Theatre

Planned caesareans are usually between 39 and 40 weeks of pregnancy but may be earlier or later depending on your circumstances. A date will be agreed with your obstetrician towards the end of your pregnancy.

A small number of women (about 1 in 10) will go into labour before their caesarean date. It is important to discuss with your midwife what may happen in this case. If you think your labour is starting, call triage for more advice. You will be offered a caesarean if labour is confirmed. If labour is very advanced, it may be safer for you and your baby to have a vaginal birth.

Occasionally, your caesarean may be rescheduled due to unforeseen circumstances.

If your caesarean birth is planned, you will meet with a midwife for a pre-assessment appointment up to 72hrs before the birth. The appointment will include:

• An opportunity to ask any questions you may have about the operation
• Information about when to stop eating and drinking before the caesarean
• Anti-acid medication to take at home before the surgery
• A blood test to determine your iron and platelet levels and your blood group.

For theatre, we will ask you to provide a nappy and a hat for your baby. If you would like some photographs taken, your birth partner can bring your or their mobile phone (or a camera) into theatre. You can find a detailed list of items we suggest you bring to the hospital here.

We can facilitate the following:

• Your birth partner staying by your side
• Skin-to-skin contact after birth as early as possible. Skin-to-skin contact is when a baby is dried, laid directly on the mother’s bare chest after birth, and covered with a warm towel. It has lots of benefits for babies and mothers. We can also facilitate birth partners to have skin-to-skin. Please mention to your midwife on the day if you would like this to happen. We can provide a larger scrub top for your birth partner to wear in theatre
• You can also discuss with the midwife who is looking after you in theatre whether you’d like initial baby checks done first or after you have had some skin-to-skin time with your baby. Initial baby checks include your baby’s weight and head circumference and an assessment of your baby’s overall condition. If there are any concerns, for instance if your baby needs some extra help with breathing, this may delay skin-to-skin
• Your own music. You can pair your own phone and playlist with our speaker or you can choose to wear headphones
• Delayed cord clamping. We aim to delay cord clamping for all babies. This means that if your baby’s condition at birth allows, we will wait 1 minute before the cord is clamped and cut. Your birth partner with then be offered to trim the cord
• The option for you or your birth partner to discover the baby’s sex
• The option for your or your birth partner’s voice to be the first voices that your baby hears
• The option for your birth partner to take pictures or a video (with the permission of the theatre team)

A note on lighting:

Adequate lighting is essential to perform your caesarean safely and to assess your and your baby’s wellbeing at any time. If you are concerned that the lighting may disturb your experience, you can discuss this with your team before the birth. Some women will choose to wear an eye-mask.

Do you facilitate vaginal “seeding”?

“Seeding” is the practice of swabbing the woman’s vaginal fluids and applying them to the baby’s skin. It has been described as a way to expose your baby to your “good bacteria”.There is no evidence that this practice improves your baby’s health. If you want vaginal seeding, we recommend you research this topic and discuss how you would like to proceed with your team.

Alternatives to boost your baby’s “good bacteria” and help them develop their immune system:

• skin-to-skin contact. Not just after the birth, but in the following hours, days and weeks.
• breastfeeding (click here for more information on infant feeding and classes available at Kingston Maternity)
• avoid bathing your baby for at least 24 hours and preferably longer.

You will meet some members of your team:– the midwife who will attend the birth. They will check your details and perform an antenatal check as well as completing a theatre checklist. This is a good time to discuss your birth preferences.

– the obstetrician who will perform the surgery. After going through potential risks and benefits, they will ask you to sign a hospital consent form for a caesarean.

– the anaesthetist, the doctor in charge of pain management, will ask you a few questions about your health and medications you take. They will also check your airway by inspecting your mouth.

When the team is ready for your birth, you and your chosen birthing partner will be accompanied to theatres.

Along with your midwife and obstetrician, you will meet the team who will be looking after you:

Anaesthetist– this is the doctor who looks after your pain relief and provides your anaesthetic. They will insert an intravenous line – usually in your non-dominant hand – and then administer the regional anaesthetic in your back which is usually spinal anaesthetic.

You can find more information on pain relief for birth here

ODP (Operating Department Practitioner) – assists the Anaesthetist

The scrub –This is the person who passes equipment to the obstetricians during your baby’s birth. They also help prepare you to be moved to the recovery room.

The runner – This person helps the scrub set up the theatre and get all equipment ready. They also bring anything extra that the team need while you are in theatre and help prepare you to be moved to the recovery room.

1st Assistant – This is the second obstetrician who helps the lead obstetrician perform the caesarean.

