I find it absolutely appalling that many childbirth “education” classes don’t cover Caesarian sections (C/S) or gloss over them. Statistically, 20-30% of women will have an operative birth. Birth, by the way, is thus defined by the free dictionary, “the emergence and separation of offspring from the body of the mother.” Birth does not require that you squeeze that baby out of your hoo-hoo in front of a lot of women who are chanting and celebrating their “woo.”
I’ve been in the room for C/S in about 5 different hospitals so far and I’m going to give you a blow-by-blow of how they go down. Of course, regional differences exist in terms of procedures and policies, so your C/S may (have been/ be) slightly different. Some women will have positive experiences and memories of their C/S, some will have negative. That goes for partners and support people too.
Before you even get to the OR tons of preparation goes on…the room is cleaned and sanitized. Surgical supplies and instruments are brought up from the “sterile core” and counted. The anesthesia machine and equipment is checked and drugs are prepared. Your anesthesiologist will speak with you about your health, your pregnancy and your anesthetic. This consult can take anywhere from 30 minutes for an elective or semi-urgent C/S to 30 seconds if it’s a true emergency.
When the star of the show (that’s you mom!) is brought in, you’ll have some monitors placed:
a pulse oximeter to measure your oxygen saturation and heart rate
a blood pressure cuff to measure your blood pressure
three to five ECG patches to monitor your heart
an external fetal heart rate monitor if you are having a C/S for fetal distress
Next, you’ll receive an anesthetic. For most mom’s that will be a spinal (injection into the back) or via an epidural (a top-up if an epidural is already in place). Rarely, a general anesthetic will be used. A spinal or an epidural can be placed with you sitting up and curled forward (like a panda bear) or with you on your side curled in the fetal position. If you are obese or have scoliosis it is much easier for the anesthesiologist to find the right spot if you are sitting up. One of the labour and delivery nurses or OR nurses will be in front of you, helping you to get into the best position and supporting you. The anesthesiologist will wash your back off with antiseptic solution. This contains alcohol and it feels really really cold. In my experience, women having contractions will sometimes not notice this step but almost all other women will jump so I warn everybody. Next, some local anesthetic, like lidocaine, will be used to numb the skin. After that, a longer needle will be used to find the epidural or spinal space and medication (for a spinal) will be injected or a catheter (for an epidural) will be placed. Most women won’t feel anything other than a little pressure with this longer needle. I was one of those women, I didn’t feel anything at all after the numbing medication was used in my skin.
Once the anesthetic is placed, things start to happen rather quickly. You’ll be helped to lie down on your back. Accept this help because your legs will start to feel quite weak. A wedge will be placed under your right side to shift your uterus to the left so it doesn’t compress your large abdominal blood vessels. Some temporary drapes will be placed while an OR nurse places a urinary catheter. You might feel like you don’t want a catheter but draining the bladder is an essential step to make the surgery easier for the surgeon and safer for you and the catheter will be removed after the procedure is over.
Next, your abdomen will be washed with antiseptic solution to sterilize the skin and sterile drapes will be placed by the surgeon and his or her assistants. At this time the anesthesiologist will be working hard to monitor your response to the spinal or epidural injection.
Your support person/ partner is now invited into the OR. They are given a stool placed by your head where they can hold your hand and the two of you can speak easily. It’s not common to have more than one support person in the OR because there just isn’t space for more than one person plus the anesthesiologist plus the anesthetic equipment up by your head. Some hospitals and surgeons will accommodate maternal musical requests. Some women find it helpful to have a picture of their family, other children or sonogram placed on their chest to look at during the procedure. No one will accommodate low lighting because the surgeons and operative nurses need to see what they are doing.
The surgeons will test to make sure you are numb before they do anything. You should expect to feel pressure and pulling sensations but nothing sharp. They will get down to the uterus and make an incision in it…then they will pull the baby out. Often a bit of pressure on your upper abdomen/ lower chest helps them with this step and they will warn you when this is about to happen. Sometimes they are so intent on what they are doing that they forget. That’s when I take over. Part of my job is to support you through the procedure and that means explaining what is happening. That pressure can be pretty intense. If you’ve been labouring or pushing for a while before the C/S that baby’s head can be wedged pretty far down in your pelvis.
The baby comes out, the cord is clamped and cut, and the baby is handed off to a member of the “baby team” in a way that keeps the OB sterile. Many OBs will hold the baby up over the drapes so that mom can see it before handing it off. Your support person is usually invited to look over the drapes so they can see the birth. Different hospitals have different policies regarding filming parts of the procedure. Pictures are usually always welcomed.
One great thing is that ORs are now being designed and set up so that the mom can see the baby team and the baby bassinet so that the baby is not out of her site at all from the moment he or she is born to the moment he or she is brought over to the mom. I think that is a great improvement and really reassuring to moms. After being checked out, the baby will be swaddled (the ORs are pretty chilly and we don’t want him or her to get too cold) and brought over to mom. We try to place the baby on mom’s chest and have the dad or other mom or support person help to hold him or her there so that the family can get to know each other. Sometimes dads fall in love so quickly with their baby that they stand there holding him or her and cooing and forget that mom wants to see and touch the baby too. That’s also when I’ll step in or on of the OR or LDR nurses will because mom and baby need to get together as soon as possible. Sometimes the anesthetic monitors and cords make it difficult for mom to get her hands on the baby. I try to facilitate this as much as possible. I wish we had reliable cordless monitors.
If mom is doing well, we leave things like this until the end of the procedure or until the baby’s vital signs need to be checked again. Most anesthesiologists will take some family pictures but sometimes we are busy doing other things to look after you.
Once all the stitches are in place and the dressing is applied, the drapes come down. Everyone admires the baby. Mom is moved to a stretcher and the baby is placed on her chest for the ride to the recovery room. In the recovery room, after vital signs are taken on mom and baby, skin to skin happens as soon as possible and, if mom wants, she can nurse her brand new child. Unlike with every other surgery we do on adults, we allow a support person to be with mom and baby in the recovery room.
I`ve just re-read what I`ve written and it sounds really dry and sterile…but I have a confession for you. When a baby is born in the OR I tear up each and every time. It is beautiful and wonderful and miraculous. Every single time.