Detailed references for the following FAQs can be found in Caesarean Birth: A positive approach to preparation and recovery.
Answers to many more questions about the procedure, its benefits and risks, recovery and much more can be found in Caesarean Birth: A positive approach to preparation and recovery.
I have been told I need a caesarean. Do I have to consent?
Not necessarily, however there may be very good medical reasons why you should and you should ask your health professionals to full explain these to you.
The following classifications are often used to categorise your situation:
- There is an immediate threat to your or your baby’s life (level 1)
- You or your baby are compromised but it is not immediately life-threatening (level 2)
- Neither you nor your baby are compromised but would benefit from early delivery (level 3)
- Delivery is timed to suit you or staff availability (level 4)
Some reasons are clear cut, others less so. Understanding the distinctions between suggested and required can make all the difference to your ability to negotiate before or during your labour and may change the course of your birth. Some conditions mean you may have weeks/days to prepare yourself for a caesarean, others require immediate surgery.
A doctor’s recommendation is sometimes just that – a recommendation – vaginal birth could still be a possibility. In other situations a caesarean may really be the only option. A combination of factors is leading some practitioners to err on the side of caution and offer caesareans when a vaginal birth may still be possible.
In the case of twins it is difficult to give a black and white answer and yet for women carrying multiple babies a caesarean is often recommended. The experience of your practitioner/hospital may play a significant part in the recommendations made. Many twins are now born by caesarean thereby reducing the opportunity for some practitioners to gain sufficient experience in twin delivery. In addition, the position of the babies will effect recommendations. Many twins are both head down at term, with a significant number showing the first baby head down and the second breech. Where there are no other complications (e.g. entangled umbilical cords, identical twins sharing a placenta and amniotic sac etc.) both these positions should be considered acceptable for a vaginal birth attempt. Where the first twin is breech or indeed one or more is in the transverse position (lying across the uterus) a caesarean will be necessary. Given the increased likelihood of caesarean delivery during the birth of twins it is advisable to address caesarean requirements in your vaginal birth plan and definitely enquire about your hospital’s policy on twin births. Some hospitals require all mothers of twins to give birth in the operating room, even if they plan a vaginal birth. Some hospitals also insist on the insertion of an epidural anaesthesia needle even if no medication is planned for the vaginal attempt.
There are many other grey medical situations and Caesarean Birth: A positive approach to preparation and recovery provides detailed guidance on the distinction between those situations where a caesarean really is required and those where it can stillbe a matter of debate. It also provides advice on how to help avoid a caesarean or indeed request and plan for one.
I am frightened of giving birth, can I have a caesarean?
Unfortunately there is no clear answer to this question. Some practitioners will grant a caesarean on grounds of extreme distress, particularly where previous birth trauma is clearly evident, other will not.
Some hospitals have a policy to only allow caesareans for clear medical reasons. However in the UK if your hospital will not agree to a caesarean they are obliged to refer you for a second opinion either within the same hospital or to another one. In actual fact you may find that your hospital does not have a ban on maternal request caesareans and you have actually been hearing the personal opinion of each practitioner.
The General Medical Council (2000) stated that it is the duty of practitioners “to recognise that even when active treatment is not indicated, the duty to provide care to alleviate distress remains.” In other words in cases of extreme tokophobia (fear of childbirth) it may be possible to present your case in such a way as to justify the need for a caesarean on the grounds of the extreme distress likely to arise through attempting labour. The results from a study comparing psychological reactions of women following vaginal birth (both instrumental and straightforward) and planned and unplanned caesareans revealed that for women suffering from extreme tokophobia it may actually be beneficial to plan a caesarean. Psychological outcomes for these women were found to be far more positive than for those who had undergone an emergency caesarean or instrumental vaginal delivery.
Unfortunately fear of giving birth is quite common, but the extent of the fear varies significantly from one woman to the next. Some women start to worry about labour as their time draws near while others experience significant fear well before they are even pregnant. In many cases the fear is managable, but some women are so afraid that it is classified as a morbid dread. Tokophobia can hamper a woman’s ability to cope with her labour and may even impact the progress of that labour. (i) It can cause others to request a caesarean in the absence of any medical need and still others may choose to remain childless or abort a much wanted baby.
Despite the evidence referred to above many countries do not formally recognise fear of childbirth as a reason for a maternal request caesarean. It is important therefore that you get to the bottom of what is causing your fear in order to deal with it where possible. The UK does recognise tokophobia as a valid medical reason, though you may find you still have a number of hoops to jump through before gaining agreement. Caesarean Birth: A positive approach to preparation and recovery offers a lot more information about the origins of such fear, ways of tackling it and possible approaches to take when trying to negotiate a caesarean on the grounds of fear of childbirth, particularly in the absence of any other medical need.
When is it safe to schedule a caesarean?
Official guidelines state that a caesarean should be scheduled no earlier than 39 weeks. (i) (ii) This is to ensure that your baby is fully mature and able to cope outside the womb. Accurate assessment of your conception date is therefore very important, so check thoroughly before confirming your caesarean date.
Planning a caesarean for week 39 reduces the risk of breathing difficulties to no longer statistically significantly different to that of vaginal birth at the same stage (iii) and of course many babies arrive without problems around this time naturally.
