• clinical negligence - caesarean claims

Elective Caesarean Section Delivery

What is a Caesarean Section?

A caesarean section or a C-section is an operation to deliver your baby through an incision made in your abdomen and womb. The cut is usually made across your abdomen, just below your bikini line however in emergency situations the incision may be vertical.

It may be a planned (elective) procedure or done in an emergency.  It is an operation that carries a number of risks and benefits, which your obstetrician should discuss with you in good time so that you are well-equipped to make an informed decision as to whether this is right for you and your baby.

The proximity to birth will dictate the detail of the discussion, so it is recommended that the mode of delivery is given early consideration so that you may discuss your options and have time to think about it.  There are also logistical considerations as not all maternity units are equipped or able to perform caesarean sections and it may require you to be referred to a different maternity unit.

If there is a chance that an emergency caesarean section may be required, again the earlier the benefits and risks are discussed the better as in the moment there may be little or no time to do this or you may not be in a state of mind to absorb what you are being told.

Weighing up how to bring new life into this world at the 11th hour whilst: in pain, sleep-deprived, on strong medication and anxious is best avoided.


How Common is it?

Between 20% and 25% of mothers have a caesarean section delivery, according to the NHS.  Whether you should have a caesarean section is individual to you and your baby.

Legal Rights

Doctors will not recommend a caesarean section unless they consider it is necessary for medical reasons.  However, if you are certain that you do not want a vaginal birth and understand the risks of a caesarean section and the impact on future births, you can ask for a caesarean section.  If your consultant does not feel that they can support your decision, you can ask to be referred to another consultant or, if necessary another maternity unit.

Doctors must ensure that your informed consent as to the mode of delivery is obtained.  Failure to do so would constitute negligence unless you were unable to provide your consent, (e.g. unconscious).

Making an Informed Decision

It is important to be aware of the possible complications of having a caesarean section and these include:

  • Infection of the wound or womb lining;
  • Blood clots;
  • Excessive bleeding;
  • Damage to nearby areas, such as the bladder or the ureter;
  • Temporary breathing difficulties for your baby;
  • Accidentally cutting the baby when your womb is opened.

One of the benefits of having a planned caesarean section means that you know when your baby will be born; this can help if you suffer from anxiety or if you have other children you can arrange childcare in advance.

Other benefits include:

  • You won't have the pain of contractions to contend with;
  • You won’t have to worry about tearing to the perineum;
  • You are less likely to experience heavy bleeding in the days following the birth;
  • You are less likely to suffer stress incontinence (leaking urine);
  • If you are expecting a large baby a caesarean section avoids the risk of the shoulders getting stuck during delivery (also known as shoulder dystocia).

These lists are not exhaustive and are no substitute for a proper discussion with your consultant as everybody is different, including individual risks and wishes.  The risk to one mother of developing blood clots can be very different to another depending on their medical history.

What to Expect

If you are considering a planned caesarean section you should know what to expect.

Before the procedure takes place you will be given an epidural or spinal block, this means that you will be awake but the lower half of your body will numb so you won’t feel any pain, but you may feel some tugging.

You can be accompanied by one person and they will be asked to sit by your head. If you have a general anaesthetic, you will not be awake and you will not be allowed to have anyone accompany you.

During the procedure a screen will be placed across your body so you will not be able to see what is happening, but the doctors and nurses should let you know what is happening. An incision about 10-20cm long will be made in your abdomen and womb so that your baby can be delivered. Once your baby has been delivered you and your birth partner will be able to see and hold your baby, all being well.

Once you have met your baby and enjoyed a few moments together, you will be stitched up and you and your baby will be taken for recovery and monitoring. 

Recovering from a caesarean section usually takes longer that recovering from a vaginal birth and you may need to stay in the hospital for a few days. You will need to take things easy at first and you may experience some discomfort. You may also need to avoid some activities such as driving for six weeks or so.

As the wound heals it will eventually form a scar. This may be red and obvious at first, but it should fade with time. 

Stigma

With up to 1 in 4 mothers having a caesarean section birth and a large amount of those being planned, the associated stigma is starting to fade. However, there are still a number of people who view caesarean section as taking the easy way out.  The stigma of having a caesarean section should not stop you from making the right decision for you.

It is your right to choose your mode of delivery and your request should be dealt with professionally, with the associated risks and benefits of all options having been discussed in full.  Working together with your consultant and healthcare team should facilitate you reaching the right decision together.

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