Caesarean Section

Most women will not need blood tests.

Prior to the operation you need to see an anaesthesiologist. You will get an appointment for the examination in e-boks or when you get the date for your operation. The examination takes place at the Anaesthetic Outpatient Ward (Regionalhospital Gødstrup, fløj R i Klinik for bedøvelse).

• You will recive the date for the planned caesarean section in your e-boks. Changes may happen due to planning.
• The day before the planned caesarean section we would like you to call the Antenatal and Postnatal Ward after 4 pm to arrange for the exact arrival time on the day of the operation – phone number 78434770 press 4.
• In the morning on the operation day, you need to take Paracetamol as described on the paper "Important appoinments and information"
• 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 disinfection of your skin
• Pubic hair need 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. If 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 hours 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 support you during the Caesarean section.

On the day of the operation you will arrive at the Inter-professional Training Unit (Studieafsnittet) 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/companion will need to change clothes

You will:

• Receive an ID bracelet with your name and CPR number on it
• Get help to remove your pubic hair if needed
• Be offered an intravenous infusion of medication to reduce bleeding during and after the Caesarean section

If possible, the midwife who is attending the Caesarean section will stop by to meet you.
At the time of the operation the hospital porter will come and take you to the OR (Operating Room).

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

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

You may take pictures at the OR if in agreement with the staff. Video recording is not permitted.

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 who will carry out the Caesarean section
• 2 OR nurses
• A midwife who will take care of the baby
• Students may 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, 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.

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 bonding to your baby.
You will be able to discuss the option of skin to skin Caesarean section with the staff prior to the operation. Optionally you can se a small film about skin to skin Caesarean section.

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.

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.

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 normal function.

Bladder infection and pelvic inflammatory diseases occur slightly more often after a Caesarean section than after a vaginal birth. These 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 Ward.

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 Inter-professional Training Unit/Antenatal and Postnatal Ward.
You will be under close observation during the next 1½ - 2 hours until you can move your legs and your blood pressure is stable.
You may 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 arised 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 Inter-professional Training Unit/Antenatal and 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 1-2 hours after birth.

We offer a family room to you and your partner/companion and 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 2 nights for first-time mothers and 1 night for mothers who had babies before. It is also possible to be discharged on the very same day if all is well.

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 be removed approximately 24 hours after the Caesarean section unless you have a special PICO bandage, which need to stay on for the first 7 days.
It is important to rinse the wound daily in the shower.
Normally, you will be able to take care of your baby yourself.

Food and Drink
You may eat and drink whatever you prefer.

Treatment of Pain
After the Caesarean section you will experience pain in the wound and contractions in your uterus (afterpains).
We recommend that you receive pain-relief tablets routinely and regularly 4 times a day ensuring that you will not experience sudden pain when the tablets stop working.
The treatment consists of 2 tablets of Paracetamol (1 gram) and 2 tablets of Ibuprofen (400 milligrams) four times within 24 hours. Additionally, you may receive 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 on problems with urination. 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 must start again
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 "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.
Mostly, you will see a doctor or a medical student during your stay and have the opportunity to discuss the operation. Feel free to request a medical consultation.

We recommend that you take Paracetamol and Ibuprofen for the first 2½ days. Those are pain-relief medications. The first couple of days, we may add Morphine as needed.

You will probably need to continue Paracetamol and Ibuprofen – both "over-the-counter" medicine – after discharge. 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 will 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 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 cutting the nerve endings. 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 you to 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 good skin 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 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 closely monitoring of you and the baby at the delivery.

You will be admitted to the Inter-professional Training Unit at the Antenatal and Postnatal Ward (Svangre-barselsafsnittet).
In the Inter-professional Training Unit nursing, midwifery, and medical students work together in cross-curricular teams in close cooperation with trained nurses, midwives, and doctors. We value education and high professional standards in the Training Unit.