Caesarean Delivery

When discussing caesarean section rates, it is important to consider the different reasons for such a procedure. You can divide these different reasons into the following categories:
When comparing Obstetricians or Hospitals, with respect to caesarean section rates, only Emergency rates should  be used (and then cautiously). For example: If my total caesarean section rate is 30% and a hospitals rate was 25%, you might conclude that I had a higher rate. However, if I have a large number of elective caesareans because of maternal choice, the actual emergency rate might only be 10% compared to the hospital which does not perform any elective caesareans at maternal request. Different specialists and hospitals have different clientele, but usually the labouring women are fairly similar.

Emergency Caesarean Section 15 - 20% of my patients, who labour, will require delivery by caesarean section because of events which occur in the labour. This compares favourably with an expected 10-20% rate across a number of studies.

Medically Indicated Elective Caesarean Section
A caesarean section may be required, prior to the onset of labour, for the management of known or suspected medical problems, e.g.
Social - Elective Caesarean Section This is where a women chooses to avoid labour and potential vaginal delivery. Her reasons for this are always discussed and these women are always given information regarding the potential risks and benefits of BOTH vaginal and caesarean delivery. In some ways it is the ultimate choice. Elective Caesarean Section is a safer procedure than an Emergency Caesarean Section. This is due to the lower risk of infection and the more controlled atmosphere, BUT problems may still occur.
Caesarean section can be done under a general anaesthetic or regional anaesthetic (Epidural  or Spinal). These will be discussed at one of your antenatal classes. The majority of women will be awake for the caesarean (Epidural or Spinal), so your partner will also be in the operating theatre to share the experience.
While the vast majority of women are fine, the following difficulties may arise and can be mildly annoying though very unpleasant to potentially lethal:

Because it is a major operation there will be physical restrictions to what you can do after you leave hospital.You can usually drive within a week of returning home if:

you can drive, have a licence and do not have significant pain that prevents you from driving effectively.


What to expect on arrival to the maternity unit: You will be given instructions to shower. The Anaesthetist will usually see you in your room prior to surgery but this can vary with the degree of urgency of your case and how late the Anaesthetist is running.

A porter / orderly / nurse will take you to the theatre area in a wheelchair or on a bed. Dads usually go with you and will be advised where and how to change into theatre gear. Another nurse will meet you in the theatre and confirm your details, following which you will wait on your bed in the anaesthetic bay for the theatre to become free ( or for us to finish our cup of tea). These days, a spinal anaesthetic is usually inserted for elective cases and emergencies. If an epidural is already present and working, this will be "topped up" and the operation performed under epidural.

When the epidural / spinal is "in" then you lie down and a catheter is inserted into the bladder. Women who come from labour ward with an epidural will usually have a catheter inserted already.
The belly is washed with a cleaning solution, usually betadine, unless you have an allergy to seafood or iodine. Special drapes are placed on the abdomen and a screen is placed between the anaesthetic area and the surgical area. We call this the blood-brain barrier.
We always test the effectiveness of the anaesthetic block before starting to cut.

The baby will be delivered between 10 seconds and 5 minutes after starting, depending on the urgency of the case. After a quick check to ensure there are no breathing issues, you will be given the baby for skin to skin and can feed if you would like to do so. Meanwhile, the procedure continues and dad is taking photos of the baby/s and everyone is chatting madly. It can be a bustling and happy place.

After you have been put back together, Dad will take the baby to be weighed and will join you in the recovery area with your baby. 

You will stay in this area for about 30 minutes before going back to the ward.
These steps will be much the same for an emergency caesarean.