Caesarean section

Please refer to the leaflet issued by the Dutch Association for Obstetrics and Gynaecology (NVOG) for general information about a caesarean section. The text can be found online.

For more information please check our website.

A caesarean section, or C-section, is an operation to deliver your baby through a cut made in your belly (abdomen wall). The operation takes approximately 45 minutes, sometimes longer, sometimes shorter. Usually, the baby is born within 15 minutes from the start of the procedure. Afterwards the gynaecologist will close your womb and all layers of your abdomen wall with stitches.

Reasons for having a caesarean section

Your gynaecologist will advise you to have a caesarean only if a normal vaginal birth is not possible or when a normal vaginal birth could put you and/or your unborn baby at risk. Because complications may arise when having a caesarean, the procedure is only performed for a valid reason.

Planned caesarean section

Sometimes the need for a caesarean already becomes apparent before childbirth. For example if you have a low-lying placenta (placenta blocking the cervix); your baby is in a bottom-down, or breech, position; when a myoma prevents your baby from engaging; or in case of complications such as a malfunctioning placenta. In these cases we speak of a planned or an elective caesarean.

Caesarean section during delivery

Often the need for a caesarean section only becomes apparent during delivery. This is called an unplanned or emergency caesarean. The most common reasons for an unplanned caesarean are non progressing labour and/or your child being in danger of a lack of oxygen.

Natural caesarean (or gentle caesarean)

When undergoing a planned or unplanned caesarean in Diakonessenhuis, you may choose to have a natural caesarean. This is also called a ‘gentle caesarean’. Since during a caesarean section the baby is lifted from your belly by a gynaecologist, you as parents miss some introductory moments that you would have had during a vaginal birth. During a gentle caesarean we pay more attention to this and if you wish you may watch your baby being born. After a short checkup by a paediatrician in theatre your child will be placed on your chest immediately and will stay there as long as possible, preferably during the rest of the procedure. The gentle caesarean agrees well with our views on family centred care, which focusses on parents and child.

Maternal assisted caesarean

If you are having a planned caesarean section, you can opt for the mother-assisted caesarean section at the Diakonessenhuis in consultation with the gynaecologist. With a maternal assisted caesarean section, the mother can lift the baby out of the abdomen herself and place it directly on the breast. This way, the mother is the first to touch the baby and immediate skin-to-skin contact can take place. If it is medically appropriate, the paediatrician will check the baby while it is on the mother's chest. The baby remains on the chest during the rest of the operation. The maternal assisted caesarean section fits in well with our vision of family-oriented care in which parents and child are central.

The maternal assisted caesarean section is not a standard procedure and is therefore not always possible. We have to check the planning well in advance to see if it is possible and the gynaecologist who performs the caesarean section will instruct the mother in advance. Also, there may be medical grounds on which the gynaecologist may decide to remove the baby from the abdomen him/herself.

Examinations and interviews

Just like when preparing for any surgical procedure your medical condition will be assessed prior to an elective caesarean. Your gynaecologist and an intake nurse will ask you some questions about your health and occasionally a physical examination will be carried out, such as listening to your heart and lungs. Furthermore, blood tests will be done if these have not recently been done in the hospital, and the gynaecologist or anesthesiologist will discuss the epidural with you.

No depilating or body cream

Do not depilate the surgical site at least one week prior to your surgery. This helps reducing the risk of an infection due to skin damage to a minimum. Do not use any body cream on the morning of your caesarean.

Fasting

On the day of your surgery you need to fast. This means that your stomach should be as empty as possible to reduce the chance of stomach contents entering your bronchial tubes during surgery. This is done for your own safety. Please keep to the following rules:

• You may have a light breakfast up to 6 hours prior to your surgery.
• Up to two hours prior to your surgery you are allowed no food but can drink clear fluids only, such as water, tea, coffee without milk, apple juice and other see-through drinks. Do not drink any milk products, carbonated drinks, juices containing solids or drinks containing alcohol.
• Stop drinking altogether 2 hours prior to your surgery.

What to bring to the hospital

On the day of your admission please bring the following items:

• your ID-card
• baby clothes (several items) and a hooded baby towel  
• Maxi-Cosi
• comfortable T-shirt  
• nightclothes  
• partner’s nightclothes
• underwear (loose fitting)
• dressing gown
• slippers  
• toiletries
• alarm clock or watch  
• books, magazines, games, music  
• camera (remember to bring batteries and a memory card)

Furthermore, bring as few valuables as possible.

