What to expect when you are having a caesarean birth
Unless it is an emergency and you are given general anaesthetic, caesareans are generally performed while you are still conscious, with an epidural to block any sensation of the procedure. As well as having the epidural administered to your back, there will also be a catheter inserted to drain your bladder. A drip in your arm will supply extra fluids or pain relief as needed. A heart monitor may also be used.
Even if you are being given an 'emergency' caesarean, there is often time for an epidural procedure however in a true medical emergency the procedures may need to be carried out within minutes, simultaneously by multiple caregivers. The woman will need to have a General anaesthetic (making her unconscious) for adequate pain relief. This is because there is usually not enough time to administer an epidural or wait for a 'top up' of more epidural anaesthetic (if one is already in place) to take effect in time for the operation.
In an emergency situation the woman can feel like she is being attended to from all angles and asked numerous questions, but having little chance to have her own questions answered. The partner or support person can feel a little helpless and overwhelmed, watching all the procedures take place so quickly, while trying to come to terms with what is happening. In these circumstances, it is good for the partner to stay close with the woman, try and stay calm and be guided by the caregivers
Who is there
Once the actual operation commences, there will be many people in the operating room. These can include an anaesthetist, surgeon (either your private obstetrician or the hospital obstetrician or a senior obstetric registrar) , An assistant for the surgeon (usually another more junior doctor such as a resident or a registrar, training in obstetrics), a scrub nurse, an anaesthetic nurse, the midwife, and a paediatric resident or registrar or specialist. If you are having twins or more, there may be 3 to 4 extra personnel added to the above.
NOTE: The partner or support person would usually be asked to leave the operating theatre if the woman was given a general anaesthetic.
Sensations for the woman
If the woman is having an epidural or a spinal anaesthetic, then she will be awake, hear noises and feel sensations but should experience no pain. Women who experience a Caesarean with an epidural (or spinal) often talk about their body feeling like it is a warm, heavy, 'dead' weight, from the waist down. Many women say they can feel movement and unusual 'rummaging' sensations in their belly as the baby is being manoeuvred for the birth and some liken the incision to someone 'drawing' on their skin, but that it was not painful.
Rarely, the woman will feel that she is not tolerating these sensations or that there is some pain. In this situation it is possible for the anaesthetist to give a general anaesthetic very quickly, or more medications down the epidural catheter, if needed. It is important to know that this is possible as it can allow the woman to feel some control over the situation.
Be aware that many of the sensations you feel will be momentary and will usually pass within a few seconds.
The most preferred technique used to deliver babies is the 'Lower Segment Caesarean Section' (or LSCS) which is a low transverse or horizontal incision in the lower segment of the uterus. The 'Classical Caesarean' (CS) is an incision made higher up in the middle of the uterus into the upper segment of the uterus. This option may be used in some special situations eg a true emergency, a transverse position, multiple babies or a very premature baby. On rare occasions a low vertical caesarean may be carried out.
Below is a description of a LSCS operation - the most common type.
The first cut is made through the skin, horizontally across the top of the woman's bikini line just under the pubic hairline. The incision is usually about 15 to 20cm long. The abdominal muscles are gently pulled to each side of the woman's body by the surgeon. This action exposes the woman's bladder, which sits low, in front of the uterus. The bladder is moved down out of the way with an instrument called a 'retractor' and the lower segment of the uterus can then be visualised by the surgeon.
At this point a 10 to 12 cm incision is made horizontally, across the lower segment of the uterus (usually similar to the incision on the skin). When this happens the amniotic fluid from around the baby gushes out. The surgeon's assistant will use a small suction tube to collect this fluid as it flows out (this may be heard as a loud liquid 'sucking sound', similar to the sound you would hear as the bath tub empties).
After the incision is made into the uterus, the baby's shoulder (or lower back if breech) can clearly be seen in the uterus. The baby's head (if full term and in a head down position) is usually at a level lower than the incision, engaged in the woman's pelvis. If the baby is breech, often their bottom is engaged in the pelvis. The surgeon will use either their hands or a set of small 'lift out' forceps (forceps are not used on a baby's bottom if the baby is in a breech position, in this case the hands are used), to bring the baby's head (or bottom) up and out of the woman's pelvis and through the incision. This can require some pressure and movement from the surgeon, which the woman is often able to sense if awake.
Once the baby's entire body leaves the uterus, this is documented as the time of birth.
Unless there are any problems with the baby, your partner is allowed to hold your newborn almost straight away. About thirty minutes later, once the placenta has been delivered and the incision closed up again, you will be able to as well.