Tuesday, 24 May 2011

"I Just Found Out I Need A Caesarean Section"

Caesarean Sections are surprisingly common these days with nearly 10% of births ending in the surgery. Caesarean's come in two forms; elective and emergency. Please note that a caesarean is a complex procedure and a the risk of turning this article into a book I am simply going to give you an overview of what to expect.

An emergency caesarean is obviously named so because they are required on short notice. The baby is coming and one complication or another means that baby needs to come out and come out now. Elective caesarean's aren't always "elective". They may be required because of pre-existing medical conditions or perhaps you have a mischievous baby who hasn't turned around yet.

Shaving - This varies from one hospital from the next and each Doctor has his own preferences. Many like to shave a little off the top of the pubic region to give them better access to baby. Other Doctor's don't do this because the shaved skin harbors bacteria that can cause infection.

Catheter - Your nurse may insert a catheter before or after your epidural. Not only is this necessary because you will be out of action for the following day or two, it also drains the bladder ensuring a smaller chance of it being accidentally nicked by the scalpel or scissors during the surgery.

Not to worry - you can pick your dignity up when you are discharged and the professionals who are working with you take very good care of it!

Anesthetic - No surgery is complete without anesthetic. There are two forms that are used for elective caesareans; the spinal and the epidural. Both have the same result of numbing you from the chest down. You will be required to sit still (or sometimes to lie, depending on your Dr) while a small needle is inserted into the space in your spinal column. A spinal is a one off shot. The epidural is left in place - a very fine catheter is inserted into the vertebral column and secured in place. Anesthetic is then injected into the spinal fluid - many women feel a warm tingly sensation in the area as it begins to take effect.
Many women experience a warm
tingly feeling in the area as
the spinal anesthetic begins to take effect

Epidural's are the favored option because they can be topped up if required during surgery and can stay in place for 48hours, offering you pain relief in the following days.

Yes, there is a danger of paralysis but it's very rare. More common are the monstrous headaches which sometimes occur after the needle is removed and is caused by a small amount of spinal fluids to leak. It may last a day or two before you feel any relief. Again, this is rare but it is something you should be aware of.

In the cases of an emergency caesarians, a general anaesthetic is sometimes required as it gives your OB the quickest access to a baby in distress. If you have an epidural in place during labour, your Doctors can simply increase the dose to numb the area. General anesthetics have always been high risk and are avoided unless absolutely necessary because of the effects that they have on both mother and child - babies suffer the effects of the anesthetic and mothers can have trouble bonding with baby.

During the Surgery
Many women feel a little overwhelmed by the operating theatre, overwhelmed with nervous tension, excitement and fear of what  may happen. Unless there is a serious problem, you can invite a loved one to hold your hand throughout the event. A screen is placed between you and your tummy so you will not be able to see the team working on you. In some cases (and if requested), this screen can be lowered at the last minute for you to watch baby emerge.

There can be as few as five (often more) Doctors and nurses buzzing around but you can take comfort knowing that they are all very knowledgeable and experienced.

Some teams like to have the radio on or chat about what they have planned for the weekend - you may think that this is unprofessional or that they aren't giving their full attention to the task at hand but it's actually a good sign as it means that there are no complications. Don't fear if your don't hear any chatting though, it depends on the team involved.
Your Doctor will need to make two incisions to get to baby - one in the skin and the second in the uterus. The first into the skin, will depend on the position of the baby and the urgency in which baby has to come out. Given the choice, the vertical (or low transverse) incision is always preferred as it cuts along the grain of the muscle and therefore heals faster. At this point, some Doctors prefer to make a little incision in the uterus with the scalpel and use scissors to open the uterus.

You will feel pressure and tugging
sensations but the experience
should be painless
If you experience any pain during the surgery, all you have to do is ask! It does happen occasionally as the Anaestheseologist trys to find the balance between not enough anesthetic which will leave you in pain and too much anesthetic which can cause breathing difficulty. You will find that you can still feel all the tugging and pulling and the sensation of pressure but you should not experience any pain.

If you have had a spinal and experience a lot of pain, there will be no other option other than to give you a general aneasthetic. This is why epidural's are preferred as they can be topped up with anaesthetic as required. On the other hand, patients with an epidural have a slightly higher occurence of those monsterous headaches because the width of the catheter leaves a larger hole compared to that made with the fine needle of a spinal.
The curtain may be lowered for
 you to watch the moment your
baby enters the world.

Before you know it the bun is finally out of the oven and you get to welcome baby into the world. The Doctor's will begin putting Humpty Dumpty back together again and they are far more capable of this than all the kings soldiers and all the kings men combined. The whole procedure takes about 40 minutes from start to finish providing there are no complications along the way, however the experience is far from over.

