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Labour and birth A Caesarean under an epidural anaesthetic. NEXT TIME Once a Caesarean always a Caesarean? If you have your first baby by Caesarean section, this does not necessarily mean that any future baby will be delivered in this way.Vaginal birth after a previous Caesarean can and does happen.This will depend on your own particular circumstances (see page 129). You can discuss your hopes and plans for any other deliveries with your doctor or midwife. 102 A Caesarean section may be ‘elective’ (that is, planned in advance) or ‘emergency’. An elective Caesarean may be recommended if labour is judged to be dangerous for you or the baby. An emergency Caesarean may be necessary if complications develop and delivery needs to be quick. This may be before or during labour. Sometimes the cervix does not dilate fully during labour and an emergency Caesarean will be suggested, but, providing you and the baby are well, there is no need to proceed with great haste. Whenever a Caesarean is suggested, your doctor should explain why it is necessary and any possible sideeffects. Do not hesitate to ask questions. Where possible, the operation is performed under epidural anaesthesia (see page 92) or the similar spinal anaesthetic. A general anaesthetic is sometimes used, particularly when the baby needs to be delivered very quickly or if there are technical problems, but this increases the risks for you and the baby. This is why epidural and spinal anaesthetics are recommended. If you have an epidural, you will be awake throughout the operation, but you won’t feel pain, just some tugging and pulling and wetness when the waters break. A screen will be put across your chest so that you cannot see what is being done. The doctors will talk to you and let you know what is happening. The operation takes about 30–40 minutes. One advantage of an epidural or spinal anaesthetic is that you are awake at the moment of delivery and can see and hold your baby immediately. Most hospitals are willing to let your partner be present at a Caesarean under epidural or spinal so that they can give you lots of support and welcome the baby at birth. Please ask. After a Caesarean you will be uncomfortable for a few days, as you would expect to be after any major surgery. It will be difficult to sit up or stand up straight, and it will hurt to laugh. You will have to stay in hospital a bit longer, about five to seven days, but this will depend on your condition. You will also have to take it easy once you are home, and you will need help. You shouldn’t lift anything heavy or drive a car for six weeks. Your doctor or midwife will advise you on how much you can do. Postnatal exercises are especially important after a Caesarean to get your muscles working again, but take things at a gentle pace. The midwife or hospital physiotherapist will tell you when you should begin them. You can also contact the Caesarean Support Network for information and support (see page 147). BREECH BIRTH A breech birth is when a baby is born bottom first. Your obstetrician and midwife will discuss with you the best and safest way for your breech baby to be born. They may arrange an ultrasound scan to assess how big your baby is. They may advise a Caesarean section, or they may encourage vaginal delivery depending upon your individual circumstances. Ultimately, the decision is yours.
Labour and birth A vaginal breech delivery is a little more complicated than the usual ‘head first’ delivery. An epidural may be recommended, and forceps may be used to deliver the baby’s head (see page 101). In some units you may be offered the option of an external cephalic version (ECV). The baby is turned into the usual head down position (cephalic) by pressing on the woman’s tummy. TWINS If you are expecting twins, labour may start early because the womb becomes very stretched with two babies. More people will usually be present at the birth – for example, a midwife, an obstetrician, and usually two paediatricians, one for each baby. The process of labour is the same, but the babies will be closely monitored, usually by using an electronic monitor and a scalp clip on the first baby once the waters have broken (see pages 96–7). You will be given a drip in case it is needed later and an epidural will often be recommended. Once the first baby has been born, the midwife or doctor will check the position of the second by feeling your abdomen and doing a vaginal examination. If the second baby is in a good position to be born, the waters surrounding the baby will be broken and the second baby should be born very soon after the first because the cervix is already fully dilated. If contractions stop after the first birth, hormones will be added to the drip to restart them. Triplets or more babies are almost always delivered by elective Caesarean section. If you’re expecting twins or more babies, you might like to contact the Twins and Multiple Births Association (TAMBA) for advice and support (see page 148). W HAT YOUR COMPANION CAN DO Whoever your labour partner is – the baby’s father, a close friend, or a relative – there are quite a few practical things that he or she can do to help you, although probably none of them are as important as just being with you. You can’t know in advance what your labour is going to be like or how each of you will cope. But there are many ways in which a partner can help. Your labour partner can: • keep you company and help pass the time in the early stages; • hold your hand, wipe your face, give you sips of water, massage your back and shoulders, help you move about or change position, or anything else that helps and comforts you as your labour progresses and your contractions get stronger; • remind you how to use relaxation and breathing techniques, perhaps breathing with you if it helps; • support your decisions about, for example, pain relief; • help you make it clear to the midwife or doctor what help you need – and the other way round – which can help you to feel much more in control of the situation; • as your baby is born, tell you what is happening, because you can’t see what is going on for yourself. For very many couples, being together during labour and welcoming their baby together is an experience that they can’t begin to put into words. And many fathers who have seen their baby born and who have played a part themselves say they feel much closer to the child from the very start. 103
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Pre the nancy gbook Your complete g
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11 LABOUR AND BIRTH Getting ready f
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Your pregnancy at a glance 16-20 we
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Introduction Every parent is differ
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Your health in pregnancy • Eat pl
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Your health in pregnancy VEGETARIAN
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Your health in pregnancy S MOKING W
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Your health in pregnancy P HYSICAL
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Your health in pregnancy Foot exerc
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Your health in pregnancy PARVOVIRUS
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2 Conception To understand about co
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Conception T HE WOMAN’ S MONTHLY
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Conception T HE BEST TIME TO GET PR
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Conception K NOWING THAT YOU’ RE
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How the baby develops WEEKS 4-5 Wee
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How the baby develops WEEKS 15-22 T
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4 Deciding where to have your baby
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Deciding where to have your baby HO
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Deciding where to have your baby B
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5 Feelings and relationships From t
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Feelings and relationships WORRYING
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Feelings and relationships FAMILIES
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Feelings and relationships C OPING
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6 Mainly for men Some pregnancies h
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Mainly for men PRACTICAL SUPPORT Yo
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Page 125 and 126: The early weeks: your baby CHANGING
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Page 133 and 134: Rights and benefits How much is it?
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