caesarean section
Labour & birth

Caesarean sections in Ireland

There’s no doubt that caesarean sections in Ireland are on the rise. A study conducted by the Economic and Social Research Institute (ESRI), UCD and Trinity College Dublin, found that C-section births have increased from 7% in 1984 to 13% in 1993 and 30% by 2014.

Finding out what to expect during a C-section as well as the risk and benefits – both during the procedure and afterwards – can help you prepare.

What is a C-section?

A Caesarean section (C-section) is an operation that enables your baby to be born through an incision made on your pregnant abdomen. A C-section may be planned for medical reasons or you may experience an emergency Caesarean when labour does not go as planned. An emergency C-section usually occurs after labour has begun.

What if I have a general anaesthetic?

If you have a general anaesthetic, you will be asleep for the procedure. This is rare, but it may be needed if there is a reason why staying awake is not suitable. The doctor will give you oxygen to breathe before the general anaesthetic is started. If this type of anaesthetic is chosen, your partner will be asked to stay in the waiting room and he will be able to see and hold the baby after the birth.

“Five of my seven children were born by c-section. The first C-section was a little bit surreal. Unlike a vaginal birth, there is no pain at the time of delivery and this baby is just ‘lifted out’ of your tummy. The two tips I would give anyone who has a C-section is to stay on top of your pain medication afterwards, in the early days especially, and get moving as soon as you can – without overdoing it. I found my fifth C-section as easy to recover from as my first. I think it helped knowing what to expect and knowing how to help myself recover.”

  • Jen Hogan

What happens during a caesarean section?

  • In theatre there will be a team to care for you and your baby.
  • Equipment will be attached to you to measure your blood pressure, heart rate and the amount of oxygen in your blood.
  • The anaesthetist will set up a drip to give you fluid through your veins prior to the anaesthetic.
  • An epidural or spinal will be sited by the anaesthetist.
  • When the anaesthetic has taken effect, a urinary catheter tube will be inserted into your bladder to keep it empty during the operation. This should not be uncomfortable.
  • For the operation, you will be placed on your back, slightly tilted to your left side.
  • You should mention if you feel sick to the anaesthetist. This may be caused by a drop in blood pressure and the anaesthetist will give you treatment to help you.
  • A screen will be put up at the level of your chest to separate you and your partner from the site of the operation.
  • Your abdomen will be washed with antiseptic and covered with sterile drapes. The anaesthetist will stay with you all the time.
  • The staff will let you know what is happening as they go along.
  • Once the operation is underway, you should tell the anaesthetist if you are uncomfortable at any time. The anaesthetist can give you more pain relief as required.
  • Occasionally, it may be necessary to give a general anaesthetic, but this is very rare.
  • Immediately after the birth, your baby is checked and skin-to-skin starts.
  • It usually takes another 20- 30 minutes to complete your operation.
  • If you are not feeling well or feeling sleepy, your partner can do skin-to-skin with baby.

caesarean section

A planned caesarean section

A planned Caesarean section will be scheduled before the onset of labour for a specific clinical indication. Other reasons for a C-section include a breech presentation, where it is not safe to turn a baby or turning a baby has been unsuccessful. Another reason is placenta previa, where the afterbirth is covering the vaginal opening. A repeat C-section will be planned if the woman has had two or more previous C-sections.

A request from the expectant mum is not, on its own, an indication for Caesarean section. Specific reasons for the request should be explored, discussed and recorded. When a woman requests a Caesarean in the absence of an identifiable reason, the overall benefits and risks of Caesarean section compared with vaginal birth should be discussed and recorded.

When a woman requests a C-section because of a fear of childbirth, she should be offered counselling, such as cognitive behavioural therapy, to help address her fears in a supportive manner. This results in reduced fear of pain in labour and shorter labour.

Emergency caesarean section

The decision to carry out an emergency C-section will be made if your baby’s wellbeing or your own health are at risk. Some examples of this would be antepartum haemorrhage (a bleed before delivery), abruption (when the afterbirth comes away from the wall of the uterus) or uterine rupture.

Q. Is it possible to give birth vaginally (VBAC) if your first baby’s birth was a C-section?

A. Having a vaginal birth after having a C-section can be a safe choice for most women. Whether it is right for you depends on several things, including why you had a C-section before and how many C-sections you’ve had. You and your doctor can talk about your risk for having problems during a VBAC trial of labour.

According to Rosaline O’Donovan, Assistant Director of Midwifery at CUMH: “If a woman goes into spontaneous labour by themselves, they have a 70% chance of a vaginal delivery next time. It is important to be assessed and monitored during the labour as each case is individual.” As with any labour, if the mother or baby shows signs of distress, an emergency Caesarean section is done.

The benefits of a VBAC compared to a C-section include:

  • Avoiding another scar on your uterus. This is important if you are planning on a future pregnancy. The more scars you have on your uterus, the greater the chance of problems with a later pregnancy.
  • Less pain after delivery.
  • Fewer days in the hospital and a shorter recovery at home.
  • A lower risk of infection.

More like this:

Outlining your birth preferences
The ultimate hospital bag checklist
Birth story: change of plan

Ask Sarah

Q I’ve heard a lot about the Paleo diet and as I am very interested in reducing the amount of processed foods and grain based meals my family eats, we are considering following this diet. From what I read it seems to be a back-to-basics type of eating. Is a Paleo diet safe for children? My kids are aged seven and nine.

