…
Most theatres have a tape deck…bring your own music!!!
I had a hideously emergency C/s…. catheter shoved (yes really) in on labour ward as they made the decision to operate, dry-shaved with what felt like a blunt razor, (still have bald patches!!) My husband was flung scrubs, changed in labour ward with all & sundry there, had to ask if he should take off his jeans first. He was left to chase the trolley down the corridor….
The only good (!!) bit about my c/s prepping was that I yelled at the anaesthetist cos when I asked him what he would use (don’t ask me how I was clear headed enough to think of this at the time) he said ” oh we’ll just put you to sleep and then you’ll have your baby” and I said “No you ***** well won’t, I want a spinal!” and he said, “Oh, well it doesn’t take any longer to do so if you want me to, OK…”
That was my assertive triumph!!
I told them there was no way they’d do a GA (general anaesthetic) – I was determined to know if my baby was alive – I had been told that it was unlikely so there was no way I was having a GA.
The midwife did say that with it being an emergency they may have to do a GA but the doctor said it wouldn’t make any difference, they could do it quick enough with an epidural/spinal and (this was out of normal earshot but they didn’t realise I have exceptional hearing can can hear a quiet conversation at some distance) the baby was probably already dead or nearly dead.
Karen’s caesarean birth story is on this site.
One thing that stands out in my mind about my c-sections is that as soon as the spinal anesthesia was administered, I could no longer feel my contractions, or even the lower part of my body, so it was like I wasn’t experiencing labor anymore and I was completely physically and mentally detached from the delivery of my baby. It was such a strange feeling.
All of a sudden I was no longer in labor yet no longer pregnant. All of a sudden they were holding a baby. It had to register in my mind where that baby came from.
Because of the feeling of detachment I had from my baby being born, I also had a strange feeling that he had died. I asked them to bring the baby over to me so that I could make sure he was alive. I kissed his cheek and then they were taking him away. I asked them to bring them back because it still hadn’t registered in my mind that he was alive.
The hardest things about my cesarean sections was the separation from my babies.
Last year, one of the women from my GP practice was having a planned C/S (previous C/S for CPD (cephalo-pelvic disproportion))…and was absolutely terrified from her previous experience. She wanted me or my colleague there, I said that I couldn’t promise as it would depend on the team on the day…we didn’t usually attend for C/S. Anyway, we were ‘quiet’ so I could go.
When I walked on the ward and she saw me…she was so pleased and relieved. I remember thinking as I stood “cwtching” (Welsh for ‘cuddling’) her as her epidural was sited that this was another way of “being with woman”. This woman needed me more that day than some of the women that I had been with in labour. It still brings tears to my eyes.
Most CS nowadays are done under spinal or epidural and usually if the baby is ok it goes to the parents to goo over while the suturing is being done.
I have some lovely photos of a Twin CS done for fulminating PIH (Pregnancy Induced Hypertension) and the woman is there with both her babies in her arms supported by her husband and me while the closing up suturing is being done.
The surgeon was one of the most sensitive obstetricians I have ever had the pleasure of working with. He understood how disappointed the couple were and asked if the husband would like to cut the cords. As baby 1 was delivered the husband came round from the womans head and, under instruction and with guidance from the midwife, cut the cord and took the baby to his wife. This was repeated with twin 2 and I took some lovely photographs.
I commented to my colleages about the surgeon’s sensitivity and was told that he had married a midwife who had educated him!!
Here’s a short description of what it was like when neither I nor my husband witnessed our birth. I had my first baby by GA Section 20 years ago.
To this day I could not swear to you that he is mine.
I was CONVINCED that the hospital had given me someone else’s baby and kept mine.
I wanted to go home without him.
Looking after a baby who was ” not the baby I was pregnant with” , was an endless 24 hours a day drudgery.
It took me 5 months before I would wake up in the morning and not check for a pregnant belly, praying that it had all been a dream.
I couldn’t tell anyone how I felt. New mothers were not supposed to be sad when they had a healthy live baby.
At least a midwife from the labour should meet again with the woman to describe the birth to her. Any detail would help to make the connection between the imaginary baby of the pregnancy and the real baby she was given.