Admission date and time

One working day prior to your caesarean you will receive a phone call in the afternoon telling you what time you are expected at the maternity suites (the so-called kraamsuites).

Your stay

During your stay you will be in one of our maternity suites. A maternity suite is a room with a home-like atmosphere. Colours, warm furnishings, a hi-fi set and a spare bed for your partner help create a familiar atmosphere. A maternity suite is not just a room. It is also a way of care surrounding the baby’s birth. In Diakonessenhuis we work in line with the philosophy of ‘Family Centred Care’. We focus on parents and child. The complete care surrounding birth and maternity period takes place in this one and only room. Your care takers will come to you. You do not have to move around within the hospital. You will be actively participating in the care you get and you are the one to decide when visitors are welcome, just as you are at home.

When having a caesarean section two types of anaesthetics will be possible: a general anaesthetic or a spinal anaesthetic. Which of the two is advised depends among other things on the reason for your caesarean section, the degree of urgency and common practice in the hospital. In Diakonessenhuis a spinal anaesthetic is most common. Should you have an explicit preference, please let us know.

General anaesthetic

When having a general anaesthetic (GA) you will be asleep during the caesarean. A general anaesthetic will be given in such a way that your child receives as little medication such as sleep-inducing drugs and painkillers via the placenta as possible. The medication for a GA will be administered via an intravenous drip. Sometimes you’ll be given some oxygen via a nasal cannula or a face mask. While you are sleeping a tube will be placed in your trachea for artificial respiration. You will feel no pain and will wake up after the surgery is finished and your baby and the placenta will have been born.

Spinal anaesthetic

When having a spinal anaesthetic (injection in the back) the anaesthetist will administer the anaesthetic fluid between the (dorsal) vertebrae. Soon this will numb the lower part of your body and your legs. Sometimes you might experience a short period of nausea due to a blood pressure drop. When having a spinal anaesthetic you will be awake for your baby’s birth and even during the procedure you will be able to see, hear and touch your child. You will feel no pain during the surgery; sometimes you will feel some pushing or pulling at your belly. Rarely, the anaesthetic fluid may spread more upwards than just the lower part of your body. Breathing appears to be more difficult then. This is unpleasant, but harmless.

Preparations

On the ward you will be asked to wear a hospital gown. Shortly before your surgery you will be brought to the theatre. You are not allowed to wear any jewellery, hair pins, make up and nail varnish. Contact lenses or dentures must be removed. On the ward or in theatre a nurse or physician will insert a catheter into your bladder to empty it. The urine will be collected in a special bag. You will be given an IV before the operation through which you will be administered an antibiotic to reduce the risk of an infection of the wound. When a caesarean section is needed during delivery these preparations will be done at greater speed.

The procedure

Nearly always your gynaecologist will make a cut across your lower belly (a ‘bikini cut’). This is a cut of about 15-18cm long just above your pubic bone, approximately at the pubic hairline. Rarely a cut will have to be made from your navel downwards. After the skin is cut, the fat tissue and a layer of strengthening connective tissue above the abdominal muscles will be cut across. The long abdominal muscles, from the rib arch downwards, will be pushed aside. Subsequently the gynaecologist will open the abdominal cavity.

The bladder which lies partly across the womb will be separated from the womb and pushed downwards. Next, the gynaecologist will usually lift your baby from you via a cut across the womb. Often this involves some pushing on your belly.

When your baby is born, the umbilical cord will be cut. Since everything has to remain sterile, the father is not allowed to do this unlike in natural childbirth. After the umbilical cord is cut, you will be administered some medication to make your womb contract, via your drip. After the placenta is born, the gynaecologist will suture your womb and all layers of the abdominal wall. 

In Diakonessenhuis your partner or someone else is allowed to be present during your caesarean. During a GA that person may follow the procedure from a theatre window. In case you want to take pictures or make a video recording, please discuss this beforehand with a nurse on the ward.

Caring for your baby

A paediatrician will check your baby within a few hours after birth. If no problems are expected when having a planned caesarean, this checkup by a paediatrician might take place later. Depending on the reason for your caesarean section, the duration of the pregnancy and the condition of your child, your baby will be placed in an incubator or in a common cot, in your room or in the incubator ward. But first and foremost you will have had skin-to-skin contact with your baby in the operating room.

