Caesarean Section

This article provides an overview of Caesarean section – why they are performed and the risks and complications associated with Cesarean section.

If you want to read more about the operation, the before and after, what it involves and what it feels like, check out Caesarean in Detail.

Caesareans have become an almost common place way of giving birth today – while only 50 years ago it would have been quite unusual.

In 1984 the caesarean section rate in New Zealand was just 9.6%. By 2014 this had increased to 25% of all births in that year. And the actual figure could be even higher. The caesarean section rate at Auckland hospital was almost 35%.

The unusual name for this childbirth delivery procedure is linked to its history – it is associated with Julius Caesar, although it is highly unlikely that he was born this way, as his mother outlived him (in those days the operation was only done to save the baby when the mother had no chance of survival!).

There are several terms for the procedure – Caesarean, C section and Caesar. All refer to a Caesarean section and in your maternity notes you may see LSCS, which stands for Lower Section Caesarean Section.

So what is a Caesarean section, why would you have one and what are the risks and complications?

What is a Caesarean Section?

This is major abdominal surgery to deliver a baby (or babies) through the wall of the lower womb and abdomen.

Here are some common terms you will hear in relation to Caesareans:

• LSCS (a Lower Segment Caesarean Section) – usually in New Zealand today, the skin incision will be made just under the bikini line, through the abdominal muscle and then the lower segment of the womb.
• Classical incision – previously the incision was done down the centre of the abdomen, leaving a long scar and higher risk of complications.
• Elective Caesarean Sections are planned in advance and are done before labour has started.
• Emergency Caesarean Sections are done after labour has started when it proves difficult or impossible to deliver the baby through the birth canal.
• Crash Sections are done because of obstetric emergencies, such as haemorrhage or foetal distress when either the life of the mother, baby (or both) is at risk.

Why would I have a Caesarean Section?

There are many reasons why a woman may be advised or may choose to have an elective or emergency caesarean section. Each birth is unique and decisions should be made on an individual basis, involving women, their maternity professionals and their family/ whanau.

These are the most common reasons for caesarean sections in New Zealand today, the medical terms and their explanations:

• Fetal distress – the baby not coping with the labour (they get a reduced blood supply from the placenta during contractions, which most babies cope well with, but some do not).
• Failure to progress – despite contractions, the cervix does not open and the baby does not move down the mother’s pelvis.
• Mal presentations – the baby’s head is not coming first, it may be bottom first (breech) or shoulder first (this is rare).
• Haemorrhage – a dangerous amount of blood loss could occur in pregnancy (ante partum haemorrhage) or in labour (intra partum haemorrhage).
• Failed induction of labour – if the induction does not result in you going into labour, you could end up needing a Caesarean section. For further information see the Kiwi Families article on Induction of Labour.
• Obstetric emergencies – such as cord prolapse (the umbilical cord comes down in front of baby’s head, potentially cutting off the blood supply to baby) or rupture of the womb itself. Despite the impression we get from TV hospital dramas, these emergencies are uncommon.
• Previous caesarean section – which sometimes is an indication to plan a caesarean for the next birth.
• Problems in pregnancy such as severe pre-eclampsia – a disease of pregnancy which presents as raised blood pressure, protein in the urine and swelling of hands, feet and face, which may make labour inadvisable.
• Placenta praevia – the placenta is covering the opening at the bottom of the womb (the cervix) making it impossible to birth the baby vaginally.
• Previous complicated vaginal delivery – for example, if you have had a severe tear or difficult forceps delivery with a previous birth, a Caesarean section may be advisable.

What are the risks and complications of Caesarean Section?

Any operation has risks and complications, the main ones are:

• Haemorrhage – loss of a large amount of blood, sometimes requiring a blood transfusion.
• Infection – either transmitted during surgery or afterwards, requiring antibiotics.
• Blood clot or thrombosis – due to the immobility around the time of the operation.
• Wound breakdown – after the operation.
• Breathing problems -the baby has an increased risk of breathing problems if born by Caesarean section, as their lungs have not had some of the fluid squeezed out, as they do in vaginal birth.

Whilst the staff will do everything they can to minimise these risks, it is not possible to prevent them in all cases.

What can I do?

Firstly, minimise your chances of having a caesarean birth – keep fit and healthy, eat well and take advice from your Lead Maternity Carer in pregnancy about posture and baby positioning to aid a normal birth.

Ensure you have had the opportunity to explore your options for the birth with your health professionals; for example trying to avoid repeat caesarean sections, by attempting a vaginal birth first.

If you are anaemic in pregnancy (your routine blood tests will tell you this) ensure that you take your iron tablets, with vitamin C to help absorption, to prevent your risk of haemorrhage.

Stay mobile in labour as much as possible, to aid your labour and to prevent the complications of blood clots. Do gentle leg exercises and take deep breaths every ½ hour or so, if you are confined to bed.

Keep any wounds scrupulously clean and report any redness or swelling to your LMC immediately.

To read more about a caesarean section, and the pre and post op procedures, check out Caesarean in Detail. You’ll also want to take a look at the first 24 hours after a c-section. And we also provide information on vaginal birth after a caesarean section (VBAC).