I am convinced that the reason that my husband and I found first-time parenthood so traumatic was the emergency section under GA. My husband describes very clearly his feelings of being left totally alone in a corridor for 20 minutes, not knowing if either of us were alive or dead.
I now know that I was lied to over the reason for the section as well. I was told the baby was in distress but the notes state that she wasn’t and it was good old ‘failure to progress’.
Am I too cynical in believing that the fact that it was the Saturday night before Christmas and the anaesthetist had a party to go to that made them so keen to do it and that there was another one “needing” to be done after me that made not enough time for a spinal block ?
Having seen one of my children anaesthetised last year I can understand the viewpoint that the father might find it traumatic but to be left alone with no support or information and neither parent “present” at the birth is no way to start family life.
My sister had her baby by emergency section. I was really upset by the phone call I received from the new father, to tell me that one minute every thing was fine and the next the room was full of people and they rushed mum away so quickly that he did not know what was happening.
My sister has not spoken about the time in hospital at all and has found bonding with her new son difficult. She was so saddened that the right to have her baby was taken away. It was also her partner’s first child, so perhaps the expectations were higher.
At the time I remember thinking “At least they are OK”, but after being a member of the list and reading your experiences I am now not so sure, although I was not present at the hospital I can’t help now thinking perhaps this was another experience that could have been made less traumatic.
I will just hold on to the thought that we can make a difference.
I was wondering if any of you have thoughts on what happens when a woman has to have a c/section under general anasthetic?. This happened to me a couple of years ago….my induction became an emergency and there was no time to set up an epidural. My husband was banned from theatre, resulting in my son’s birth being a total mystery to the both of us.
When I had my daughter, a couple of months ago, I was determined to have a VBAC, but the little minx went breech at the last minute and I was forced to have a c/section again. I have a back problem which meant they were keen to do a GA again, and no amount of petitioning would let them allow my husband to be there, though no proper reason was ever given.
Is this the case everywhere? Do you all think this is right? (I ended up with an epidural and beautiful birth by the way, though I will still try for a VBAC next time!!!)
The reason given at our unit is that the birth partner is there to do just that give support and if the woman has a GA then she is asleep and there is no need for him/her to be in theatre. They can go with them to the door and we bring them into recovery afterwards. I also try to explain briefly who will be in there and what will happen.
I suppose we all get a little blasé about what happens in theatre and forget that other people don’t know what goes on in there.
A C/Section is a major operation, one of the many risks is that of infection, so ideally a minimum number of people should be in theatre. The idea of having someone with you for the C/S is for support for you…abirth partner. If you are asleep, then that person has no need to be there.
Most obstetric theatres have a waiting area for the woman’s birth partner to wait if she is asleep, and allow him (or her) to go into the recovery/baby room straight after the birth to see the baby, and watch him/her being checked and weighed.
Don’t underestimate the distress your partner may feel at seeing you lying there asleep and helpless. Theatres can be very frightening places…problems can occur very quickly, and there may not be time to explain things to observers.
I’m glad that you were able to be awake this time…and as you say, you may yet get to have a VBAC 🙂
I agree that it could be traumatic for a partner to see his partner under general anesthetic, but that is equally true for partners observing their partners undergoing all manner of butchery in the delivery room.
For some couples, being present is even more importnat when the woman is under GA because they feel strongly that the father at least should be present to welcome their baby into the world. It should boil down to the couple being given the full facts about what to expect so that they make an informed decsion about whether it is appropriate for them to be present or not.
I would suggest that refusal to ‘allow’ the father to be present is just yet another example of patriarchy in action.
As a non-midwife who has had a c-section (under epidural and with partner) I have to agree with you. People need to have the procedure explained carefully beforehand, but as long as this has been done it I think partners should be given the choice to be present.
Speaking as a mother I have found it hard to come to terms with the way my daughter was brought into the world – but at least I was awake and I saw her immediately. I can’t imagine how traumatic I would have found it to have had a GA in terms of ‘missing’ the birth, and if I had I would have at least wanted my partner to witness her arrival and to be see our daughter ASAP.
I really think it should be an informed choice.
