Preparing for birth can be exciting, but you may also feel a bit anxious especially if it is your first baby.
In the following web pages we have outlined some of the things you may need to know about preparing for the birth of your baby. The information includes the difference between pre-labour and true labour; what to expect if you need an emergency caesarean section; treatment for streptococcus B and raspberry leaf tea.
We hope you find the information useful, that it addresses many of the questions you may have at this stage of your pregnancy and helps you begin to prepare for the birth of your baby!
Having a caesarean section
What is a caesarean section?
A caesarean section is a surgical procedure to deliver a baby by making an incision into the mother’s lower abdomen and uterus.
There are two kinds of caesarean section an emergency caesarean and a planned caesarean section, often referred to as an elective caesarean.
The difference between the two types is essentially when the decision to have a caesarean is made. An emergency caesarean is when the caesarean is not anticipated during the pregnancy and is required after labour has begun. A planned caesarean section is anticipated during the pregnancy and able to be scheduled prior to labour commencing.
A planned caesarean section is termed as an elective procedure because it is scheduled and not an emergency. Many people confuse the medical category of “elective” as meaning a preferential decision rather than a caesarean section which is medically required; this is not the case.
Who may need to have caesarean section?
A woman may be advised to have a caesarean section to deliver her baby if her health or the health of her baby may be at risk during a natural birth. For some of the conditions listed below a caesarean section may be the only option. However, depending on the condition and your specific risk factors a vaginal delivery may be possible. Your doctor can give you specific advice.
Some reasons a woman may need to have a caesarean section include:
- if her placenta is covering her cervix, known as placenta praevia;
- if she has preeclampsia or eclampsia;
- if she has diabetes;
- if she is morbidly obese;
- if she has had heavy bleeding during pregnancy;
- if the placenta is not functioning well and restricting oxygen or nutrients to the baby, known as intrauterine growth restriction;
- if her uterus has ruptured;
- if she has had a previous caesarean section;
- if induction of labour has failed;
- if she has an infectious disease, such as active herpes, AIDS or HIV;
- if a previous vaginal birth has been traumatic;
- if she is not able to cope with labour;
- if her baby is too big to pass through their pelvis;
- if her baby is not in a suitable position for a vaginal delivery;
- if her baby is distressed and if continuing a vaginal delivery may lead to more distress;
- if her labour is not progressing, and
- if it is a multiple pregnancy.
Are caesarean sections dangerous to me or my baby?
There are always risks associated with any surgical procedure; however there are rarely complications with caesarean section deliveries. If your doctor recommends a caesarean section it is because they have identified risks to you or your baby which outweigh the risks of the surgical procedure.
Could my partner be present at the caesarean section birth?
Most hospitals try to accommodate partners being present during a caesarean delivery. Most caesarean sections are performed under local anaesthetic and partners can be present. However, if you require general anaesthetic they may not be able to be in the theatre. Also, in some emergency caesarean cases, due to the urgency or complexity, your partner may not able to be present. Medical staff are aware of the importance of having partners present for such a momentous occasion and do not restrict partners being at the birth of their baby unless there are very important medical reasons.
What kind of anaesthetic would I be given during the operation?
Most women only need to have an epidural or spinal block and can therefore still enjoy the birth of their child. Occasionally women may need to have general anaesthetic, if an epidural or spinal block may not take effect quickly enough, although this is rare.
Can you describe what will happen during the procedure?
First a drip will be placed in your arm. Next, you would be given an anaesthetic and then a catheter will be placed into your bladder to drain your urine. When you are ready for the procedure to begin a large drape will be hung across your chest, so that you and your partner do not have to watch the procedure but can still enjoy the birth of your child. During the procedure it is normal to feel sensations of pushing and pulling, however you will not feel any pain.
How much time does the operation take?
Typically a caesarean section takes approximately 40 minutes. The birth of the baby is relatively quick, usually occurring only five to ten minutes after the surgery begins. Most of the time required for the procedure is for stitching the layers of uterus and abdominal muscle after the baby has been delivered.
