Caesarean Section

You will have to consult an obstetrician at the hospital in the process of planning the caesarean section. You will receive an invitation by post or digitally with the date and time.

Most women will not need blood tests prior to the operation, but you will need to see an anaesthesiologist. He or she will inform you about the anaesthesia for the caersarean section.

Normally you can se the anaesthesiologist directly after talking to the obstetrician. Otherwise you will receive an invitation from the hospital.

• The day before the planned caesarean section you need to call the Antenatal Ward (Fødeafsnittet) to arrange for the exact arrival time on the day of the operation – see under Contact Information.
• In the morning on the operation day, you need to take 2 x 500 mg Paracetamol (Pamol, Pinex, Panodil) Take the medicine 2 hours before surgery.
• We expect you to shower before your admission. Please pay extra attention to cleaning the belly button. Please, do not apply body lotion to your abdomen. This prevents the effects of the surgical alcohol used for disinfecting of your skin.
• Pubic hair needs to be removed with a trimmer. Do not use a razor as it may cause small cuts to the skin allowing bacteria to enter. If you have not had the chance to remove the pubic hair yourself, the staff will help you on admission.
• Please remove piercings close to the area of incision prior to the operation due to the risk of infection.
• You are not allowed to wear fake nails, nail polish, jewellery or makeup during the operation as we need to assess your blood circulation during the operation by observing the colour of your skin and nails
• Food: It is important that the stomach is empty to avoid the risk of vomiting during the operation regardless of which type of anaesthesia you are receiving. Therefore, you are not allowed to eat 6 hours before the operation. This includes intake of milk products. In case you are awake during the night before the operation it may be a good idea to have a light meal before the 6 hour limit.
• Drinking: We recommend everyone to drink up until 2 hours before the operation. You are allowed to drink clear liquids including water, juice without fruit pulp, tea and coffee without milk. Sugary drinks such as juice may reduce nausea after the caesarean section.
• You may brush your teeth.
• If you smoke, you are allowed to smoke up until 2 hours before the operation

Your partner or a companion may stay with you during the caesarean section.

On the day of the operation you will arrive at the Antenatal Ward (Fødeafsnittet) at the time agreed on the phone the day before. Feel free to ask any questions you may have.

You will be prepared for the caesarean section:

• Both you and your partner/compaion will need to change clothes. You recieve colthes at the hospital.

You will:

• Receive an ID bracelet with your name and CPR-number on it
• Get help to remove your pubic hair if needed
• Get an ultrasound scan if the reason for the caesarean section is a baby in a breech presentation (UK). If the baby is no longer in breech there is no indication for the caesarean section. 

If possible, the doctor who is performing the caesarean section will stop by to meet you.

At the time of the operation you, your partner and the midwife will walk  to the OR (Operating Room) together.

Please be prepared for some waiting time in case of emergency situations.

Two doctors will carry out the operation. You will meet one of the doctors just before the operation.

You may take pictures at the OR if the staff agrees to it. Video recording is not permitted and your phone needs to be on flight mode.

There will be a lot of staff in the OR, each with a specific role:

• An anaesthesiologist who will administer the anaesthesia.
• An anaesthetic nurse who will observe you during surgery.
• The obstetricians/gynecologists who will carry out the caesarean section
• 2 OR nurses
• A midwife who will take care of the baby
• Students may also attend

A spinal anaesthetic will be given unless there are particular reasons to choose a general anaesthetic.

It is the anaesthesiologist, who gives the anaesthetic. Few experience pain during the administration.

Before the anaesthesia is given, we will establish an IV access and you will be connected to a monitor enabling us to monitor your blood pressure and your pulse. You will also receive oxygen through a nasal catheter.

The spinal anaesthetic will make you pain free and you will be awake when the baby is born. You will still be able to feel touch, but it is not painful.

You may experience nausea and uneasiness and if this happens, you will be given medicine to counteract the symptoms. These will disappear within a few minutes.

At the OR just prior to the operation you will have a catheter placed in your bladder. It is done after the anesthesia so you wont feel discomfort. 
  

After the catheter in your bladder has been placed, your abdomen will be disinfected with a surgical alcohol.

Your body will be covered with a sterile surgical cover creating a barrier between your upper and lower body to prevent you and your companion from seeing the operation.

The obstetrician will make an incision in the area right above your pubic hair line. During the operation you will feel pressure on your abdomen to help the baby out.

Provided everything goes as planned you will be offered a special method named "skin to skin caesarean section". By this method the surgical cover will be lowered allowing you to see the baby being born.