The infection point was made to me, but seemed to fall flat as 3 medical and nursing students were allowed in, while my partner wasn’t!
As far as psychological support only being necessary when a partner is awake, the qualitative research done with mothers suggests that partners have a vital role in reporting the birth story and welcoming the child. And yes, of course it is distressing to see a partner unconscious and undergoing surgery, but from what I remember of my own midwifery placements, forceps, episiotomies and many other procedures can be traumatic, yet partners have a role to play. The unknown, locked doors and secrecy can be just as distressing, particularly when a partner has been there throughout a long labour, supporting his partner.
I was shocked as a student to realise that a father wouldn’t be allowed into C/S if woman had GA. I had presumed that he was present because his child was being born, but came to realise that most other people believed his presence was purely as a supporter of his partner – therefore if she is unconsious, he doesn’t need to be there. On the contrary I think her unconsiousness makes his presence as “witness” even more important for mother, father and child.
Since then I have on one occasion seen a father present during C/S under GA. The couple asked if it was possible, and the surgeon had no objections.
Some thoughts from an experience I had as a student midwife going into theatre with a woman for a planned C/S operation (repeat section). She was adamant that she wanted a GA but was upset about both parents missing the birth. With the permission of the theatre staff and surgeon I took lots of photographs of the birth, from the baby being lifted clear of the abdomen, carried in the arms of the gowned midwife to the paediatrician at the resuscitaire, and several pictures of baby being wrapped and dried. Then of course the babe went straight to Dad on the maternity ward, where I took more photos. The Mum also asked that no-one tell her the sex of the baby until she asked or saw the baby herself, and asked us to leave the baby unclothed until she could see him/her.
Last year this mother was back for another elective caesarian and she told me that she really appreciated the photos. Unfortunately there was no spare student or midwife to take pictures for the latest birth, although I suggested she could ask her community midwife for a “domino” just for that assistance during the birth.
I have heard of some obstetricians allowing partners into theatre when a mother has a GA, so I don’t know how they can maintain a prohibition…
Would it ever be possible for a camcorder to be left running, mounted on a tripod, in theatre so that the family could see the baby’s first moments? I suppose that there will not always be room, and people might worry that in an emergency others would have to come in, but in that situation surely the camcorder could just be shoved out of the way/turned off?
Video recorders are not permitted in our local delivery suite or theatre. They were several years ago, but there was a growing concern with the advance of technology, that video material could be manipulated and could be produced as so called evidence.
Yes, a video can be used in a litigation case. But of course it would be up to the witnesses to “prove” this as evidence. eg that it was taken when it was alleged to have been taken, that it had not been edited in any way etc and etc. I think it indicates a lack of confidence in the attendants and a sad fear of litigation. I always think fear is a bad feeling to have round a birthing woman/couple.
I was interested to read the comment from Jennifer – as being able to ‘see’ the birth seems a natural argument for a video of the birth if the mother wanted one.
Ruth commented that video cameras are no longer “allowed” in her unit for fear of manipulation of evidence and litigation – I feel this is very sad state of affairs. Firstly because it limits a woman’s choice of how she might want to experience her birth, and secondly because it is a sad reflection of the fear culture around birth. I’d be interested to know if there are any actual cases where a birth video has been used in a negligence case.
I can only speak from personal experience – which makes my comments highly subjective! – I had my last two births videoed. I chose this because I had been so withdrawn and inwardly focussed during birth that I ‘missed’ the baby being born, and I felt a video of this moment would help me to ‘see’ the actual moment of birth. On both occasions I wrote in advance to say this is what I wanted and the Midwife who attended my labour had to be comfortable with the camera being there. There was no problem.
I still watch these films. I am always moved to tears watching the birth of my sons. They are special and precious to me. The boys love watching their birth.
It is a very personal choice – from my experience when the subject has
arisen in classes most crinkle their nose in disgust at such voyeurism :-), so I can’t imagine this is a regular request….
My most precious bits of video footage are of babies 1 and 2 being weighed and measured. I was still unconscious when baby 1 was being weighed and although awake for section no2 there were complications and husband and baby were sent away (for 4 hours!). For me it was a way of recapturing some of the lost time.
