Caesarian Section

What needs to be done quickly when you come to theatre for an unplanned (non-elective) caesarian operation.

If you are having a planned (elective) Caesarian the same things are done but in a much more leisurely manner

If it is unplanned it may all may seem overwhelming to you, with people milling about, but this is what is happening (not necessarily in this order).

• The baby's heartbeat is listened to get a baseline and to ensure that it is satisfactory. This is usually done with a continuous CTG machine, which is really useful in these circumstances. If you are having a CS because of concern about the baby, listening to it will help to ascertain the degree of urgency.
  
  
• The anaesthetist will be asking you about your history of having operations and anaesthetics, and about allergies. A spinal, epidural, or general anaesthetic will be advised, and an intravenous drip started in a vein in your arm, if one is not already in place.
  
  
• If you have not already done so, you will be asked to sign a form of consent to the operation. Ideally this should be done with time for you to ask questions. However, if time is important, it may seem that we are hurrying you. But if we asked you to consent to anything before the need is apparent, that could be criticised. Could we do this better? But how?? Any ideas??
  
  
• A blood pressure cuff will be put on your upper arm so that your blood pressure can easily be checked by a machine.
  
  
• A clasp rather like a large clothes peg may be put on one of your fingers. This helps monitor the amount of oxygen in your blood
  
  
• Little sticky plasters with wires attached will be put on your chest to keep a check on your heart beat.
  
  
• Somebody will be taking blood from one of your veins to cross match with donated blood to make sure that compatible blood is available if needed. A test of your blood quality (a full blood count) will also be done on this specimen.
  
  
• Some rather tight white elastic stockings will be put on your legs. These are to prevent any clots forming in your leg veins during the operation. In some hospitals inflatable sort of boots, rather like snow boots are used for the same purpose.
  
  
• Somebody else will be putting a soft plastic tube, called a catheter, into your bladder to empty it. This is left in, and attached to a plastic bag to make sure your bladder stays empty during the operation, and for a day or so after, so that you do not need to get out of bed to go to the loo. If you would prefer it, this can be done once you are anaesthetised either by general anaesthetic or once the spinal or epidural anaesthetic is working.
  
  
• A sort of bandage called a diathermy will be wrapped round your upper left leg. This is connected to apparatus which seals blood vessels during the operation, so that blood loss can be kept to a minimum.
  
  
• Somebody will be asking you to remove any loose jewellery, earrings, watch, bracelets, necklaces, etc. so that they cannot become detached. Fixed jewellery, like rings will be covered by sticking plaster to avoid static electricity building up. The family diamonds and your Rolex should really have been left at home, but if you have any valuable jewellery please make sure it is given into your partner's care
  
  
• Somebody else will be shaving the hair at the bottom of your bump (your pubic hair). We do not shave the hair between your legs, just the bit where the stitches will be, so that hairs do not get caught in the stitches.
  
  
• You may be asked to drink some salty tasting medicine. This is sodium citrate, and it is to make your stomach juices less acid, so that if you vomit it will not be acidic.
  
  
• A name band is put on your wrist, if one is not already there, so that if you do need a general anaesthetic, your name can be checked. If you are allergic to anything another wristband usually a red one will be attached with an allergy warning printed on it. Don't forget to tell us about any allergies.
  
  
• All the people in theatre have to wear special sort of footwear usually clogs, or boots that have special antistatic soles to avoid static electricity building up. The clogs are noisy. We also wear clean closely woven cotton clothes, cover our hair and sometimes our mouths, to help avoid infection.
  
  
• A very large and bright light will be positioned overhead to enable the surgeon to have a very good light to work under this light is quite hot.
  
  
• The surgeon will probably want to do a final check on your abdomen to feel how the baby is lying, it may be necessary to examine you internally.

While all of this is happening to you, other people are getting other things ready. The person who will be passing instruments and equipment to the surgeon is setting out on trolleys everything likely to be needed, so that it is ready to hand. They count and check with another person how many instruments, swabs, stitches they have, so that during the operation they can keep track, and ensure that you don't leave theatre with more than you came in with! These two people may just seem to be chatting, but they are counting out loud to each other.

The paediatrician (baby doctor) will come in, prepare and check the resuscitation equipment, in case your baby needs help after it is born.

We use suction equipment during the operation and check it before we start. This makes a hissing noise.

There is a lot to be done, if it has all to be done quickly, it must seem like everyone is scurrying around in a chaotic fashion. But it is organised chaos, and very necessary. We do check and cross check, that it is all done before we start.

In addition to all this, at least four people will be "scrubbing up" and putting on sterile clothes. They will be:

1. The person in charge of the instruments as mentioned previously, she or he will have scrubbed up first, and everybody else has to avoid touching this person as they move around.
2. The surgeon
3. Another doctor or midwife to assist the surgeon
4. The midwife who will take the baby to the paediatician, and assist with the resuscitation of the baby if necessary.

Other people who may be in theatre

• If there is serious concern about the baby there may be a specialist baby nurse present as well.
• A nurse or midwife who is "running" This is someone who is fetching and carrying and generally assisting, but who is not "scrubbed up" They will check the swabs used and the instruments used with the scrubbed, instrument person.
• An operating department assistant. This is a person with special training whose role is to assist the anaesthetist.
• Your own midwife to give you support, though she may have been asked to scrub to assist, or to take the baby.
• Your partner or other relative or friend of your choice, who will be asked to wear the special theatre clothes.

Even though birth by Caesarian Section is not without risks and is marginally not as safe as a normal birth, everything that is being done to and for you is being done to make the operative birth of your baby as safe for you and your baby as possible.

If you are having an epidural or spinal anaesthetic the anaesthetist will check very carefully that you will not feel any pain during the operation, though it will be explained that you will feel the movements of the baby being delivered through the incision in your abdomen. Many anaesthetists check the effectiveness of the numbness of your abdomen by rubbing a block of ice over your abdomen and possibly your breasts. Research has shown that the ice is a better method of ascertaining a complete numbness that using a pinprick. The anaesthetist will explain exactly what s/he is doing and that if you have chosen an epidural or spinal anaesthetic it is very occasionally necessary to give you a general anaesthetic i.e. put you to sleep. Please do not hesitate to ask the anaesthetist or surgeon any questions you wish.

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