Caring for the mother

• After a caesarean blood pressure, pulse, blood loss and urine production will be monitored regularly. You will be administered fluids via your drip. After a spinal you will not have full control over your legs during the first hours. Gradually you will regain full feeling and strength in your legs.
• The bladder catheter which drains off the urine sometimes causes some discomfort. Usually a nurse will remove the catheter the day after your surgery. 
• To prevent you from developing thrombosis (blood clots) you will be given blood thinning medication (Heparin) by means of an injection via the skin of your belly or upper leg once daily. Often on the day after your surgery your blood will be tested to check you for anaemia. If necessary, a physician will discuss a blood transfusion with you or the use of iron pills after you will have had stools again.
• The first days you often feel weak and slightly dizzy when getting up. This will wear out gradually. After one or two days your bowel movements will start again. Often your belly is still swollen then and you may experience painful cramps. The day after your surgery and depending on potential nausea and the starting of bowel movements, you will gradually start eating again.
• Just after your caesarean your wound will hurt and you may still experience some painful contractions. You will be given painkillers for this. The abdominal wall often hurts, not only close to the scar but also upwards towards your navel. This is due to the fact that underneath the skin the cut across the abdominal wall is from the navel downwards to your pubic bone. Usually dissolvable materials are used to suture your skin which do not have to be removed. If you have other stitches or clips they will be removed approximately one week afterwards.

Breastfeeding

Basically you can start breastfeeding after a caesarean. It makes no difference if you had a planned or an emergency caesarean, or if you had a GA or a spinal anaesthetic. The condition of your child does matter.

If your baby is in an incubator you can express milk. The milk will be given in a bottle or - if there are any feeding issues - via a tube (a thin tube that goes via the nose into the baby’s stomach).

If all is well with your child after the spinal, you can benefit from the baby’s first sucking reflex shortly after birth. In general you can start breastfeeding your baby soon after you have regained consciousness after a GA too. In that way the production of milk starts promptly and your baby can benefit from the first feed, the so-called colostrum or foremilk.

On the first day feeding in a lying position is usually the most comfortable. Lying on your side with a pillow under your head, a pillow behind your back and a pillow under your upper leg is often the easiest. A nurse will assist you with this.

Discharge

Generally, discharge is on the third day after a caesarean section. The pace of your recovery and the health condition of your baby (admission in an incubator ward) play a part in this ofcourse.

Advice when at home

At home you will need to take time for further recovery. The time needed for recovery after a caesarean section is often longer than after a natural vaginal delivery. You are not only a mother (again), but besides that you are recovering from surgery.

• A common complaint after a caesarean section is tiredness. The best thing to do is to accept this and try to take as much rest as possible. Accept any help family and friends might offer you. Sometimes your health insurance will reimburse additional maternity care at home after discharge from the hospital. A maternity assistant can answer your questions, take over household chores and support your partner.
• The more help you’ll have when you come home, the easier the transition will be and you will get used to your new life situation more quickly. You can apply for Maternity Care with your Homecare Services. Sometimes your GP, midwife, hospital or a social worker can help you with this.
• After the first weeks you will notice that you are gradually able to do more. 
• Avoid heavy lifting (such as bin bags, heavy shopping baskets) up till 6 weeks, but you may gradually expand your activities e.g. to light housework, smaller shopping. 
• Be careful when having sexual intercourse, swimming or bathing if you still have some vaginal discharge. Taking a shower is always permitted. Should your wound still leak some fluids or a little blood, you may cleanse the wound in the shower, carefully dry it and cover it with a dry gauze dressing to protect your clothes.
• You may start training your abdominal muscles 6 weeks after the surgery. By then all separate layers of the abdominal wall will have healed completely. At the sides of the scar you might experience some pulling feelings at first. This is caused by the internal stitches.
• The use of contraceptives does not differ from after a ‘normal’ delivery. If needed, ask your midwife, GP or gynaecologist for advice. 
• Do not have sexual intercourse until the bloody discharge has stopped. It takes most women quite a while before they enjoy having sexual intercourse again.
• Because the nerves in the skin on your belly have been cut for the ‘bikini cut’, you will have a numb feeling around the scar for quite some time. Just above this numb area there often is an area halfway up the navel that is extra sensitive. It usually takes 6 to 12 months before the feeling in your abdominal wall will be back to normal again.

Problems at home

If there are any problems at home, please contact your midwife who does the follow up during your maternity period. When the maternity follow up visits have ended, please contact your GP in case of any problems.