I know this isn’t about the actual birth but I do still tell clients who might be having an elective section that in our local hospital they do send dad and baby away while mother is being stitched up and if they don’t feel up to fighting this practice (which I deeply object to) then a video at least allows mum to see something of what she missed.
Jenny (antenatal teacher)
I saw figures somewhere that 53% of obstetricians are now willing to allow partners in theatre for CS under GA, which is vastly up on what it was.
I think the notion that just because a woman is unconscious she does not need the father of her child there at the birth is, or the father does not wish to be present …well, words fail me.
Obviously it will have to be explained that intubation doesn’t look very pretty (but these days thanks to TV people are familiar with that), and preferably someone should be able to explain what is going on just as they would I trust if the woman were conscious.
I did not ‘see’ my babies born because I was kneeling and facing the wrong way (too many beanbags etc to see anything downwards) It matters a lot to me that my husband saw our babies emerge into the world.
Who comes into the operating theatre for a caesarean?
I counted 12 people when I had my emergency c- section. 4 were midwives, 1 paediatrian, 1 doctor, 1 anaesthetist – but who were the others?
There is usually an anaesthetist, an ODA (operating department assistant – his assistant), a surgeon (registrar), SHO (Senior House Officer – a doctor and the surgeon’s assistant), theatre nurse (in charge of instruments for the operation), a midwife to take the baby from the surgeon, a paediatrician (if it is an emergency), a runner (who runs around getting things) and possibly students.
Wow…12 must be a record…why 4 midwives?? For a “normal” c/s the minimum would be…1 scrub nurse (may or may not be a midwife), 1 “runner” (non-sterile helper for scrub nurse), 1 surgeon (registrar or consultant), 1 assistant (could be any Dr…once in an emergency when we had 2 c/s at same time the 2nd c/s had the consultant on call plus a med student!), 1 anaesthetist, 1 ODA (operating department assistant…ie helps the anaesthetist), 1 paediatrician, 1 midwife. That makes 8.
We have the midwife scrubbed to take the baby at the table…the paed is waiting in the baby resuscitation room.
3 midwives (the one with me in labour, my community midwife, who came in off-shift while I was in labour, and the senior midwife, who was drafted in as things went pear-shaped)
1 surgeon’s assistant
1 theatre nurse
1 other nurse (presumable a runner)
So including my husband, me and the baby that made 14 bodies in the room!! No students as it was 3am!
Yellow Wellies and Stockings…
Do you use boots or stockings to protect against blood clots in caesarean mothers?
The famous yellow wellies!!! (Well, they’re yellow in my hospital) :-)))) I say to the women that they “will do your walking for you” while you’re lying down. They inflate and deflate during the op to help prevent deep vein thrombosis.
We use inflatable gaiters in theatre and while mum is bed-bound.
The last hospital I worked at had boots – yellow wellies. When I first saw them I wondered what they were for. They work on a cycle – one wellie inflates and the other deflates – which is supposed to keep the circulation in the legs going for the period the woman is on the operating table.
The hospital I trained at had gel bags to rest the womans legs on, to prevent trauma to the legs – as this is what can cause deep vein thrombosis (DVT) following the operation. Stirrups in theatre were also made from gel bags, also to prevent trauma during operative vaginal births.
I had delightful surgical stockings which were to help prevent blood clots forming. They are terrible things, especially when you get eczema on the lower legs like I do – even wearing tights is itchy, but those stockings were terrible.
TEDS – those horrible thick white stockings designed to stop thrombo-embolism in the legs (aka clots or deep-vein thrombosis (DVT))
I had to wear a very fetching pair of surgical stockings which they put on straight after – to help prevent any blood clots forming in my leg. I was sent home with them (though immediately took them off) and for some reason I still have them lurking in my cellar (sort of horrible keepsake I suppose).
Are women’s arms strapped down during caesareans in the UK?
We do not strap down arms – this is the 21st century!!!!