When could I hold my baby?
Ideally once the umbilical cord is clamped and cut the baby can be given to you for your first cuddle. A nurse would then take the baby for general tests, which take approximately ten minutes. Depending on the hospital, the baby may then stay with you in the recovery room or be taken to the postnatal ward with your partner while you begin to recover.
How much time does it take to recover from a caesarean section?
The recovery period after a caesarean section varies for each individual, but can take between six weeks and six months. Immediately after a caesarean section most women feel a degree of discomfort and pain relief is available. The woman would also have a drip and a urinary catheter in place for at least 24 hours after the surgery and often the epidural will be kept in place for up to 48 hours.
Women who have a general anaesthetic may feel fairly ‘groggy’ afterwards and may find it difficult to focus on their baby, this is quite normal. After a caesarean section women require plenty of rest and your doctor may recommend some gentle exercises to help with your recovery.
How much time would I need to spend in hospital?
Usually women who have had a caesarean section stay in hospital for approximately five days to recover. This may vary depending on your recovery rate.
When can I begin breastfeeding after a caesarean section?
Most hospitals encourage breastfeeding as soon as possible after delivery. You may be able to begin feeding your baby in the recovery room or when you arrive in your room on the postnatal ward. Staff will support you and ensure that you feel comfortable during feeding.
Is it normal to feel emotional after a caesarean section?
Often women feel highly emotional after birth and these emotions can be compounded if they have also had an unplanned surgery. It is important to talk about these feelings. Your doctor and staff on the postnatal wards are there to support you.
If I have a caesarean section once, does it rule out having future vaginal deliveries?
Not necessarily. Depending on the reasons for having a caesarean section in the first place, you may be able to have a vaginal birth for future deliveries; this is referred to as a vaginal birth after caesarean section (VBAC). Your obstetrician will be able to discuss your particular risks for future deliveries.
Going into labour
How do I know if I am in labour?
You will start experiencing contractions which last for 30 to 60 seconds and occur every ten minutes or less. The contractions do not ease when you lie down and it becomes difficult to talk through the contractions.
What is pre-labour?
When your body begins to show signs of labour it is known as pre-labour or false labour. You may pre-labour for several hours, days or weeks before true labour begins. Pre-labour may stop completely or gradually increase to become true labour.
Some signs of pre-labour include:
- contractions that are irregular and sometimes painful;
- contractions that may be hardly noticeable, while others may make you stop what you are doing;
- contractions that can be felt in your abdomen, groin or lower back;
- contractions that tend to slow down when you lie down and rest;
- contractions may occur every two to three minutes and at other times be 10 to 15 minutes apart, and
- a mucous discharge that can be clear, pink, red or brown in colour. The discharge is from the mucous plug that has sealed your cervix. This discharge is known as a ‘show’.
When should I go to the Hospital?
It is best to develop a plan for when you should go to hospital with your doctor during your pregnancy. It is generally recommended that you phone the hospital or your doctor before you go to the Hospital so your stage of labour can be assessed.
There are some factors which may require urgent attention including:
- if you are less than 37 weeks pregnant and your membranes have ruptured, you experience vaginal bleeding or have contractions, and
- if you are more than 38 weeks pregnant and you have bright coloured bleeding.
What can I do to ease the discomfort of pre-labour?
There are a few simple steps you can take to help ease the discomfort of pre-labour. Some of these steps include:
- eating and drinking as normal. If you feel nauseous eat small meals frequently and drink water or diluted fruit juice;
- continuing with your normal activities. If you are pre-labouring during the day take a gentle walk or swim, but do not tire yourself;
- trying to rest well at night. If you are not allergic to paracetamol try taking two before you go to bed;
- having a warm bath, or
- using a heat pack on your back or abdomen.
