I have with us Cassie Phillips, a labor and deliver nurse who has so kindly offered to contribute a guest post sharing with us what happens during the C-Section preparation phase. Cassie will also be discussing why C-Sections most often occur, the differences between planned, unplanned and emergency C-Sections and a few details about having a C-Section that you may not already know.
Take it away Cassie…
It doesn’t matter if this is your first baby or tenth; first c-section or seventh, every delivery is different. As a labor and delivery nurse I’ll share with you my experiences with regard to C-Section preparation and I encourage your questions below.
Why Do I Need a C-Section?
There are many reasons you may need a c-section and depending on why you need a C-Section will determine whether it is planned or unplanned.
So let’s first look at the legitimate medical reasons to have a C-Section.
Reasons for a Planned C-Section
1. Breech baby. This is one of the main reasons for a planned primary c-section. If the baby is breech, frank breech, or basically any position except head down, you will need to have a c-section. The doctor can try to do an external version to rotate the baby, but this is uncommon, especially if it is your first baby.
2. Placenta previa. This is a condition in which the placenta covers the cervix. When placenta previa occurs your cervix cannot dilate without detaching the placenta, which can be life threatening for both mom and baby. The safest alternative is a c-section.
3. Previous c-section. If you had a vertical incision or classical incision with your first c-section you will have to have a c-section with each baby. If your incision is along your bikini line you may be a good candidate for a Vaginal Birth After C-Section (VBAC), but you need to discuss this with your doctor first.
4. Elective c-section. Some mothers opt to have a c-section for personal reasons. This is discouraged, but you can talk to your doctor about your options.
5. Infections. If you have a sexually transmitted disease such as HIV or genital herpes, you will need to have a c-section to prevent your baby from being infected.
6. Multiple Births. Some doctors will delivery twins vaginally, but more than 2 and you will most likely have a c-section.
7. Mother’s medical condition that may warrant a c-section. There are medical conditions that can cause you to need a c-section. Pre-eclampsia is one condition that some doctors will not allow you to deliver vaginally. If you have had previous surgeries on your uterus or an issue with your uterus may cause the need for a c-section as well, but this is something you will know very early on in your pregnancy most of the time.
8. Baby’s medical condition that may warrant a c-section. Sometimes there is a problem with the baby such as a heart condition that may cause the baby to need to be born via c-section.
Reasons for an Unplanned C-Section
1. Emergency. Most unplanned c-sections are due to an emergency. This can be something endangering the mother’s life, baby’s life, or both. In an emergency there is no time to explain what is going on, you will be whisked away and have your baby within a matter of minutes. Emergencies can be from placental abruption, prolapsed cord, decreased fetal heart rate (fetal distress), and others. In these cases, just trust your doctors and nurses. It will be scary no matter how prepared you are, but trust me, it is just as scary for your nurses and doctor, but they are just better at hiding it.
2. Labor stalls. How horrible, you have been laboring for 12 or more hours and you are still only one centimeter dilated. It sucks, but it happens, and in these cases, if your water has broken you have to deliver, so you will have a c-section.
3. You are complete, but the baby won’t budge. This has to be the most frustrating, for everyone. Trust me, even your nurses hate this because they have worked with you all day to get you to complete and have been pushing with you for what seems like hours (maybe it really has been). This can happen for many reasons, your pelvis just doesn’t open up to allow the baby through, the baby is just too big, the cord is to short, or any number of other reasons. It happens, it sucks, and that’s all I can say.
Preparing for a c-section, planned or unplanned?
You can prepare for any delivery you want. The trick is to do your research. Know what your options are, know what can happen, and know what to expect during the delivery. That is why I am here, because there is so much more to having a C-Section than having abdominal surgery.
What do I need to know then?
As I stated before there are two ways a c-section can happen, planned and unplanned, and both happen in very different ways!
Preparing for A Planned C-Section
If you are having a planned c-section, your delivery will go something like this.
