Elective caesarean section

In preparation for your caesarean section

Before your elective caesarean section, a couple of pre-operative tests will need to be undertaken. These will include a swab looking for MRSA. MRSA is a bacteria often found on the skin and in the nose of healthy people but can cause infections after surgery. This will be done 4 to 6 weeks prior to your surgery usually at one of your hospital appointments. A blood test needs to be carried out to check that you are not anaemic. A sample will be kept in case you need a blood transfusion during or after the caesarean.

We will ask you to attend the Day Assessment Unit (DAU) for this within 72 hours of the operation. At this appointment you will be advised on deep breathing exercises and the benefit of mobilising after your caesarean. 

Do I need to do anything before my surgery?

• You will be given a prescription for two antacid tablets called Omeprazole to collect from the hospital pharmacy.
• One tablet should be taken at bedtime before your operation date.
• The second tablet is taken at 6am on the morning of your operation. You will need to drink 200ml of clear apple juice at the same time.
• Nothing to eat after midnight. but you can drink clear fluids until 6.30 am.
• You may wish to trim your pubic hair, but please do not shave it. Have a shower on the morning of your surgery – you will need to use two towels to dry yourself (one for your body and one for your pelvic area).
• Your belongings will remain at your bedside on the Maternity Ward/Delivery Suite while you are in theatre.
• You are advised not to bring valuables into the hospital.
• There is a limited amount of space so please do not bring in too much.  We need easy access to be able to record observations for you and your baby particularly in the first 24 hours.

What to bring with you

• A light dressing gown -to put over your theatre gown.
• Light pyjamas or nightdresses - it is hot in hospital.
• Large comfortable pants that will not rub on the caesarean wound.
• Comfortable bras, sanitary wear, toiletries.
• Slippers, crocs or flip-flops.
• Sports-top water bottle (an old lucozade bottle for instance) to assist with ease of drinking.
• A mug, favourite teabags or juice and a pillow from home may help you feel at ease.
• Buy some pain relief ready for use at home as this is not offered routinely on discharge. Paracetamol and ibuprofen can be used. Codeine products are not recommended if you are breastfeeding.
• Two hats - babies lose a third of their heat from their head.  It is important for them to keep warm.
• Vests and baby-grows.
• Disposable nappies.
• Unscented wipes or cotton wool.
• Any expressed colostrum that you have saved.
• Mums who choose to give artificial formula should bring in four to six ready-made formula cartons (200mls). Additional equipment will be supplied.
• The hospital supplies sheets and blankets on the ward.
• As part of your elective ceaserean section birth plan we can discuss with you in advance the options of playing music in theatre and aromotherapy, delayed cord clamping for c-section babies, and the benefits of skin to skin contact with your baby.
  
  

Admission to hospital

• The midwife caring for you will either prepare you for your caesarean section on the Maternity Ward or Delivery Suite.  Please arrive no later than 7.30am, ring the buzzer for either and we will take you to the respective area.
• You will be welcomed to the ward by the midwife who is assigned to prepare you for theatre, and to answer any questions you may have.
• An anaesthetist will come and see you and discuss the most appropriate anaesthetic for you.
• If your caesarean section is being performed for a breech presentation you will have a scan to confirm presentation on the ward.  If your baby has turned to head first, your surgery will be cancelled to await spontaneous labour.
• You will need to remove all your jewellery, make-up and nail varnish if you have not already done so.
• Your blood pressure, pulse, temperature and baby’s heart rate will be checked.
• You will be weighed to ensure the most suitable equipment will be used and medication dosages are correct for your weight.
• You will then be asked to change into a hospital gown.
• The midwife will ask you about how you wish to feed the baby and about giving your baby
  Vitamin K.
• One car park concession ticket is available on the day of the operation. Please ask the midwives regarding availability.

Transfer to theatre

Most women walk to theatre, which is located on the Delivery Suite, so please remember to bring your slippers.