Right after being born the baby will be placed skin to skin at your chest allowing it to sense the warmth and security from your body and begin the search for the nipple.

We know that this early contact is essential to breastfeeding as well as to bonding with your baby.

You will be able to discuss the option of skin to skin caesarean section with the staff prior to the operation. 

In case the baby needs examination or treatment after being born, we will take the baby to a special table just outside the OR where an anaesthesiologist and a pediatrician will examine the baby. The baby will be placed on your chest as soon as possible hereafter.

The vast majority of caesarean sections are performed without complications and serious complications are very rare.

Headaches

1 % of women experience an unpleasant headache from the spinal anaesthesia. The headache occurs when in an upward position but tends to disappear when lying down. The headache is not dangerous but may require treatment. You can try to reduce the discomfort yourself by drinking plenty of fluids preferably containing caffeine.

Emptying your bladder

Some experience difficulties emptying the bladder when a local anaesthetic has been administered. If this occurs, it may be necessary to empty your bladder with a catheter until your bladder works properly again. For most women, it only takes a couple of days before the bladder returns to its normal function.

Infections and blood clots

Bladder infection and pelvic inflammatory diseases occur slightly more often after a caesarean section than after vaginal birth. These types of infections are treated with antibiotics.

Few women experience an infection of the caesarean section wound which requires extra treatment.

A caesarean section increases the risk of blood clots in your legs. This is prevented by getting out of bed and going for walks on the labour ward/postnatal ward.

If damage occurs during the operation

Damage to your bowel or your urinary tract can occur during the operation. This happens 1-5 times for every 1000 caesarean sections. Such injuries may require a new operation, but will rarely cause problems later on.

Provided everything goes as planned you will be transferred back to the labour ward/postnatal ward.

You will be under close observation during the next 1-2 hours until you can move your legs and your blood pressure is stable.

You receive pain-relief medicine as needed. This can be given through a vein and/or as a tablet.

We will be observing the amount of bleeding from your vagina and from the incision on your abdomen if this occurs.

If you have had a general anaesthetic or complications have arisen during the operation, you will be transferred to the recovery ward on the intensive care unit for observation after the caesarean section. When stable, you will be transferred to the postnatal ward.

Peace and quiet

The first hours with your newborn baby are very unique and cannot be repeated later on. We recommend that you lie skin to skin and get acquainted.

For many new families it makes sense to be as few people as possible around the baby during these first hours. Consider postponing visitors until later.

Baby at the breast

Most babies will show interest at the breast within the first hours if left undisturbed skin to skin with their mother. The baby will show signs of being ready to suckle.

Perhaps you will need a little extra practical help from your partner/companion or the staff for the first couple of breastfeedings.

The suckling needs of babies may vary. Some babies might feel nauseated by amniotic fluid they may have swallowed and therefore seem uninterested in suckling.

We know that skin to skin contact in the first hours after the caesarean section has a positive effect on both breastfeeding and bonding between baby and parents.

Nausea

During the first hours after the caesarean section you may experience nausea. Drinking sugary fluids up until 2 hours before the Caesarean section can help prevent this. It is also important to try to eat and drink after the operation.

If needed, medicine to counteract or reduce nausea can be given.

Itchiness after spinal anaesthesia

You may experience itchiness due to the medication after a spinal anaesthesia. It will usually disappear after a couple of hours. In some cases, you may be given medicine to reduce the itchiness.

Examination of the baby

The baby will be weighed, measured, and examined a few hours after birth.

We offer a family room to you and your partner/companion where the staff will be available to guide and help you according to your needs.

We recommend that your partner or companion stay with you in order to create the best conditions for getting to know your new baby together.
The expected admission time is 1-2 nights. 

Get out of bed as quickly as possible

Within 6 hours after the caesarean section you will need to get out of bed for the first time in order to "restart" your body after the operation. Please take a walk in the ward as quickly as possible.

The catheter in your bladder will be removed at the latest 6 hours after the operation.

During the days following the caesarean section it is important that you mobilize and rest alternately. It is advisable that you get out of bed for a couple of hours in the morning, in the afternoon, and in the evening.
You can take a shower whenever you feel like it.

The bandage will stay on for 6-7 days after the caesarean section. If it detatches in the shower, you won't need to put on a new one. 

Normally, you will be able to take care of your baby yourself.

Food and drink

You may eat and drink whatever you prefer. If you have allergies or don't eat special types of food, please let the nurses know.

Treatment of pain

After the caesarean section you will experience pain in the wound and contractions in your uterus (after-pains).