Caesareans are sometimes conducted earlier than 39 weeks for medical reasons and this can cause respiratory problems for some babies. However, many studies acknowledge that both prematurity (iv) (v) (vi) (vii) and the underlying reason for the caesarean play a significant part in the likelihood of experiencing breathing difficulties rather than the caesarean itself. It may be that caesareans without labour increase risk, (viii) but research is unclear on this specific point. What is clear is that the later your caesarean the lower the risk.
It may be that you would prefer to wait for labour to commence before your caesarean begins. This way you know that your baby is signalling that she is ready to be born. Such a preference is possible in some cases but is dependent upon your medical situation. Caesarean Birth: A positive approach to preparation and recovery discusses the risks and benefits of such an approach and offers more information about those specific situations where it may be necessary to schedule a caesarean prior to 39 weeks.
If I have previously had a caesarean, can I have a vaginal delivery this time round?
It is not unusual to be told that if you have already had a caesarean all future births should be this way too. However a vaginal birth after a caesarean (VBAC) is increasingly offered to women. If your pregnancy has progressed normally and there are no known medical conditions indicating that it would be unsafe for you to labour, there is no reason why you should not attempt a vaginal delivery. The risk of scar rupture is incredibly low and alone should not be used as the reason for you to have a caesarean. (i)
However if your case is not straightforward (e.g. your previous internal incision was vertical rather than horizontal or a scar on your womb has ruptured before) you may have difficulty finding a practitioner prepared to support your request. On top of this while it should be your specific situation not policies or practitioner preferences driving the decision, it is the case that concerns about scars rupturing does lead some practitioners to err on the side of caution and encourage you to deliver via caesarean.
Before making a final decision ensure you understand the risks and benefits of both VBAC and repeat caesarean then check out the policies at your place of birth. Caesarean Birth: A positive approach to preparation and recovery provides lots of information about VBACs from how to help avoid a caesarean and the criteria increasing your chances of gaining agreement for a VBAC to how to realistically prepare yourself for another caesarean outcome.
Can I be awake for surgery?
The majority of caesareans are carried out while you are awake using a regional anaesthetic – either epidural or spinal. It is only in specific circumstances that a general will be used e.g. where surgery needs to be carried out as quickly as possible or where other forms of anaesthesia are not working etc.
Caesarean Birth: A positive approach to preparation and recovery covers the benefits and risks of both regional and general anaesthetic and describes the whole caesarean procedure in detail including what to expect during your preparation for surgery (there are no off-putting pictures).
Can I breastfeed straightaway?
Breastfeeding is actively encouraged in many places so your desire to breastfeed is likely to be fully supported wherever you give birth. However women and some practitioners are not used to the idea that women can actually feed in theatre. It is more common to attempt the first feed back on the ward or in some cases in the recovery room. So make your position on breastfeeding clear and check that your pain relief is going to be compatible with breastfeeding.
If you do want to breastfeed in theatre ensure that your gown opens at the front before lying down (this means it will be on backwards and that it is not trapped underneath the screen (this is also the case even if you only want to hold your baby skin-to-skin in theatre). Check your arms are not going to be restricted (other than the IV drip) and that monitors are attached to your back rather than your chest. Such techniques are increasingly referred to as part of a natural caesarean.Remember you will be flat on your back and so will require assistance from your birth partner in positioning your baby and in keeping your baby in position while surgery continues.
Feeding in the recovery room is more straightforward as you will have been raised to a reclining position and will no longer be as restricted in your movement by screens and wires.
Caesarean Birth: A positive approach to preparation and recovery talks in much more detail about the benefits of breastfeeding and the various positions you can try to make feeding easier following a caesarean delivery.
How soon after a caesarean can I pick up my baby?
Assuming all has gone well and your baby does not require additional support (and you are not under a general anaesthetic) she can be with you within moments of her delivery. While in surgery you will naturally be reliant upon other people to pass her to you but once back on the ward your birth partner is likely to be with you for several hours and can pass your baby to you without your needing to get out of bed. In most situations you will be strong enough and capable enough to pick up your baby immediately in any case. If she is not already on the bed with you, the thing that is more likely to take time is getting over to her cot in the first place. Moving about in the first few hours is uncomfortable and for some very painful. However this is understood by staff and they do expect to be needed more regularly by mothers recovering from a caesarean in the first 12 hours.
That said it is not impossible to get up and you will be encouraged to get up and start moving about within 12 hours any case.
It is important to take your early recovery seriously and Caesarean Birth: A positive approach to preparation and recovery talks at length about how to prepare for the early days following surgery and the sorts of things you can try both in hospital and once back at home. For example, you may ask for assistance building a safe area on your bed where your baby can stay with you instead of the cot, while hospital policies do not advocate bed-sharing there are ways and means of making this possible with the support of your practitioners.
Is my car insurance invalidated if I drive within 6 weeks of having a caesarean?
It is commonly believed that car insurance prevents you from driving until after you have passed your six week check. However many women feel relatively back to normal by their six week check (at least as normal as they can be when coping with a newborn while being severely sleep deprived) and it can feel very frustrating to be restricted in this way.
Our research suggests that it may not be the case that your insurer does not cover you to drive until you have passed your 6 week check. Of those contacted during UK research the majority of insurers recommended you do not drive for 6 weeks after a caesarean but did not state this as a policy requirement. They did however state that rather than aiming for a particular date, you should listen to your body and only do what you feel able to. The recommendation was that you should not drive until you feel in full control of your car and able to do an emergency stop if necessary. For some women this may be as early as four weeks after their birth.