Don’t worry …

It's going to be OK!

YOUR CESAREAN SECTION

  • Be at the hospital 2.5 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

ON THE DAY OF YOUR SURGERY …

  • 263x252-clock-csectionYou may shower and brush your teeth. Remember not to eat for at least 8 hours before the time of surgery.
  • 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. 2.5 hours before the C-section.

CHECK IN

  • Check in at Admitting. When entering the hospital from Oak Street, it is the first entrance on your left. This is entrance 97, the Labour and Delivery entrance.
  • Park the car and pay for parking. Leave your bags in the car. You can get them later. Bring the camera, picture I.D. and your B.C. Services card with you. Only after the surgery, when you are in a postpartum ward, should you get the bags and take them to the ward where you are staying.
  • The clerk at Admitting desk will ask 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 will both get changed into your OR clothes and you will have an IV started in your hand.

IN THE WARD

  • The anesthesiologist and the surgical team will come to meet you. I will see you in the pre-admission area before you go to the O.R. Remember to tell them of any allergies or medical concerns you may have.

ONTO THE O.R.

  • 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.
  • Once in the O.R. 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.

CESAREAN SURGERY

  • 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. If you have a previous scar this will be removed. You will have only one scar.

BABY ON THE WAY …

  • When the baby is born, you will feel me pushing on 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 may not be filmed or photographed, but as the baby is being born, your partner may stand up and take photos of the birth. Video is not allowed. The baby is handed to a nurse who will bring the baby to you so you can touch and hold your baby.
  • 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 will try to bring the baby to you so you can touch and hold your baby.
  • After you have held your baby for a few moments the nurse takes the baby over to the pediatrician who will be standing close to the bed. 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.

RECOVERY ROOM

  • After the surgery is complete all three of you will be moved to the recovery room where you will stay for an hour or so.The baby will have skin-to-skin contact with you and you can start to breastfeed.
  • If you have visitors waiting outside the operating room anxious to see the baby, a nurse or I will take the baby, along with your partner, to see the visitors for a quick visit. They will have to wait until you move to the ward to see you, which may take an hour or more. I suggest that your visitors leave at this time and come back in 3 or 4 hours, when you have been settled in your postpartum room.

  • While you are in the recovery room, the nurses will take your blood pressure and check your incision. The nurses will help you with breastfeeding.

  • You will be thirsty after the surgery. You may have sips of water and ice chips to chew on.

POST OPERATIVE CARE

263x252-coffee-csectionOnce you get to your room you can eat and drink if you wish. Start slowly.

  • You may drink coffee.

  • The nurses may not give you anything to eat or drink for a while, so your partner can 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 anesthetic 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.
  • Pat the wound dry after you wet it.
  • The wound dressing will be removed after your first shower.

The incision will hurt at the edges and may feel numb in the centre. It will hurt when you sit up, laugh, sneeze or cough. You cannot break your wound open even though it may feel as if you can.

  • Pain medication will be given to you on a regular basis for the first 24 hours after the surgery. This will consist of a combination of Tylenol and an anti-inflammatory. If you are still in pain you can ask for some extra pain medication called hydromorphone (Dilaudid).
  • Try to stay ahead of the pain. Don’t let the pain get too severe before you ask for more pain medication.
  • All the medications you get in hospital are breastfeeding-friendly.

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 hydromorphone (Dilaudid). This is given only 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.

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.

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 no one is available to help out, the nurses on the ward will help you.

After the surgery you may feel very bloated and have a lot of gas pains.

Eating, drinking and chewing gum helps you pass the gas and also helps to get your bowel moving again.

GOING HOME

263x252-pushstroller-csection

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 on 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. Resume driving only when you feel completely comfortable and safe to do so.

There will be a steri-strip over the incision. Leave it on for a week after going home.

To remove it, 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.

It is common to have a small amount of bleeding coming from the incision for up to six weeks after the surgery. The bleeding is usually from the stitch coming to the surface or from an ingrown hair on or near the incision.

WHAT HAPPENS IF I GO INTO labour OR MY WATERS BREAK 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 labour—that is, they come regularly 5 to 7 minutes apart and are intense enough that you cannot ignore them.

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 your way.

WHAT TO WATCH FOR?

  • Fever (greater than 38.5 degrees Celcius)

  • 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.