Preparing to welcome a new baby is an exciting yet nervewracking time of life.

One in three babies are born via caesarean in Australia. Some of these are “emergency” procedures – not planned but occurring during labour for various reasons. In other cases the need, or preference, for caesarean birth is identified prior to labour, and is a planned event.

With planned caesareans there is obviously more thought put into preparing for the exact scenario and more time to ask questions and discuss options. Even where a vaginal birth is planned some discussion can go into the scenario of unplanned c-section during labour.

 

According to new research commissioned by Johnson & Johnson Medical, many Aussie mums are shying away from important conversations with their obstetrician with close to half (46%) feeling unprepared for their planned caesarean.

Obstetrician and gynaecologist, Dr James Orford shares the key conversation topics women need to discuss with their doctor before welcoming their little one via c-section.

According to new research close to half (46%) of Australian mums feel unprepared for their planned caesarean.

1. Risk of surgical complications, and anaesthetic complications, for both this procedure and possibly future pregnancies or surgeries.

2. Potential loss of benefits of vaginal birth to mother and baby.

3. Potential benefits, or avoidance of risks of vaginal birth to mother or baby.

4. Is vaginal birth an option next pregnancy – usually a vaginal birth after caesarean (VBAC) is an option for the next pregnancy, with a small number of exceptions.

5. Timing of elective caesarean birth:

  • Balancing up the risk of labour starting and “emergency / unplanned” surgery if left till later in pregnancy
  • With the risk of special care nursery admission for respiratory issues and feeding issues, if done too early

Before your planned caesarean, ask your doctor questions to ensure your informed.

6. Type of regional anaesthesia used, this is usually a discussion with the attending anaesthetist regarding spinal analgesia, epidural , or combination of both, or rarely – general anesthesia

7. Will antibiotics be used? There is good evidence that a single dose of antibiotics, given at caesarean section, lowers the risk of uterine lining, bladder, and wound infections substantially.

8. Post operative pain management, to relieve pain and facilitate early mobilisation. Usually arranged by anaesthetist

9. Anti-coagulation post caesarean. Will blood thinners be required? This decision rests on a number of elements or risk factors, including previous medical history, the mothers age, weight, type of caesarean. Obstetricians will weigh up the decrease rate of venous thrombo-embolism ( DVT, PE) when blood thinners are used, versus the potential increase rate of bleeding, and possible wound haematoma, collection, infection needing surgical drainage and re-suturing in following days / weeks.

10. Wound closure of caesarean sections, which include:

  • Closure of the uterine incision through which the baby and placenta is born.
  • Closure of the rectus sheath layer (3rd layer down, below the skin and subcutaneous layer). This layer is the strongest layer and provides the main security of the whole abdominal wall closure. This is the main reason for the advice to avoid heavy lifting, and strenuous exercise for 6 weeks, as this is how long it takes to get a good 90% plus strength. Early severe strain on this layer of the closure may cause the layer to separate and for incisional hernias to develop, or rarely for the wound to open.
  • Skin closure – there are several methods available to close the skin layer, including metal staples, non-absorbable sutures (that need removing), absorbable sutures (that dissolve), glue. They all have some benefits and disadvantages potentially, and it is wise to discuss with the Obstetrician the options they have or prefer.
  • Wound dressing. Again, there are several options to cover the incision, with factors such as previous experience of any reactions to dressings, or risk of wound collections / infections that may guide the choice of dressing.

There are several methods available to close the caesarean wound, find out about all of them and the method your obstetrician prefers to do.

11. When can I mobilise, pick up the baby? Usually early mobilisation is encouraged, and it is safe to pick up the baby as soon as pain allows. Often the hospital physiotherapist will provide some guidance to new mums about abdominal wall and pelvic floor care and exercises.

12. When can I drive a car? There is no definitive answer to this, and advice varies somewhat. The guiding principle is that you must be able to perform all the actions of driving, such as steering, looking over your shoulder, and crucially – to break suddenly,  quickly and safely without any delay due pain from the incision, or undue fatigue from sleepless nights. This can often be around the 3 week mark, but may be sooner or longer depending on each case.

13. When can we have our next baby? There is some evidence that conceiving in the first year after birth may be associated with slightly higher rates of pre-term birth and lower birth weights. If a VBAC is desired then it is preferable to have at least 18 months from the caesarean to the following labour.

14. What time should we wake the baby for the morning feed each day – ha just joking . it will wake you!!