Maternity Leaflet: Elective (Planned) Caesarean Section

Elective (Planned) Caesarean Section: You have been provided with this leaflet because you are planning to have a caesarean section for your birth. This may be because of personal choice, a concern or risk factor in your current pregnancy, medical history or due to events in a previous pregnancy and birth.

Leaflet Details

Patient Information

Introduction

You have been provided with this leaflet because you are planning to have a caesarean section for your birth. This may be because of personal choice, a concern or risk factor in your current pregnancy, medical history or due to events in a previous pregnancy and birth.

This leaflet contains vital information to help you prepare for your caesarean, explains what happens during your caesarean and what to expect after birth.

Preparing for your caesarean

When and where is my Caesarean?

• Your provisional caesarean date can be found in your Badgernet Maternity Notes app. A week before you will also receive a text message confirming your caesarean date. This message will include a time; this will not necessarily be the time of your caesarean.
   
• Your Caesarean will either be in Main Theatres or on Labour Ward. Please note down where this is as the arrival time and location depends on this.
   
• In rare circumstances, your caesarean date may be changed. We endeavour to communicate this with you as soon as possible.

Appointment and tests before my Caesarean

• An appointment will be made for the day before your caesarean for a blood test, in Antenatal Clinic or Maternity Triage
   
• We will take some blood samples from you (Full blood count and Group & Save).
   
• This is to check your iron levels (haemoglobin), platelets and to confirm your blood group in case a blood transfusion is needed.
   
• Your consent form should be completed when the caesarean section is booked. If missed, this can be completed at a later appointment or at the above appointment. If you wish to, you can have a copy of this form.

Pre-op pack

• You will receive your Pre-op pack at your pre- op appointment which includes the blood tests. This pack includes
   
• 3 Tablets:
   
• 2x Omeprazole 20mg, one tablet to take the evening before at 10PM, and one tablet in the morning at 6AM
   
• 1x Metoclopramide 10mg to take in the morning at 6AM
   
• Hibiscrub - Wash for face, body, and hair the evening before and face and body the morning of your caesarean section. Do not use conditioner or moisturizers after the hibiscrub
   
• If your caesarean is planned for the afternoon, please take your medications as follows the day of your caesarean:
   
• Omeprazole at 0600 and 1200
   
• Metoclopramide at 1200

Preparing for caesarean at home

• If your caesarean is in the morning, please fast from midnight, sips of water only are allowed until 0600.
   
• If your caesarean is in the afternoon, please fast from 0730, you may have a light breakfast beforehand and sips of water only after this until 1200.
   
• Please remove all nail polish / gel nails, any piercings and jewellery including rings and earrings before coming to hospital
   
• Please remove clip in hair extensions and false eye lashes.
   
• Shaving is not required.
   
• Ensure you have a supply of paracetamol and ibuprofen at home for when you are discharged.
   
• Prepare a pack with baby essentials to take to theatre with you - a hat, a nappy or two, and baby’s first outfit.
   
• You may have given your consent to be able to self-administer your medications whilst in hospital. If this is the case, please ensure you pack a sufficient supply of paracetamol and ibuprofen in your hospital bag, and have a supply of this at home  

The day of the caesarean

Please arrive by 7am to Joan Booker ward if your Caesarean is booked for main theatre in the morning.

If your caesarean is booked in the afternoon, please arrive by 12pm.

If your caesarean is booked for Labour Ward, please arrive by 8AM.

At times, your caesarean section may be moved from Main Theatres to Labour Ward if the list overruns. If this is the case you will be informed once we are aware that this is necessary.

On arrival for the caesarean

• Your observations will be checked, and the midwife will listen to your baby’s heart rate.
   
• You will be provided with anti-embolic stockings and a hospital gown. You will be given a name band.
   
• You will be given a warming blanket; this will be placed in between your sheet and normal blanket.
   
• Your birth partner will be given some scrubs (theatre wear). Once changed, they should stay by the bedside and not leave the ward/go outside.
   
• The surgeon and anaesthetist will confirm the procedure / anaesthesia with you and confirm if any further questions.
   
• If you have collected colostrum, bring up to 5 syringes with you. Ensure every syringe is labelled separately with your name, date of birth, and the date and time it was expressed - keep them frozen from the time of collection, and transport with ice packs. If you are feeding with formula milk, bring some ready-to-use small bottles of first milk. Take at least one of these with you to theatre.
   
• Main theatre is a couple of minutes from Joan Booker Ward through the hospital. A porter will come to collect you and bring you to theatre on your bed when the team are ready.

In theatre

• A small plastic tube (cannula) will be inserted in your hand or arm by the anaesthetist.
   
• Most caesareans are done under spinal anaesthesia. This means you remain awake throughout the procedure.
   
• After the spinal, the midwife will listen to the fetal heart rate. They will also insert a catheter into your bladder to ensure this remains empty through the procedure.
   
• A cleansing of the vagina is routinely done, to reduce the risk of infection.
   
• A “time out” is done by the team to confirm if there are any concerns. This is routine before all surgeries.
   
• Your birth partner will be able to sit next to you once everything is set up in theatre and can stay throughout the procedure.
   
• The surgery usually lasts about an hour to an hour and a half.
   