Follow up visit at the clinic

We advise you to make a follow up appointment at the Gynaecology Outpatient Clinic approximately 4-6 weeks after delivery. Preferably make the appointment with the gynaecologist or assistant gynaecologist who was involved during your delivery. Make this appointment within 42 days after your delivery in view of reimbursement by your health insurance company.

Every surgery, including a caesarean section, has some risks. Luckily, severe complications are rare, especially when you are healthy. The most common complications are listed in the following.

Anaemia

During each caesarean there is blood loss. When there is substantial blood loss, there will be anaemia. Often a blood transfusion or the use of iron pills is needed afterwards. When the placenta is blocking the cervix (a low-lying placenta) there is a high risk of severe blood loss and blood transfusion.

Bladder infection

Occasionally bladder infections occur after a caesarean section. Your urine will be tested in the hospital should you have any complaints. If necessary, you will be given an antibiotic.

Bleeding in the abdomen (belly)

Continued bleeding of subsequent bleeding can be a rare complication when having a caesarean section. Occasionally a second operation is needed.

Haemorrhage in the wound

A subcutaneous haemorrhage in the wound area occurs when a small vessel in the fat tissue underneath the skin keeps bleeding. This is more likely to happen when there is an anomaly in blood clotting after the caesarean, e.g. because of a lack of blood platelets due to severe high blood pressure.

Infection

Sometimes wound infection occurs. This is more likely to happen when having a caesarean after a lengthy delivery.

Thrombosis

As with every surgery there is an increased risk of thrombosis. To prevent this you will be administered blood thinning medication until you will be out of bed more often.

Damage to the bladder

Damage to the bladder is a rare complication. This is more likely to happen when you have had a caesarean several times. There may be adhesions in the bladder area then. Damage to the bladder can well be sutured. You most likely will need to have a catheter for a longer period though.

Impaired bowel function (Ileus)

After a caesarean section your bowels need to start functioning again. Rarely this does not happen or happens too slowly. Fluids will then gather in your stomach and bowels leading to nausea and vomiting. In that case, a gastric tube may be needed to drain off the fluids. Only after this your bowel movements will be restored.

Should you wish to become pregnant again soon, we advise you to wait at least 6 months but preferably 12 months before getting pregnant again. The need for a caesarean in a future delivery depends on the reason for this caesarean. Therefore discuss the likelihood of a ‘normal’ delivery in future pregnancies when coming in for your follow up visit. Often a caesarean section is not needed when having your next child. However, you will always be given a medical indication for delivery in a hospital.

The perception of a caesarean section varies widely. Some women suffer from emotional problems because of it. They are disappointed that delivery could not take place in the ordinary way and have the feeling a normal delivery ‘was taken away’ from them. Sometimes they have feelings of failure. When having a general anaesthetic women are not conscious at the birth of their child, which sometimes makes it more difficult for them to get used to their baby.

If you experience any of those feelings, discuss these with your partner, friends and family. When coming in for your follow up visit, please discuss your emotions and questions such as the reason for this caesarean. This may also help you deal with your emotions. Write down any questions beforehand so you will not forget to ask them.

It is also possible to discuss the whole procedure again with your gynaecologist, midwife or GP after a longer period or prior to a following pregnancy should you feel the need to do so.

Sometimes it can also bring relief to share your experiences with people who have had similar experiences. You can contact them via Vereniging Keizersnede-Ouders (the Dutch Society for Caesarean Parents).

For partners a caesarean can be difficult to deal with too sometimes. He/she sees you carry the baby for 9 months, and then, sometimes after hours of labour, even undergo surgery to have the baby delivered. Sometimes partners feel useless because they feel having been able to do hardly anything to help you. He/she may also have feared that something would go wrong. If there are such feelings, try to discuss them between you.

In general a caesarean section will be reimbursed. To be sure, please contact your health care insurance company about the terms and conditions.

Questions

If you have any questions, please contact the Gynaecology Outpatient Clinic by using the telephone number on the last page of this leaflet.

Patient organizations

Vereniging Keizersnede-Ouders (VKO) (Dutch Society for Caesarean Parents)
Contrabas 53
4876 VG Etten-Leur

Telephone 076 503 71 17
available from Monday to Friday from 10am-9pm.

Textual comments

Should you find information missing or unclear, please let us know. For medical questions about your treatment please contact the ward involved by using the telephone numbers on the last page of this leaflet. Please report your comments on our information to the Communication Department via [email protected].

The Gynaecology Outpatient Clinic
088 250 6178

Maternity suites (Kraamsuites) (4 AB)
088 250 6042