You will schedule your surgery (yes, it is a major surgery). You will be given a time to show up at the hospital, usually around 2 hours before, and instructions. These instructions usually include getting blood work a day or two before your planned c-section. DO NOT EAT AFTER MIDNIGHT THE NIGHT BEFORE YOUR SURGERY!
Once you arrive on the unit, you will be placed in a room in a bed, and asked to change your clothes. Please take off everything; you can usually leave on your bra, but not your underwear. Also, if you have any tongue or lip piercings, take them out, sometimes you have to be intubated during surgery, and having piercings increases risk of complications. You may be asked to give a urine sample as well.
Then you will be hooked up to a monitor to monitor your blood pressure, contractions (if you are having any) and the baby’s heart rate. An IV will be started and you will be asked lots of health and medical questions. Please be honest when answering these questions. For example if you are taking drugs we need to know about it; if you have an STD, we need to know about it; your doctors really do send over their charts from the office.
After all of this, you will sit in your room, for what seems like forever, until the whole team is ready for your c-section. Keep in mind that you are not the only pregnant women your doctor may be taking care of, meaning if she is not on time for your delivery, she is most likely attending another delivery.
The team that will be in on your delivery includes your nurse, a nurse for the baby, your doctor, a physician assistant, a surgical technician, anesthesiologist, and nurse anesthetist, so getting everyone coordinated can take some time.
Now, the order of things here may vary depending on the hospital, for example where I work, we put the catheter in after the spinal, while at other hospitals, they do it before.
Once everyone is ready, you will be wheeled or walked to the operating room, which will be bright and cold. You will be asked to get on the bed, which again, will be cold. You will sit for your spinal, and this will depend on the anesthesiologist’s preference, some will have you lie on your side, sit on the side of the bed or just sit with your legs stretched over the bed. You will have to curve your spine into a “C”, the best way to explain it is to curve your back like a mad cat. After this you will lay down on your back and a roll will be placed under one side of your back. You will also be getting periodic blood pressure checks and you will have oxygen on.
You will feel the warmth in your toes and creep up your body. You will NOT be able to move with a spinal, usually for about 2 hours. You may even feel like it is hard to breath, don’t freak out, but you can let the anesthesiologist know. There is no need to worry though. As you are numbing and once you are numb a lot of things will happen at once. You will have to put your arms straight out on boards. They will but pumps on your feet to keep your blood circulating, you will get a Foley catheter placed to drain your bladder, and you will get your belly cleaned. You will also get some warm blankets!
Once all of this is done, a big blue drape will be placed over you, DO NOT MOVE IT! The side that you do not see is sterile, keeping your incision sterile. If your husband is allowed to be in the room with you he will be brought in at this time. The doctor may ask if you are feeling anything, and this is her testing how numb you are prior to starting.
Once they know you are numb, they will start the incision. During this time you will feel a lot of what I call the “three Ps of c-sections”, pushing, pulling, and pressure. During all of this you may feel nauseous, let the nurse anesthetist know and she will get you something for it, but try not to vomit, if you are heaving the doctor cannot cut because she might nick something. At some point it may feel like someone is sitting on your chest, and that’s because they are, well not really. With a c-section, babies don’t have the force of labor to push them down, so often times someone has to push on the top of your stomach to get the baby out, and it takes a lot of pressure to do this! Just stay calm and know that your baby will be here soon.
The second you hear someone call out a time is the time your baby is born. If you don’t hear crying right away, stay calm; it is normal after a c-section. Often times the doctor wants to suction the baby’s mouth first to get the fluid out. Even at that, not all babies cry after they are born.
Your baby will be taken to the warmer, and you may or may not be able to see him during this time. You may get to have skin-to-skin in the delivery room depending on the hospital policy. You will at least get to see your baby before he is taken to the nursery, unless there is something wrong with him. Usually dad will go with the baby to the nursery.