The anaesthetist needs IV access, plus the woman needs IV fluids until her bowel is back to normal, so she will have an infusion running. Her arm is usually laid out straight along an extension to the table, angled out so that the venflon is not under the sterile field, and therefore is easily reached by the anaesthetist. To give support, to prevent her arm falling off the extension, and to protect the venflon…a loose tie is wrapped around her arm. One of her fingers on this hand has a ‘peg’ attached which records her oxygen saturation levels. Her other arm has the BP cuff attached, and can be moved freely.
When it was normal for all women to have a general anaesthetic an arm-width board was used either side to support the arms (one with blood pressure cuff one with drips etc. In order that the arm didn’t fall off, strapping was/is still used. Not necessary with spinal as women retain control.
I certainly didn’t have my arms strapped down, and I think it’s a horrible thought. If they’d tried that with me they’d have been told where to go!
I have never seen a woman’s arms strapped down during a CS. Sometimes an arm is supported on a little arm board if there is trouble with a drip. Most women would not wish to have their movements restricted in this way and would, I hope, refuse to permit it.
Is a catheter necessary? Optional?
A woman has the option of refusing to have a catheter inserted or indeed any other treatment she does not consent to have. A surgeon has the right to refuse to perform any procedure that he does not wish to and which he/she believes is hazardous to the patient.
Having an indwelling catheter is not just about having an empty bladder at the beginning of a CS – it is really highly desirable to ensure that the bladder stays empty during the operation. At the start the surgeon does not know how long it will take or which unexpected complications/hazards may be encountered. I have to say that I think it is unreasonable to consent to a CS and not consent to an indwelling catheter for the duration of the surgery.
I completely agree. A full bladder during abdominal surgery does nobody any favours. [If a woman refused to have a catheter] I wonder if the reason given for the catheter was understood by the woman before surgery? How would she have felt if she had had to undergo a bladder/ureter repair – all for the want of a catheter during surgery?
This could have have a serious long-term affect on her continency, and hence, even more so on her dignity. Also on her post natal morbidity and her ability to care for her new baby. I feel that this is taking an unnecessary stance and also running an unnecessary risk.
I am a strong advocate of women taking decisions about their own care. If I feel that I have given all the relevant information AND that it has been understood, then I will give my total support to that decision – with very few exceptions. However, I think in the above circumstance that I would have done my level best to persuade her to re-think.
Mary put it in a nutshell when she mentioned “unexpected complications”. Worst case scenario – try haemorrhage ++, IV fluids ++, trying to obtain a fluid balance and also insert a catheter at the same time under surgical greens. Nightmare.
As you have probably gathered, I feel very strongly about this and can only conclude that the woman did not understand the reason for the urinary catheter.
Is is common for c-section babies to be asleep when they were born?
I think it depends on whether you have been in labour or not. If it is an elective c/s then it often seems to be a shock to the baby. There they are minding their own business and suddenly they are dragged out and they are often asleep. If there has been some labour maybe they are slightly more aware of what is coming.
Babies are awake…they do all the usual things like yell, cry and pee all over the sterile field!!!
On this site:
- Choosing Elective Caesareans
- Caesarean Section for Maternal Choice by Sara McAleese
- Forced Caesareans
- Risks of Caesareans
- Vaginal Birth After Caesarean
On other sites:
Please note that some of the US-based info below mentions the mother having her arms strapped down during an operation; this is not normal in the UK, and even if it is in a particular hospital, the mother can refuse to have it done.
Caesarian Section: What to Expect, by Mary Cronk. What to expect if you have an unplanned or a planned section (www.marycronkmidwiferyservices.co.uk).
Caesarean Section FAQ by Robin Elise Weiss
Childbirth.org links on caesarean sections
A Positive Caesarean, by Birthrites midwifery
Planning Your Cesarean FAQ
Making Caesarean Delivery Work for You
Parentsplace.com caesarean birthplan
Cesarean Voices – A web site by, for, and about cesarean born people
Discusses whether being born by caesarean affects a child’s personality.
Joanne Steele’s article on parenting a caesarean-born child
The Ideal Caesarean Birth – by Robert Oliver, M.D.
Some interesting ideas eg squeezing the baby as it is taken out of the womb, to simulate a vaginal birth.
AH Updated 21 March 2001