Be at the hospital 2 hours before the scheduled start time of the surgery

Last time you can eat is 8 hours before the surgery

You may drink clear fluids up to 6 hours before the surgery

You can sip clear fluids until your surgery.

Don’t worry its going to be OK.

On the day of your surgery you may shower and brush your teeth. Remember not to eat.
If you need to take any of your regular medication you may do so. You can sip some water to help you swallow the medication.

If you are taking insulin for diabetes, the diabetic clinic nurse or doctor will direct you on when to take the insulin and also when you are to eat and drink.

Be at the hospital aprox.2 to 21/2 hours before the C-section.

Check in at admitting (when entering the hospital from Oak Street it is the first entrance on your left. Park the car and leave the bags in the car. You can get them later. Bring the camera and other personal items with you. Only after the surgery when you are in a postpartum ward should you get the bags and take them to the ward in which you will be staying.

The clerk at the admitting desk will admit you and ask you if you want a private room. If you have extended medical insurance ask for a private room. If you do not have extended medical insurance do not pay extra for a private room. I will try to arrange this for you at no charge, if possible.

From the admitting area you will be taken to the surgical day unit.There you both will get changed into your OR clothes and you will have an IV started in your hand. Bring some reading material, as there will be a little wait before you have your surgery.

The anesthesiologist and the surgical team will come by to meet you. Remember to tell them of any allergies or medical concerns you may have.

About 30 minutes before the C-section you will be taken into the O.R. Your partner gets to sit and wait outside the O.R. at this time. There you will sit on the O.R table and you will get some local anesthetic into your lower back. The nurses will help you bend forward while this is being given. This is not painful. The needle and solution used are the same as you get when you get dental freezing. Once your lower back is numb you will get the spinal anesthetic. This is given by another small needle that goes into your lower back. You will not feel this, as the area will be anaesthetized and numb. Soon after receiving the spinal anesthetic you will be helped to lie down on the operating table. In a few minutes your legs will start to feel numb. You will not be able to move them. This often feels very strange.
Once you are completely numb the nurse will insert a catheter into your bladder. You will not feel this.

After the spinal you might feel a little shaky, nauseated and dizzy. This usually gets better pretty quickly. Tell the anesthesiologist as they can give you some medication to help reduce these symptoms. It often helps to close your eyes and relax.

After the preparations are done your partner will come and join you. They will be seated next to you on your left.

Don’t worry about feeling the surgery. Before I start I will test to ensure that you are comfortable. You may feel pressure but no pain. There will also be a small screen at the level of your chest, which prevents you or your partner from seeing the surgery.
The cut is made low down through a bikini incision. I make the cut as small as possible as this is all that you will remember me buy.

If you have a previous scar this will be removed. You will only have one scar.
When the baby is born you will feel me pushing on the top of your tummy for a few moments. I will give you warning before the baby is born so your partner can get the camera ready. The surgery cannot be filmed or photographed but as the baby is being born, your partner can stand up and take photos of the birth. Video is not allowed.
Once the baby is born I will hold it up for you to see.

I cut the baby’s cord and the screen is lowered so you can see the baby. The baby gets handed to a nurse who takes the baby over to the pediatrician. Your partner goes with your baby if they wish to. The baby is examined and weighed and brought back to you as soon as possible.

You can get to cuddle your baby at this point. We encourage skin-to-skin contact. If you do not feel you are able to hold your baby at this point, the baby will be given to your partner to hold. The baby can have skin-to-skin contact with your partner at this time.
You will not be able to breastfeed in the O.R. but you can start as soon as you are in the recovery room. It takes me a few more minutes to complete the surgery. The skin is closed with a dissolving stitch that lies beneath the skin. There are no stitches to remove after the surgery.

After the surgery is complete all three of you will be moved to the recovery room where you will probably stay for an hour or so. From here on the baby stays with you .The baby will have skin-to-skin contact with you and you can start to breastfeed. Unfortunately, no visitors are allowed into the recovery room. They will have to wait until you move to the ward to see you. While you are in the recovery room the nurses will take your blood pressure and check you incision.

Post Operative Care

Once you get to your room you can eat and drink if you wish. Start slowly. You can drink coffee. The nurses on the ward may not give you anything to eat or drink for a while so your partner may go to the fridge on the ward to get you some water or juice to drink. There will also be some crackers on the ward for you to snack on.
The IV usually comes out before bedtime. The catheter comes out the next morning.

Getting moving

I encourage you to get up and out of bed as soon as possible. The freezing takes a few hours to wear off. You can probably start to get up and out of bed 6 hours after the surgery.

When I do the surgery I do not cut your muscles so when you get moving you cannot injure yourself or damage your incision. You may shower the next morning. Just pat the wound dry after you wet it.

The incision will hurt at the edges. It may feel numb at the centre of the wound.
It will hurt when you sit up, laugh, sneeze or cough. You cannot break your wound open although you feel like you might.

Pain medication will be given to you on a regular basis for the first 24 hours after the surgery. Try to stay ahead of the pain. Don’t let the pain get too severe before you ask for more pain medication if you have pain.

On the second day after the surgery you will be given Tylenol and Advil to take on your own every 4 to 6 hours. This helps somewhat but if you continue to have pain ask the nurse for extra pain medication called Dilaudid. This is only given if you ask for it. It is very effective at reducing pain but it can have some side effects such as nausea and making you feel dizzy. You will also get a stool softener.

You will probably not have a bowel movement for a few days.

All the medication given to you is safe for breastfeeding.

Your partner can stay in the room with you and this is often very helpful as you will not be able to get out of bed to pick up your baby. They sleep on the floor and the hospital will provide a foam mattress. If your partner cannot stay overnight in hospital to help you, try to get a family member or friend to help out. If no one is available to help out, the nurses on the ward will help you.

Going Home

If this is your first c section you will probably stay for 3 to 4 days in the hospital. If this is not your first c section you may go home earlier if you wish as long as you and the baby are doing well.

When you go home there are no restrictions as to what you can do.

You may climb stairs; lift the car seat and push the stroller. You can lift any weight as long as it is not painful. If you have other children at home you will not be able to lift them up but you can have them sit on your lap. They can press up against the incision without injuring you.

You should not drive for 10 to 14 days after your surgery. Only resume driving when you feel completely comfortable and safe to do so.

There will be a dressing over the incision. Leave it on for a week after going home. To remove it you just pull it off as you would a bandaid.

After the dressing is removed, apply polysporin over the incision twice daily. This helps the healing process and helps prevent infection.

What happens if I go into labor or break my waters before my c.section date?

This may happen but the chance of it happening is small. If you do start to get contractions wait to see if they progress into active labor. I suggest you wait until the contractions become regular say 5 to 7 minutes apart and they are intense enough that you cannot ignore them. Also, if your water breaks with or without you having contractions come to the hospital immediately. Do not eat or drink anything. It may help to notify the staff before you arrive so that things are ready when you arrive. Please call 604-875-3070 and let the staff know that you are on route.

What to watch for:

• Fever (greater than 38.5c)
• Redness, swelling or worsening pain over the wound.
• Pus or blood oozing from the incision
• Very heavy vaginal bleeding (soaking a pad every 10 minutes for an hour)
• Bruising around the wound that is getting worse.

Problems? Who to call:

Call my office at 604 874 6848.

After hours call 604 875 2161 and ask for the On-site doctor on call.

If you feel that your problem may be urgent or serious go back to B.C. Women’s Hospital immediately.