• A nappy and some baby clothes will be needed.
• Your birth partners will be given theatre clothes and shoes to change into.
• Cameras are permitted in theatre, but you might be asked not to take photos at certain times (requests for video recording must be made well in advance).
• The majority of women will have a spinal anaethestic, but if you are having a general anaesthetic your birth partner will not be allowed to come into theatre, but will wait close by for you and your baby’s return.
• Only your birth partner will be given access to delivery suite and the theatre.  The visitor restrictions are for all women’s safety.
  
  

After the caesarean and going home

• You will come out of theatre with a “drip” (intravenous line), which will be discontinued when you are drinking enough and a catheter which will be removed approximately 12 hours after surgery.
• Oral pain relief is offered regularly by the midwives.  If you require additional pain relief please ask a member of the staff.
• You will be able to sit out in the chair by the evening and have a shower the same evening or the following morning.
• You will go home the following day unless there is a medical reason why this is not appropriate.
• It is important that you have good support when you go home so that you don’t overdo it.

Care of your caesarean wound

The stitches are usually dissolvable, but occasionally they will need to be removed on the fifth day post caesarean.  The dressing will be removed by the midwife between two and seven days after the surgery – depending on the type of dressing used. Once it is removed it is good practice to keep the wound clean and dry, as you would with any other cut on your skin.  Clean the wound once or twice a day by wiping it gently but firmly using clean water and a soft unscented wipe/swab.  Always wash your hands first.   It is good for the wound to get some air, as this helps to prevent infection and aids healing.  It may be necessary to lie down and lift up your tummy from time to time.

• You will be given advice before your operation on deep breathing exercises, the importance of maintaining a good posture and pelvic floor exercises.
• Should you need to cough or sneeze, support your tummy firmly with one arm across your abdomen.
• For the first two weeks – don’t over do it!  You have had major surgery, so be kind to yourself. Avoid lifting heavy things or heavy housework for the first few weeks.  The baby or a small shopping bag is okay. However, the baby strapped into a car seat or four bags of shopping is too much!
• After surgery you are at risk of developing a DVT (Deep Vein Thrombosis), which is a blood clot in one of your legs.  Nearly all women are fitted with stockings to be worn for the first 10 days or longer if indicated.  They should be reapplied after a shower or bath.  You may also be prescribed injections to further reduce your risk of developing a DVT.  These are injected into your tummy for 10 days.  You will be shown how to do this before you go home.

You cannot drive for at least four weeks until you can safely perform an emergency stop without it hurting, also check with your insurance company.

• It is advisable to wait for at least four weeks before resuming sexual intercourse, to enable the wound to heal and for you to feel more comfortable.

Breastfeeding your baby

We encourage you to breast feed your baby, but some of the natural processes may not occur if you have a caesarean section. To help this:

• We will give you a breast-feeding pack containing syringes, labels and guidance to express breast milk for your baby from about six weeks before your surgery.
• You can bring this with you in the sterile syringe with your name, date and time when you expressed it, but remember colostrum can only be stored in the back of the fridge at home for five days at 4 ̊C or lower or two weeks if frozen in an ice compartment.
• Please ask a member of staff to support you with feeding and assisting you with getting the baby out of the cot.
• Have your baby skin to skin and keeping your baby close.  This will increase the hormones that assist with producing your breastmilk and help you pick up on the baby’s early feeding cues, as the more your baby feeds the more it will stimulate your milk production.
• There may be occasions when your baby is reluctant to feed and it is therefore important to hand express. Ask a member of staff to show you this skill as it will help with your milk production if you have not already learnt it.

Once home it is important to monitor your wound closely after the dressing is removed. If you are unable to see the wound, have someone check it on alternate days for signs of any infection. In addition to wound infections you are at an increased risk of other post-operative complications such as blood clots. Do not ignore any signs of illness:

• Severe abdominal pain, redness, or swelling around the wound site.
• Pain that is not improving or gets worse.
• Pus and discharge from the wound.
• Temperature or feeling hot and cold and generally unwell.
• Pain on passing urine or smelly vaginal discharge.
• Bleeding that soaks a sanitary pad within an hour or that contains large clots.
• Leg pain or swelling or sudden breathlessness.

Call your doctor or ring Maternity triage 07990986517 if you have any of these symptoms once home.