My Caesarean up close & personal

We asked a mum who’s been there to spill the beans on what goes on behind the green curtain.


My friends and I took our good friend Sue out a few weeks after she had her first baby, and I’ll never forget it. Sue treated us all to a blow-by-blow (and, I know now, probably wildly exaggerated) description of her 18-hour labour and drug-free birth while the rest of us (all childless) listened in mouth-dropping legs-crossed silence. We were 18.
When Sue finished, one horrified girl spoke for us all, saying, “That’s the most awful thing I’ve ever heard – if I have a baby, I’m having a caesarean.”
We all agreed, then Sue (a natural comedian clearly enjoying the impact she was having) launched into a description of breastfeeding, ensuring all her friends were meticulous about contraception for years to come.


The doctor’s view
Dr Andrew Bisits is the Director of Obstetrics at John Hunter Hospital in Newcastle and agrees that fear is often a driver behind women seeking caesareans – and that’s usually because they don’t have enough information, or they have misinformation, about what is involved in birth.
“We would do women a disservice if they expressed their fears and we simply agreed to do an elective caesarean,” he says, adding it’s important that doctors discuss these fears with their patients.
“A caesarean can be made as safe as a vaginal delivery for the mother, but it is not a safer option than a normal delivery for the baby,” he says. “And a caesarean still involves slashing through the abdomen. A normal delivery keeps the woman’s body as intact as possible.”
But there are plenty of situations where a caesarean is a medical necessity, he says; and in those cases, Australia has an excellent record for safe delivery.

A mum’s experience
To help other women understand what is actually involved, I asked Bianca to take me through a blow-by-blow description of her recent caesarean. Bianca and her partner, Phil, were hoping for a natural birth with their first child but their baby stayed resolutely in breech position from around five months.
As they live a few hours away from a major hospital, the couple agreed to an elective caesar at the local hospital.
Bianca says she was anxious from the beginning. “I had a lot of fear around what the experience would be like, even though I had absolute confidence in the doctors and the hospital staff, who were just fantastic.”
Arriving at 8am, the first step for Bianca was having her upper pubic area shaved – “a bit disconcerting!” – and then a catheter was inserted into her urethra, because she wouldn’t
be mobile enough to go to the toilet for another 24 hours.
“The catheter was the most unpleasant part of the entire procedure,” she recalls. “There’s no anaesthetic; it’s not painful, just a very weird, uncomfortable feeling.
You feel like you need to wee and it takes a while for that urge to go.”
Bianca says she felt apprehensive as she was wheeled into the operating theatre. Phil walked in with her and was taken aside and given a hat and gown.
Phil stayed ‘at the head end’ so he didn’t need a mask, which reassured Bianca.
Bianca’s anaesthetist told her (again!) about her anaesthetic options and the risk of each – a requirement before every operation, and a cannula (needle) went into the back of her hand to convey the intravenous drip (IV).
“The cannula hurt quite a bit going into my hand,” she says.
“I was surprised by how light the theatre was – and how busy,” Bianca recalls. “I thought it would be darker – like it is on TV shows, but it was just a big white room.”
She thinks there were about 15 people in the operating theatre – “and I didn’t have a clue who most of them were!”
The couple had decided to go with a spinal block anaesthetic and Bianca sat sideways on the bed, head resting on Phil’s shoulder. First, she felt the sting as a local anaesthetic was applied, then the spinal block was administered.
“When the anaesthetic goes in, warmth floods down your legs – it feels like you’ve wet yourself, then you realise you can’t feel anything.”
Bianca was rolled back onto the bed and a drape put up, blocking the view below her chest. The doctor tested that the anaesthetic was working and a theatre nurse recited Bianca’s full name, the procedure and other details to make sure they were doing the right operation.
“I was a bit spaced out and thought she was talking to me, so I’m answering ‘Yep’ to all these questions. She seemed quite amused by me contributing to this stage
of the operation!”
The operation was very quick, Bianca says. “There was no pain, just a sense of movement and some pushing and I could hear slurping noises. I was distracting myself by talking to the anaesthetist, chatting away because I was quite scared.”
Like many patients, Bianca started to get the shakes. “My lips and my chin were shaking, my whole body – or at least the part of it that had muscle control – was shaking.”
It was only five minutes before she heard someone say, “It’s a girl!”
Phil stood up and photographed their new daughter, Nina, as she was lifted from Bianca’s body and presented to her.
“They showed her bum-first – they must have wanted to make sure I knew she was a girl. I was saying, ‘Yep, I know that’s her bum, I want to see her face!’”
Nina was whipped away for a quick check by the paediatrician standing by, then brought back to Bianca for skin-to-skin contact, and the baby lay on top of Bianca for the next 20 minutes or so while the medical staff stitched each layer of muscle to repair the incision.
Bianca says she didn’t really feel anything – and just enjoyed looking at her gorgeous new baby.