Vaginal birth after caesarean (VBAC)
After a caesarean section women may want to experience a vaginal birth and others may feel more comfortable having another caesarean and knowing what to expect. It is possible for most women to have a vaginal birth after a caesarean section for a previous birth, depending on the reasons for the caesarean.
Your doctor can discuss the specific reasons you needed a caesarean section and if it will also impact future births. They can advise you on the medical pros and cons of each option and discuss your specific risk factors. You need to consider the risks in the current pregnancy; plans for further children and the likelihood of achieving a vaginal delivery. The decision is a personal one for you and your family to make in consultation with your obstetrician.
What are the advantages of a VBAC
There are a number of advantages for vaginal birth after caesarean including less post partum pain, less analgesia and earlier skin on skin contact with baby. Birth can take place outside of an operating theatre and may feel more relaxed and natural.
What are the risks for the mother of a VBAC?
The scar in the uterus from the previous caesarean section is a site of potential weakness, particularly during the contractions of labour. This potential weakness may result in a uterine rupture, which is when the uterus tears and bleeding results. The risk of a uterine rupture is approximately 0.5%. There is also a 0.05% risk that an emergency hysterectomy will be needed.
What are the risks for the baby of a VBAC?
There is a greater risk of a baby dying during a VBAC compared to a planned caesarean delivery. This risk is approximately 0.18%. This is partly due to the increased risk of delivering a baby vaginally after 39 weeks gestation, compared to before 39 weeks with a planned caesarean.
Are there any factors that make a VBAC more risky?
The risks associated with a VBAC are increased if:
- labour is induced;
- there is less than 18 months from the last birth;
- there has been more than one previous caesarean section
- inducement or augmentation of labour
- the baby weighs more than 4000g, and
- the mother is obese.
It is also worth noting a previous vaginal birth reduces the risk of a uterine scar rupture.
Are there risks in having another planned caesarean section?
All surgical procedures, no matter how routine, do have inherent risks. A caesarean section is a major surgery and does carry risks associated with anaesthesia, infection, blood loss, respiratory complications and for the baby there may be injury and complications with anaesthesia. Your doctor can discuss these risks
It may be important for you to consider how many children you would like to have, as there can be increased risks of a complication known as placenta accreta and placenta praevia with ongoing caesarean sections.
Placenta praevia occurs when the placenta covers the cervix, which obstructs normal birth, and causes significant bleeding.
Placenta accreta occurs when the placenta binds to the previous uterine scar and does not separate after the birth. It has been reported that placenta accreta increases with each caesarean section birth for example:
- 24 per cent for the first birth;
- 31 per cent for the second;
- 57 per cent, for the third;
- 1 per cent for the fourth;
- 3 per cent for the fifth and
- 7 per cent for the sixth birth.
What are the chances of a successful vaginal birth after a caesarean section?
Most studies show there is a 60 to 80 per cent chance of having a successful vaginal birth after a single previous caesarean section.
Can I have baby in any hospital?
All women electing to labour after a previous caesarean section should deliver at a hospital where there is ready access to the range of obstetric and neonatal services; your doctor can discuss which hospital is appropriate.
Are any special precautions needed during labour?
It is recommended the baby’s heart is closely monitored during labour with an electronic fetal monitor to detect any signs of distress.
It is also recommended you have an intravenous line inserted and ready to be used in case of an emergency during the labour. Blood can be taken from the line for an antibody screen and to determine your blood group. You should not eat and only drink clear fluids during the labour, in case an emergency caesarean section under general anaesthesia is required.
Inducing labour with a drip of syntocinon should be used with caution. While good evidence is lacking, mechanical methods of cervical ripening may be preferable to pharmacological methods.
There is little evidence that an epidural is harmful during a VBAC and this should be readily available in the absence of contraindications.
Careful assessment of progress in labour is needed with vaginal examinations at least four-hourly in the active phase of labour and more frequently as full dilatation approaches. The cervix should dilate at least at 1cm per hour in the active phase of labour and second stage should not exceed an hour in duration, unless birth is imminent.
What is the best decision?