• In rare cases, a general anaesthetic is needed. The birth partner will be asked to briefly wait outside theatre. Once the medication is administered and you are asleep, your birth partner can come back beside you and do skin-to-skin with baby.

A lot of people will be present in theatre including:

• Surgeon
   
• Assistant to the surgeon - this is usually a resident doctor
   
• 1 or 2 Scrub nurses
   
• Anaesthetist
   
• Operating Department Practitioner (“ODP”) - who assists the anaesthetist
   
• Midwife
   
• Obstetric Nurse
   
• Assistant Theatre Practitioner (“ATP”)

Everyone is there to support and look after you and your baby. Please ask anyone if you have any questions or concerns.

Birth

• If you wish, the drapes can be dropped so you and your birth partner can see your baby being born.
   
• The cord will be clamped and cut between 3 minutes after birth.
   
• Baby will be weighed and be given to you to provide skin-to-skin. We strongly advise for you (or your birth partner) to do this and to give first feed in skin-to-skin.
   
• You can bring your camera/phone with you to theatre. Be mindful not to take pictures of staff without prior consent.

After baby is born

• You will be in Theatres Recovery for 2 hours afterwards. Your baby and birth partner will stay with you.
   
• Your wound dressing, blood loss, observations will be checked regularly by a Midwife or Obstetric Nurse.
   
• You will be assisted with feeding your baby. We advise for the first feed to be done within the first hour after birth, in skin-to-skin. If you have some colostrum, this can be given after the feed or as a snack if baby is not ready for a full feed.
   
• After the initial recovery, you will be transferred back to your bed space in Joan Booker Ward if there are no concerns.

Postnatal care

• Postnatal care is given on Joan Booker Ward. Visiting hours are:
   
• Birth partners: any time
   
• Siblings of the baby: 0900-1300, 1500-1800
   
• Other visitors: 1500-1800
   
• You can have a maximum of two visiting adults including your birth partner at the bedside at any one time
   
• Between 1300-1500 the Joan Booker Ward has quiet time, where the lights are dimmed and noise levels reduced. This supports babies’ brain development.
   
• Your catheter and canula are usually removed the day after the surgery, however if you are mobile and well prior to this please speak to your Midwife about removal.
   
• There are regular drug rounds on the ward. Please do ask for additional pain relief in between if required. If you are part of our self-administered medications (SAMs) trial, you should take your own analgesia as required and request further analgesia from the midwives if needed.
   
• You will be advised to take Enoxaparin. This is an injection to help reduce the risk of developing blood clots after birth. Your midwife or nurse will teach you how to administer this.
   
• Depending on the type of dressing, this will be removed 3 or 7 days after birth. Please discuss with your midwife when to take the dressing off.
   
• We aim to discharge you home the day after birth if there are no other concerns. You will have care provided by our community midwifery team for up to 28 days after baby’s birth - you may be discharged sooner if you and baby are well and do not require further midwifery support.
   
• Please ensure you have a supply of paracetamol and ibuprofen at home ready for discharge.

Some pain and discomfort after a caesarean is normal, especially on mobilising. Continue to take regular pain relief to stay on top of this pain in the first days. A full recovery from a caesarean can take up to 6 weeks.

You may be able to self-administer your pain relief postnatally if this has been agreed during your pregnancy. If this is the case for you, you will be given access to a bedside locker in which you are expected to store your paracetamol and ibuprofen. Please note that if you require additional pain relief to your paracetamol and ibuprofen, this can be provided by our Midwifery team.

Caring for baby

• Babies are at risk of getting cold after birth. This can affect their breathing and feeding. To prevent this:
   
• We recommend skin-to-skin to keep baby warm. This can be done after birth, by yourself or your birth partner.
   
• Please bring a hat, nappy, vest and baby grow to theatre for baby.
   
• You are provided with a warming blanket to ensure you are not cold. This will also reduce the chance of baby becoming cold.
   
• Your baby’s breathing, temperature and heartrate will be checked regularly for the first 12 hours (minimum).
   
• You will be assisted with feeding your baby.
   
• Feeding baby within the first hour of birth is recommended.
   
• Feed your baby at least 8 times in 24 hours. Offer hand expressed colostrum between or after feeds as advised by your Midwife.
   
• If you have some harvested colostrum, please bring some with you to theatre. This can be given in theatre.
   
• If you plan to bottle feed, please bring some pre-made formula with you to theatre.
   
• Antenatally expressed colostrum is advised for first feed even if you wish to bottle feed.
   
• There are antenatal drop-in sessions in Abbey Wing, St Peter’s hospital, each Friday from 0900 to teach how to collect and give colostrum.
   
• Positioning your baby in skin-to-skin

Useful links and leaflets

On Badgernet Maternity Notes App

• Considering a caesarean birth
   
• Anaesthesia for caesarean section
   
• Feeding and Nurturing Padlet
   
• Vitamin K
   
• Collecting colostrum antenatally
   
• Hand Expressing Video
   
• Term Baby: Establishing Responsive Feeding for Breast and Bottle Fed Infants
   
• Going Home after a Caesarean Section

You are at the centre of our care, please discuss if you have any questions or concerns