The recovery
“As far as major abdominal surgery goes, it was quite easy at the time,” she says.
“But apparently it’s the equivalent of a major car crash in terms of what’s happened with your body and when they got me out of bed a day later, I really felt like I’d been hit by a truck.”
Bianca is fit and luckily didn’t lose a lot of blood during the operation, so her recovery was quite quick, but she says it can’t be compared to a normal delivery.
“I didn’t stand for 24 hours after the operation. But as I was wheeled into theatre, a woman came in, in full labour with her second child and she checked out around the same time I came back from recovery. So she was in hospital less than three hours, whereas I was in hospital for four days – and that’s quite a short time after a caesarean.”
Bianca was unable to walk for 24 hours and couldn’t drive a car for three weeks. She says that she was on a self-administered morphine drip for the first 48 hours, which she hated because the morphine made her vomit – which was very uncomfortable.
“For the first week, walking was pretty slow. There’s a lot of aching. You’re not supposed to use your stomach muscles, but for the first couple of weeks, every time Nina cried when I was asleep, it was a gut instinct, I’d sit bolt upright and then I’d be in agony, feeling as if I’d just torn my midriff asunder!”
After a normal delivery, Bianca says the body is flooded with hormones that help healing after labour, but that’s not the case after a caesar, so you need a fair bit of pain relief in the early days.
Though she knows it’s a little irrational, Bianca also feels some guilt about having a caesarean.
“I hear about women who’ve had emergency caesars who are traumatised by the fact it ended up that way,” Bianca says. “Whenever I tell people I had an elective caesar, I always have to add, ‘because she was breech’ – I can’t just say I had an elective caesar and leave it at that because I worry that they’ll think I copped out.”
Bianca says there are plenty of zealots on both sides of fraught issues like this and recalls a recent forum where one ‘expert’ argued that mothers who had caesareans were less responsive to their babies and less likely to breastfeed.
“That’s suggesting that because I’ve had a caesar, I’m a lesser mother – it’s dangerous to use statistics in a way that makes women who didn’t want a caesar feel even worse about the fact that they’ve had to have one.”
And Bianca says that despite the months of preparation and planning for the birth, it’s all receding into a blur as she enjoys her beautiful baby.
“There’s so much focus on birth and not enough on what happens next. It was a pivotal moment in my life and in Phil’s life – but Nina’s birth was a means to an end, it’s not the end in itself.”

Statistically speaking…
Australia has one of the highest rates of caesarean section in the world, with 2006 figures showing around one in three Australian babies are now born by caesarean; that’s a 60 per cent increase over the last decade and way higher than the OECD average of 22 per cent – so there’s pressure on hospitals to reduce this.
There were hundreds of submissions to the Australian government’s Maternity Services Review report, issued in February 2009, with reasons for Australia’s high caesarean rates suggested as rising maternal age and medical conditions like obesity, diabetes and hypertension. Submissions suggested women wanted caesareans for social reasons; others blamed obstetricians’ fear of legal action.
While this can’t be measured, undoubtedly some women (like my group
of 18-year-old friends), fear the ‘unknown’ of labour and birth and therefore pressure their doctors, asking for a caesarean. However, there is no doubt that in many cases, caesarean births are a necessary intervention that save many mothers’ and babies’ lives.