All team members will introduce themselves to you and your partner. They will also be wearing a badge with their name and role.

People who may also attend include: paediatricians (doctors trained to look after babies) and staff in training: medical or midwifery students.

• Your birth partner will be given a seat beside your head so they can support you and share the birth with you.
• A drape will be placed, running vertically from your chest so you can’t see the operation happening. Some find it relaxing to look at the butterfly images on the ceiling, talk to their partner or listen to their music via our speakers or headphones.
• Once the anaesthetic is working, your midwife will insert a catheter into your bladder.
• The obstetrician will then clean your abdomen with an antiseptic solution and sterile drapes will be placed over your abdomen before the operation starts.
• The caesarean is performed by the lead obstetrician and an assistant. They will make a transverse cut in your skin about 15 cm long and near the pubic hairline. If you already have a scar, the same incision line will be used, and the initial scar may be removed.
• When your baby is being born, the obstetrician will ask the staff to lower the drapes so you and your birth partner can see your baby.
• We aim to delay cord clamping by one minute for all births if there is no concern about you and your baby’s wellbeing.
• Your baby will be given to your midwife. After an initial short check your baby will be placed on your chest, skin-to-skin. Your midwife will ensure the baby is kept warm and monitor their well-being. If there are any concerns, the team will call for support from the paediatric team.
• Meanwhile, your obstetricians will close your abdomen. Most of the time the skin wound closure is done with a stitch that dissolves.
• At the end of the operation, a special dressing will be placed over your wound. The vagina is checked for concealed bleeding or clots. A rectal suppository for pain relief is administered.
• Your team will give you a gentle wash before you and your baby are transferred on the same bed to the High Dependency Unit (HDU) – the recovery ward.
• In HDU, a nurse or midwife will be performing regular checks for you and your baby. They will also assist you to feed your baby.

Stem cell collection can be performed on the day of the birth however it needs to be arranged privately before the birth. Your chosen company should provide you with the details of a practitioner who will attend to collect the required samples after your baby is born. All necessary equipment will need to be supplied by you and your chosen company.

At Kingston Maternity, we have a comprehensive range of contraceptive options available including pills, implant, intra uterine devices (coil) and sterilisation. You should discuss your options with your Consultant in an antenatal appointment.

You and you baby will be closely observed for 2 to 4 hours after a straightforward caesarean birth in our High Dependency Unit (HDU). You can continue skin-to-skin with your baby and start feeding.

Once the anaesthetic is wearing off and your observations are stable, you and your baby will be transferred to one of the postnatal wards. Please note, visitors are not permitted in HDU other than the birth partner.

Once you have arrived at the postnatal ward:

• You will be encouraged to mobilise as soon as possible. This is to reduce the chance of a blood clot and support recovery. You will resume a normal diet. The urine catheter and intravenous line are usually removed the following day.
• You will be recommended to take regular oral pain relief. You may also be prescribed a daily blood thinning injection for a minimum of 10 days.
• You will be advised to keep the dressing on your scar for 5 days and avoid a bath during this time. This is to keep the dressing as adherent as possible.

You will be discharged home when you and your baby are ready – usually within 48 hours from an uncomplicated birth.

• Your midwife will come and visit you and your baby for a postnatal check the day after you are discharged home. They will remove your dressing after 5 days and give you further information on wound care. They will arrange when and how often they see you according to your and your baby’s needs. Most families are discharged from maternity care at 10-14 days.
• You can gradually resume normal activities and start your recovery, including pelvic floor and abdominal exercises. Check this leaflet for advice and tips. After a straightforward caesarean birth, recovery takes an average of 6 weeks.
• We recommend you have an adequate supply of pain relief, such as paracetamol and ibruprofen and take regular pain relief for as long as you need. How long you need to keep taking pain relief varies from person to person, but it is likely to be a couple of weeks for most people. Aspirin, codeine or co-codamol are not usually recommended. Your midwife can advise you on the most suitable pain relief for you.
• We recommend that you do not drive, exercise or carry anything heavier than your baby until you feel able to do so and do not find it uncomfortable. This may not be for several weeks. Check with your car insurer that there is no clause that prevents you from driving before a certain timeframe.  
• You can resume sexual intercourse whenever you feel ready. It is recommended you wait for a minimum of 12 months before becoming pregnant. This will allow for your scar to fully heal and avoid increasing the risk of complications in a future pregnancy. At Kingston maternity we have a range of contraception options you can access prior to your discharge. Don’t hesitate to discuss this with your team.
• You will see your GP for a postnatal check-up 6 weeks after the birth – you will need to book this appointment yourself.