C-sections: What Happens in The Operating Room?

This is a continuation of my last post. The last post explained who typically is in the OR during the procedure and what to expect in regards to timing of your c-section. Let’s carry on where we left off!

More from Babytalk: What to Expect When You Are Getting A Cesarean Section

You Are Going To the Operating Room! Now What?

Once it’s your time to go to the OR, you and your support person will be taken to a private area, which is sometimes the same place you’ll come back to after the baby is born.

The nurse taking care of you, a.k.a the circulating nurse (see the last blog post), will talk to you about your medical history and pregnancy. He or she will ask about previous surgeries and reactions to any medications. They will also ask about your general medical and psychiatric history.

You will change into your hospital robe, and most often are asked to take everything off underneath the robe. This is because the doctors will need access to various parts of your body during the surgery. At this time you will get an IV and most hospitals will administer antibiotics to prevent infection from the c-section.

Some hospitals require you to do a wash the night before your scheduled c-sections and some tell you to shave down below. This differs from each hospital so find out from your healthcare provider what kind of preparation you need before your surgery.

Special Wishes & Birth Plans

Now is a good time to mention any special things you want done during or after the delivery. For example, some hospitals allow “natural c-sections” or “skin-to-skin” c-sections.  This might require extra staffing and means that the baby crawls right onto your chest after delivery, instead of going to a support person first. Some hospitals even have clear drapes so you can see what is going on during you baby’s birth.

Let the nurse know if you’d like your partner or support person to cut the umbilical cord. Another request that is becoming more popular is “vaginal smearing”. That is when you insert sterile gauze into your vagina before the c-section and then apply it to various places on your baby’s body after delivery. The purpose is to colonize your baby’s gut flora, this happens naturally during a vaginal delivery, but doesn’t happen during a c-section. Vaginal smearing is material for a whole other post, so stay tuned!

What Happens Once You’re in The Operating Room?

When all the doctors are ready, you will be taken into the operating room. There are a few things that have to happen before they help you birth your baby.

Pain Management.

A Spinal, Epidural, or General Anaesthetic

First of all you will want some good pain control on board. That’s the anesthesiologist’s job. You will have to get something called a spinal, or an epidural, and sometimes a combination of both those things. Basically it is freezing in the lower part of your body. It’s probably not the most comfortable part of the procedure, but you really need it! This will make it so you don’t feel pain during the procedure.

The doctor first needs to put freezing in you skin, because the needle they use to give you the spinal is pretty big and the freezing will make it so you can’t really feel that part. It feels like a little pinch on your skin, some describe it as a bee sting. After that the doctor finds the spot for medication in your back. You will be asked to lean forward, usually the nurse or another support person will support you at the front, and also to round your back and push out the lower part of your back. That makes it easier for them to find the right spot in your back to put the spinal in. Once the freezing is working all you feel is pressure from the needle that will give you pain relief.

If you get an epidural, the process is basically same, except the anesthetist leaves a thin catheter in so he or she can top up the pain meds if the c-section takes longer than normal.

Very rarely will you be put to sleep ( also called general anesthetic). I usually only see women put to sleep if they are very very nervous and ask for it, or if for whatever reason, the spinal doesn’t work. The doctor prefers not to put you to sleep because general anesthetic can cause more stress on your baby and they need to perform the operation faster than with a spinal.

Preparation Before The Surgery

When the medication is in, your nurse and doctor will help you lie down pretty quick because the medication takes effect almost immediately. Sometimes this medication can make your blood pressure drop. What that means is you’ll feel light-headed and weak, sometimes nauseated.  But don’t worry, the anesthesiologist has the good medications that will make you feel better almost instantly.

At this point things start to happen. Because the medication only lasts a certain time in your system, the doctors want to get the operation going sooner rather than later. Your belly will be “painted” with antiseptic solution to reduce infections. They will put drapes up so that you can’t see the operation itself. The team will also insert a catheter into your bladder to help you pee since you can’t while you have the spinal. They do this to keep your bladder empty and out of the way.

Once everything is prepped and set up the whole team will be in the room and it might seem quite hectic. When the doctors know they can go ahead with the operation they will call your support person in. They know this by pinching your skin and checking to see if you feel the pinch. Usually the doctors don’t like to have a lot of support people in the OR, two is the absolute maximum, although mostly they’ll only allow one support person. This is due to the sterility of the room and procedure. If you have a doula and a partner, ask your nurse if both of them can come into the room for support, but don’t be surprised if you have to choose one.

That Magical Time: The Birth of Your Baby!

Once the operation starts, things happen very quickly. You won’t feel very much, just a pulling or tugging sensation. Right before the baby is born, you might feel more pressure on your abdomen, that’s the doctors getting your baby out! They usually have to push pretty hard, but this part doesn’t typically take to long. The baby usually comes out within the first 5-10 minutes of the operation. You might hear the baby cry right away, or your baby might need a bit of stimulation and drying off before you hear him or her cry. Don’t worry, there is a whole team of people taking care of your baby at this point.

Once the baby has been dried off and checked, you will most likely be able to hold or see your baby, depending on what the current practices allow at the hospital. Some hospitals are doing skin-to-skin natural c-sections which would allow for the baby to come right on your chest after delivery. The long part of the procedure is the stitching and suturing. It usually takes about an hour to complete, give or take, depending on the team. You shouldn’t feel very much during this, maybe some pushing, pulling and tugging, but not pain.

Postpartum Recovery After a C-section

A c-section is not just a birth, it’s major abdominal surgery. So after the surgery you will go back to the recovery room for an hour or two. The nurse will monitor your blood pressure and other vital signs, as well as help you feed your baby and hold him or her skin-to-skin, depending on the facility.

Once you’re stable enough for postpartum care, the nurse will transfer you and your support person to the postpartum unit. Most women stay at least 48 hours after a c-section, it all depends on how quickly you recover. You’ll want to start walking and moving around as soon as the nurse says it’s ok. Even though it’s painful, the more you move, the faster you heal. Also, don’t hesitate to take extra pain medication if you need it. Most often women only need it for the first couple of days. The urinary catheter comes out within the first 24 hours after the c-section, but this will differ between hospitals.

In addition to all this you will be taking care of a newborn. So be kind to yourself and take it one step at a time. 

I hope this post helped ease your fears and questions about c-sections, please don’t hesitate to comment or ask questions if there is more you’d like to know!

Also, please send along your own experiences of c-sections. I’d love to post other people’s experiences for us all to learn and grow.