You will be in to operating room for a while longer while they remove your placenta and stitch you back up. Once they are finished you will be wheeled back to your room or a recovery room where you will be monitored for a while longer. Your baby may or may not be ready to come out of the nursery yet, and you may be alone in your room for a while. Eventually dad or a nurse will bring the baby to you.
Once the spinal starts to wear off you will have pain, and it wears off opposite of how it started, meaning you will gain feeling starting in your stomach and moving toward your feet. Once you start having pain I would ask for pain medicine, you do not want it to get too out of hand before getting medicine because it becomes harder to control your pain.
Recovery from a c-section is very different. You will not be able to get out of bed for a while, so you will have a catheter and the nurses will be cleaning you up. The nurses will also be checking your fundus, or your uterus to make sure it is “clamped down” like it should be. They will be pushing on your stomach, and it will hurt. It will hurt to move and cough, but you need to do it. You will also be given an incentive spirometer which is a breathing device that you are encouraged to use to help keep your lungs clear and prevent pneumonia.
You will be hooked up to an IV for a little while. You will be getting antibiotics for a day. You will also get IV pain meds for about a day. Don’t worry though, if you want to breastfeed you still can! You will have cramping in your stomach, which is normal.
You usually are in the hospital for 3 days with a c-section.
Preparing for An Unplanned c-section
I know what you are thinking, “wow that’s a lot of information for a planned c-section, and I can only imagine how long this one will be”! I will only hit on what is different with an unplanned C-Section.
As I talked about earlier, there are many reasons you may have an unplanned c-section. If it is not an emergency chances are your delivery will go pretty much the same as with a planned c-section, except you will have labored all day most likely. If you have an epidural you will not get the spinal.
The big differences come when it is an emergency c-section. In a true emergency there will not be time for a spinal. If you have an epidural, then they will use that to give you medicine, but if you do not have an epidural you will be put under general anesthesia. With this, you will not be awake when the baby is born, they will have to move fast, and your husband will not be able to come in with you.
Often in an emergency everything moves very fast. There will be what seems like hundreds of people moving and doing things around you. Trust me; they know what they are doing. In an emergency, everyone knows what to do without talking, meaning they get to your baby faster! In an emergency, seconds count and unfortunately we cannot stop to tell you what is going on, but know we do not mean to be like this. We are just trying to save your life or your baby’s life and we are very sorry!
Things have to move so fast in fact that your belly is not scrubbed, usually betadine is just poured on it, and the catheter is placed as they are cutting (but you are asleep for this so you don’t know this). Once the baby is born and you are stitched back up they will wake you up. You will have a lot of pain because you have no pain medicine like with an epidural or spinal, but once you are awake, you can have something.
Just to give you an idea of just how fast things move in an emergency, in a planned c-section, incision time to baby time is anywhere from 10 to 15 minutes, while in an emergency, incision time to baby time is under 2 minutes.
To give you a personal example, I had a patient who had a placental abruption that happened shortly after arriving to the floor. This is an emergency and can be life threatening for both mom and baby. She had nothing done, no IV, we were not planning on delivering her baby, she just came in because something felt “off”. From the time we saw blood until the time the baby was born was 12 minutes, that is getting 2 IVs started, IV fluids started, getting her off the monitor, running back to the OR with her, getting her onto the operating table, putting her under, draping her and getting to the baby. So, be prepared if you have an emergency c-section for things to move very fast!
Recovery from any c-section takes a little longer, but you can still enjoy your baby. And when you are ready to start exercising, and you have the O.K. from your doctor, there are several easy and safe exercises to do after a c-section.
I hope this has helped you understand a little more about what will happen prior and during a c-section. If you have had a c-section, how much of this do you remember? If you have any questions please post them below and I will try to answer them!
Cassie Phillips is a wife, mom, and nurse who works in Women’s health, labor and delivery, nursery and pediatric nursing. In her free time Cassie loves to do crafts and shares her knowledge and love of nursing on her blog at All Out blog .