A The Paleo diet is one of the most fashionable diets around at the moment. It is also known as the ‘caveman diet’ and is based on cutting out processed foods, starchy foods like bread and potatoes and eating more meat, vegetables and fruit.
As fad diets go, it is not the worst but there are some good and bad sides to it. Reducing the amount of processed foods we eat is always a good idea and by doing that you will usually reduce the amount of fat, salt and sugar you eat, which is a good thing! The problem with the Paleo diet is that it also cuts out dairy (on the basis that cavemen didn’t drink milk) and this means that the diet is very low in calcium. For this reason it is really not suitable for children who do need a lot of calcium for growing bones. How did cavemen manage without dairy? They ate a lot more food than we do (up to 10,000 calories per day compared to the 2,000 most of us eat). By eating that amount of food they were able to pick up just enough calcium from green vegetables and seeds. To put it in perspective, you would need to eat 16 servings of broccoli a day to get all the calcium you need. This is easier to do if you eat 10,000 calories per day rather than 2,000.
The other problem with the paleo diet is that it is not entirely based in science. Many of the Paleo diets out there say you should not eat wheat, even though we know that cavemen did in fact eat wheat and other grains. These diets also don’t recommend that you eat blubber and the big lumps of fat that were also a large part of the caveman diet!
A final problem is that many Paleo diets encourage people to cut out beans and lentils and to get their protein from meat and fish instead. Many studies over the last few years are clear that eating too much animal protein is linked with more cancer and heart disease. Eating some vegetarian meals based on beans and lentils is a great way to get your protein without always going for meat.
Is this a diet we should follow? I think there is a lot we can learn from the Paleo diets. We could all do with eating less salt, sugar and processed foods and adding in more nuts and seeds as well as more vegetables. However, I think following a strict Paleo diet could lead to low levels of calcium and vitamin D and so it is not suitable for children or teens and adults would need to think about a calcium supplement.

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Ask Allison

Q My sister-in-law and I both work three-day weeks and we help each
other out with child minding on our working days, which up until recently has worked out really well. Between us, our kids are aged between five and nine years – the problem is that it’s now become quite apparent that we have very different parenting styles. I prefer my two daughters (seven and nine) to have a structured day. For example, in my house, we have allocated times for television and iPads, etc. My sister-in-law, however, lets the kids run loose after school – homework is ignored and my kids end up wired after eating sugary treats all afternoon. I am considering looking at after-school childcare for the kids, but I’m worried that this is going to cause a family argument. Is there a diplomatic way that I can ask my sister-in-law to introduce some discipline into her child-minding days? It certainly doesn’t do her two kids any harm when I am minding them in my own house!

A
In a word, no, there is no diplomatic way to do this as it may very likely seem like your saying that your parenting style is better than
hers. As L’Óreal says, ‘now here comes the science bit.’ Dr. Kaylene
Henderson, a child psychiatrist, wrote a very interesting blog about ‘the
science behind the Mummy Wars’. She explains that before she had
children of her own she hadn’t been aware of how parents have a
very specific sense of the right parenting style. She also found that parents could be very definite in defending their chosen parenting style. Dr. Henderson, who describes herself as a curious, scientific, open-minded person, was surprised at how defensive parents could be and, at times, of their judgemental attitude towards each other. She explained the neurology of the Mummy Wars; okay, I’ll need you to bear with me for a second. Warning; I’m about to use some neuro-techie language.

Why do we judge each other?
As we have all had different experiences, this means that we all have very different memories stored in our brains. Most of our memories are ‘explicit’ memories – these are ones that we can recall easily such as important dates that mean something to us; important birthdays, special events or stories of and about our lives.
There is another type of memory called ‘implicit’ memory that plays a
key role in our parenting. This type of memory is the stuff that you do on autopilot. Psychologists call these heuristics or rules of thumb –
such as tying your shoelace, or driving your car (once you have learnt
to do both first!). Otherwise we’d really waste a huge amount of time
pondering over tasks that we have readily available to us. This seems to be where the science bit of our parenting style kicks in. This implicit memory goes all the way back to when you were an infant being parented by your parents. This is when you started the process of storing up how they did it into your memories.
Unless you make a conscious choice and effort to parent differently, what you saw and unconsciously learnt will be your automatic go-to parenting style.

We learn habits
This can really kick into gear when we feel our parenting style is
being mirrored or highlighted by disapproval from another parent. I know the cold sweat you feel when your child decides to make their outstanding bad behaviour performance at, of course, the most public and worst time. The implicit autopilot of how your parents dealt with these outbursts will flow unconsciously from you if you haven’t worked super hard to be aware and consciously change the old habits.
What’s happening for the on-looking parent is that they see you doing something they are used to doing, but you are doing it all wrong. Simply, because that is not how they know how to do it.

Find a way that works
You both have different parenting styles – who is to say which type is correct? You just need to know what works best for your family and that’s the bottom line. The irksome feelings won’t go away. You can talk to your sister-in-law, but I’m adding a caveat that it would be hard not to hurt her feelings. What we’re possibly looking at is that you prefer a more structured form of parenting, whereas your sister-in-law has a more permissive style. I’m not sure the two styles can mix, the mixture is a bit like oil and water.
If a collaborative shared form of parenting style can be agreed upon, then that is great, but our learnt hardwiring may prove difficult to change despite the intent to do so.
Perhaps, your own instinct of changing childcare might work best for you. In terms of making childcare work; the fit is ultimately the most
important aspect as you want a cohesive congruent feeling of the other caregiver to just ‘getting it’, like in any good partnership. Best of luck
with this and I wish you both well.