When planning for your birth, you must consider your options; an attempt at vaginal birth, which may or may not result in an emergency caesarean, or choosing to have a caesarean, also called a Caesarean Delivery on Maternal Request. Charlene Yared West spoke to Dr Jacky Searle, an obstetrician-gynaecologist at Life Vincent Pallotti about the risks and benefits of caesarean section. 

Reasons for a planned caesarean include: 

• Placenta praevia (a low-lying placenta)
• Breech presentation
• Previous caesarean section 
• Previous shoulder dystocia 
• An elective caesarean delivery, also called Caesarean Delivery on Maternal Request (CDMR) in the absence of a medical or obstetric reason for avoiding a vaginal birth.

Reasons for an emergency caesarean include: 

• Cephalo-pelvic disproportion (baby’s head does not fit through the mother’s pelvis) 
• Fetal distress
• Congenital malformations of the baby
• Pelvic abnormalities
• Infection of the mother
• Situations where labour isn’t recommended such as; eclampsia (seizures resulting from high blood pressure) or prematurity of the baby

BEFORE: Preparing for a Caesarean

“For a scheduled caesarean, a protocol is followed, which includes not eating or drinking for six to eight hours before surgery and shaving the bikini area where the incision will be made.” Says Dr Searle. “On arrival at hospital, there are forms to fill out and the anaesthetist will meet you and make a pre-operative assessment before surgery. You will also meet the attending paediatrician shortly before the procedure.” Dr Searle adds that women may choose to have a doula to accompany them for their caesarean. “She will often arrive with you at the hospital and pamper you before going into theatre. This can help a mother relax and connect to her baby and the imminent birth.”

In the case of an emergency caesarean, the surgery is usually done within 30 minutes of the decision being made. The mother will be accompanied by her partner, and her doula, if she has one. “This can be stressful, and even traumatic for the parents, but an adequate explanation of the necessity of the caesarean should always be provided, enabling them to understand and process the experience. All pregnant women should understand that the outcome of labour is unpredictable, but a caring team can support her through the process of childbirth and help her to feel cared for and held throughout.”

DURING: In theatre for a caesarean

In theatre, the mother will have a drip inserted and anaesthesia is almost always regional (awake) – either spinal or epidural. A urinary catheter will be inserted once the anaesthetic is working. “Women, especially those who have not chosen a caesarean, are often pleasantly surprised to find that caesarean birth can be a truly beautiful experience for a mother and her partner,” says Dr Searle. 

A gentle caesarean

A ‘gentle caesarean’refers to minimising the medicalisation of the process where possible and enhancing the gentleness. “I am proud to say that this is routine at Life Vincent Pallotti,” says Dr Searle. 

A gentle caesarean includes;

• Limiting unnecessary noise and chatter
• Dimming the lights, playing the mother’s choice of music
• Not removing the baby from its mother after birth
• Early skin-to-skin contact and early latching 

AFTER: Post-recovery form a caesarean

A regimen of analgesia will be prescribed to ensure that any post-operative pain is manageable, explains Dr Searle. “Mothers generally recover well post-caesarean, as they are motivated to get up and moving, and are distracted from post-operative discomfort by their baby! Breastfeeding is encouraged and assistance is provided for all new mothers in the maternity wards at all Life Healthcare hospitals. Mothers usually stay in hospital for four days/three nights after a caesarean section,” she says. 

VBAC: Vaginal Birth After Caesarean

“It is appropriate for any woman who has a single pregnancy, with a baby in the head down position, and who has had one previous lower section caesarean, to consider a VBAC,” says Dr Searle. “A successful VBAC is more likely in women who have also had a previous vaginal birth, taller women, women less than 40 years old, where labour occurs before 40 completed weeks, and where birth weight is less than 4kg.”

<Case Study>

Sam Suter’s empowering emergency caesarean

I had always wanted a natural birth, although I am hesitant to use that word now, as no birth is unnatural. A birth is birth, no matter how a baby comes. At 39 weeks pregnant, I was induced to attempt a vaginal birth, because my blood pressure reading was climbing and continued to increase to dangerous levels. This was around at 10am in the morning and at 10pm at night, although contractions had begun, they were ever so slight and my blood pressure was rising. The decision to have a caesarean was made because of the risk of a stroke.

 I believe all birth experiences have an element of trauma, and this is all part of it – but for me the euphoria and the memory of seeing Tom for the first time, far outweighed any trauma. What I didn’t know is that even if you’ve had a caesarean, nature takes over and the ‘love and bonding’ hormone oxytocin is released – in both mom and baby. I was definitely feeling the oxytocin and looking back, the experience is such a happy one. Happy is in fact not the word to describe it… It was the most incredible human experience I have ever had. 

The whole birth experience was not ‘perfect’ or how I had envisioned it, but I had to go with the flow, what was best for my baby and I, and I think that is a huge learning for parenthood overall.