Recovery From a Caesarean
This is the hard part. Not only have you just had a major surgery but you also have a new baby to look after. Initially, you will be wheeled off to recovery with baby in tow (providing he/she doesn't need any medical attention) where you will be kept warm and observed for about 20 minutes. Some women experience nausea as a result of the anesthesia so you may require some Maxolon (or a similar drug) at this point. Once you are given the all clear you will be transfered back to your home for the next five days on the ward. Many hospitals try to give caesarean patients a room of their own but it isn't always possible and you may find yourself sharing. This isn't always a bad thing. The last thing you need is somebody else's baby waking you throughout the night but another caesarean patient will be able to offer you empathy, encouragement and company. It also gets lonely confined to bed all by yourself.
After your surgery the wound
may be covered offer you some
extra protection.

The first day you will be heavily dependent on your nurses and the pain medication to get you through. You may be offered a light meal and will be required to stay in bed for the rest of the day. TED's will be fitted to your feet if they haven't already to ward of blood cots during this time. These are standard for the next week but cautious women will wear them for the following six weeks of limited activity during which time you are still at risk.

The following day, the catheter comes out and you are encouraged to begin walking around and take a more active role in caring for your baby. I highly recommend some support for your tummy. You may decide to purchase a bikini belt but at the very least you can also ask your nurse for some Tubi-grip to wear. The constant and even pressure not only supports your back but it help hold your tummy in place. There is no reason movement should cause the staples or sutures to rupture but you do feel very delicate and the fear of rupturing or causing yourself more pain is enough to cause you to restrict your movement - a big no-no.
A bikini belt will offer you some
 support over the following days

Tips to Speed Your Recovery

Stay ahead of the pain - You can discuss this with your nurses ahead of time, I recommend that you have your pain relief topped up every four hours or as frequently as possible. If you are in pain, you won't want to move and mobility is a vital key to healing.

Wiggle your toes - As soon as you can feel your toes again, wiggle them. Rotate your ankles, stretch your feet up and down. Do this as frequently as you remember. The earlier your start moving the earlier you will push through the pain. Movement will also ward of blood clots. You can begin light exercise the following day which involves very slow and gentle leg movements, deep breathing (which is surprisingly difficult) and lying flat while lifting your bum off the bed. All of these are very challenging but the longer you put it off, the longer your recovery. Remaining inactive is the single biggest mistake that women make to sabotage their recovery.

After my first caesarian, I was terrified that any movement would either cause me more pain or the wound to rupture. Took me months to recover. By the time I had my third, I was driving a week later (which isn't recommended by the way). I was still sore and tired and tender, but I realized that if I pushed myself a little further each day, I would get over it faster. If I stalled or limited a particular movement I would only prolong the ordeal.

Six weeks post caesarean and your
scar is  barely visible. Over the
next two years, it  will fade even more.
Request a Physio - Every hospital has them and all caesarian patients are given information about the different excersises that will assist your healing and get your body back in shape. By asking for a Phsyio to come and show you a few light exercises you will be motivated to actually do them (not just read about them) and they can also explain the exercises better in person. Technique has never been more important. Concentrate on doing the exercises correctly and frequently - as often as you remember. Whenever baby needs feeding practice taking a deep breath, rotate your ankles, wiggles your toes, try and move one leg at a time as far as you can without causing pain.

Don't push yourself - Despite what I have just said about mobility and pushing yourself through the discomfort, there is a fine line between pushing yourself and overdoing it. The absolutely vital key is to tune into your body and take frequent rests. I suppose the trick is whether you are trying to stand upright with a straight back (quite a feat at first), trying to take a deeper breath than you did last time or doing your physio, push yourself to the point where you feel a little tender and, just slowly, push a little bit further.

Your Baby Body - Most women are unhappy with the changes in their body. The weight will come and go in it's own time and you should concentrate on a well rounded and balanced diet. Drink lots of water and don't skip meals, especially if you are planning to breastfeed. Whenever you are feeling down on yourself, if you realize that you are still wearing maternity clothes six months later, whenever you don't like what you are seeing the mirror there is one and only one solution. Go and fetch your baby then go back to the mirror...now try telling me that isn't the most beautiful picture in the world!

For the following 6 weeks your activities are limited to lifting nothing heavier than your baby - which is impossible when you have prams and baths and older children that just can't be avoided. Keep this instruction in the back of your mind though, you have never had a better excuse to neglect the housework - make the most of it and rest.

If you have any queries about ceasarean's please consult your Doctor. Nurses are also an invaluable source of information - they are not only experienced with the surgery itself but they also take a more active role in caring for new mother's and babies and are positively overflowing with valuable information that they are happy to share.

I sincerely wish you all a swift and problem free recovery.

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