We recommend that you receive pain-relieving tablets routinely and regularly ensuring that you will not experience sudden pain when the tablets stop working.

The treatment consists of Paracetamol, Ibuprofen and additionally Morphine if needed.

Urination after spinal anaesthesia

It is important that you experience normal urination 3-4 hours after the catheter has been removed from your bladder.

You may not experience the urge to urinate during the first couple of days after the spinal anaesthesia and therefore you should pay extra attention to emptying your bladder.

We recommend that you try to urinate every 3-4 hours. Please contact the staff if problems with urination occures.

If the bladder becomes too distended, the uterus may have trouble contracting properly and thereby raising the risk of increased bleeding. A distended bladder may also cause long term complications.

Bowel function

Mobilization is important to get your bowels started again. This is one of the reasons why we recommend you get up and walk around.

Drink plenty of water and eat lots of fibers and vegetables – this promotes the process.

You will receive a mild laxative the first couple of days after the caesarean section. If you have experienced constipation during your pregnancy it may be a good idea to take Magnesia tablets a couple of days before the caesarean section. Magnesia is a "over-the-counter" medicine.

Guidance on rehabilitation

Postnatal exercise is just as important after a caesarean section as after a vaginal delivery.

The muscles of the pelvic floor need to be rehabilitated and re-trained as they have been affected by the pregnancy. The entire body needs help to change from pregnancy to normal mode again.

We recommend that you lift only to your pain threshold the first 6 weeks after the caesarean section. As a guideline this corresponds to the weight of the baby and the carrycot or baby car seat.

Breastfeeding guidance

You are encouraged to contact the staff at breastfeedings to receive guidance on correct suckling technique, breastfeeding positions etc.

We add on to the knowledge you already have from your antenatal classes or the experience you have from breastfeeding previously.

Doctor's examination

You do not normally need an examination after a caesarean section but it is possible to contact a doctor if needed.

The majority will however see a doctor or a medical student during their stay and have the opportunity to discuss the operation. Feel free to request a medical consultation.

We recommend that you continue to take Paracetamol and Ibuprofen when you come home from the hospital. Both types and medicine are"over-the-counter" medicine and can be bought at any pharmacy. Make sure to buy these prior to your caesarean Section if possible.

Our recommendation is that you start reducing your pain-relief medication by first reducing Ibuprofen, then Paracetamol. Most women need pain-relief medication for 8-14 days after a caesarean section. You will be given detailed instructions at discharge.

Do remember:

• It is important that you take your pain-relieving medication in order to be able to move around
• It takes 30-45 minutes for the medication to work
• No side-effects will occur in your baby through breastfeeding as long as you take the medicine as prescribed

About 8 days after the operation the staples keeping your wound closed must be removed. This can be done by your General Practitioner (GP).

It is your responsibility to make an appointment with your GP. You will receive a staple/clip remover, which your GP will use.

If you have a PICO bandage, you need to remove this bandage yourself after a week – typically just before the appointment with your GP.

If the wound has been closed with a thread, it is usually a type of thread that dissolves by itself.

It is normal to experience a swelling above the scar during the first couple of weeks. Some experiences bruising around the scar which may be sore, but this will also disappear over time.

It is also normal that the scar will be numb due to the nerve endings being cut during the operation. The normal sensation will return after a couple of weeks or months.

It is important that you shower the scar area daily and keep the scar dry to protect it from infection. If you have a skin fold, you can apply gauze to absorb any moisture.

After you have had the staples/clips removed and the scabs have gone, you can make the scar smooth and reduce numbness by massaging it with soap and oil.

We recommend that you buy a roll of "englehud" (Micropore tape) to place over the scar. "Englehud" is a paper-thin tape which can be bought at any pharmacy.  You should change the "Englehud" at least once a week.

The treatment is recommended for the first 3 months after the caesarean section to encourage the healing of the scar edges.

After this period, apply high factor sunscreen on the scar when in direct sunlight.

Even though you have had a caesarean section this time, it does not mean that you will need to have another caesarean section or that you are incapable of giving birth vaginally in the future.

If the same conditions are present in a subsequent pregnancy you will most likely have another caesarean section - otherwise a vaginal birth will be planned. You will be offered a clarifying consultation on this topic in the next pregnancy.

A few women may experience that their placenta is located over the scar of the uterus in subsequent pregnancies. This may cause severe complications at the delivery and will be closely monitored by scans throughout the pregnancy.

In rare cases the scar of the uterus may rupture at a subsequent delivery. This risk factor requires the close monitoring of you and the baby at the delivery.