This decision is best made by the woman and her family in consultation with her obstetrician. Each woman will have different risk factors and will view the risks associated with a VBAC differently. Some women may view the risks to the baby to be too great and some may see the risks as acceptable.
Home births and birth centres
Birth is a natural process and women give birth all over the world every minute of every day.
In Australia we are fortunate to have a very high standard of obstetric care and a world class health system to support women during birth and manage complications during the birth process so that both mother and baby are likely to enjoy a safe birth experience. Due to the medical care in Australia the mortality rates for both mother and baby are very low. Even within ten years the risk of a baby dying during late pregnancy and the first 30 days of life (perinatal mortality) has decreased from 1.07% in 1992 to 0.8% in 2002.
While there are clear advantages of modern medicine, some women choose not to give birth in a hospital surrounded by medical care and prefer to remain in the comfort of their home. It is important that women who choose to give birth without medical care available understand the associated risks to them and their baby.
What is a birth centre?
A birth centre is staffed by midwives and generally aims to creating a home-like environment where women can give birth. Some birth centres are within hospitals and others are stand alone facilities.
Stand alone birth centres may be a considerable distance from medical care, requiring the woman and baby to be transferred if complications occur. Many state government health services are allowing maternity units to remain open without medical support being available on site due to workforce and infrastructure constraints. Increasingly health services are unable to provide obstetricians and infrastructure such as operating theatres and newborn intensive care in metropolitan district hospitals, much less in rural and remote locations. It is important for women giving birth in these facilities that they are aware of the restrictions and lack of medical support available to them.
Who can use a birth centre?
Women who are assessed as being low risk are able to book into a birth centre. Women who have risk factors associated with the pregnancy or birth are generally not accepted and referred to a hospital where more appropriate care can be provided.
Unfortunately an issue with risk assessments during pregnancy is that more than 70% of women who develop complications have no risk factors during their initial assessment.
What are the risks associated with birth centres and home births?
A recent report by the Western Australian Department of Health in 2010 showed that the death rate of babies born at home was almost four times higher than those delivered in hospitals. It also found the risk of babies dying because of lack of oxygen was 33 times greater in planned home births.
Associate Professor David Mountain, who is the Australian Medical Associations Western Australian President, said in a hospital setting these babies could have been saved by performing a caesarean section or delivering the baby by vacuum extraction or forceps, operative procedures midwives are unable to perform.
Another study in the Netherlands, published in the British Medical Journal in 2010, showed low risk women whose primary health care providers were midwives at home or in hospital had a higher risk of their baby dying compared to women who were cared for by obstetricians.
This result is surprising, considering high risk women inherently have more risks of their baby dying than low risk women.
Of most concern was that women who were transferred from midwifery care to obstetric care during labour had a more than 3.5 fold higher risk of their baby dying compared with women who started their care with an obstetrician. They also had a 2.5 fold increased risk of their baby needing admission to a Newborn Intensive Care Centre (NICU).
The study from the Netherlands is statistically significant considering approximately 30% of all births there are home births, compared to only 2% in the UK or 1% in Australia.
An Australian study in 2004, known as the Cochrane Review, found evidence of higher risk of perinatal death in birth centres by a factor of 3 to 7, with only modest reductions in some medical interventions. Stand alone birth centres and home births have as great, or greater risks, as transfer to another location is required with the inherent delays of transportation of a woman in labour by ambulance.
The authors of the study observed “the trend toward higher rates of perinatal mortality… raises important questions. A focus on normality may have a negative impact on carers and childbearing women to detect, act upon and/or receive assistance with complications.”
Due to the inherent risks of labour and birth for both the mother and baby NASOG does not recommend home birth or stand alone birth centre birth. For women who do want a home-like birth, it encourages them to consider a birth centre within a tertiary hospital, where they have quick access to medical care if required.
This information is provided as general information only. It is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Always see your doctor regarding your personal health matters. © National Association of Specialist Obstetricians & Gynaecologists 2010