A Guide to having an Elective Caesarean Section Information for women and birth partners

 
Introduction You have been given this booklet because you are due to have a planned (elective) caesarean section. This is an operation which allows your baby/babies to be born through a surgical incision in your lower abdomen. Your doctor or midwife will have already discussed the reason for this with you. In NHS Fife we provide an Enhanced Recovery Programme (EROSS) that aims to prepare you in such a way that your recovery is quicker. This booklet explains the care you can expect to receive prior to, during and following your caesarean. You can expect us to: ? Provide antenatal education and support ? Prepare you to ensure you are in optimum condition prior to your operation ? Help make sure that you are able leave hospital as soon as you are ready ? Ensure that you have a plan in place for your postnatal care ? Support you with caring for your baby while you recover ? Do our best to make sure your stay is as comfortable as possible
Before your Caesarean Section Caesarean Section Preparation Class This class is a group education class run every Friday 1-2pm in The Parenthood Room, Victoria Hospital. This session will give you more information regarding how we prepare and help you recover from your caesarean section. You will be sent a text message to remind you to come the Friday before your section; however you are welcome to attend any Friday prior to your operation. These sessions can also be booked via Eventbrite please see
 
 
A Guide to Elective Caesarean” https://www.youtube.com/watch?v=BrO1Tcba6ic
 
Enhanced Recovery Following Elective Caesarean” https://www.youtube.com/watch?v=emZxgfJvU4A
 
“Physio following your Caesarean” https://www.youtube.com/watch?v=RegkvnIzA3A Pre-Assessment Appointment
 
 
 
This individual appointment assesses your current health. Your midwife will perform an antenatal check. You will be offered a blood test so that we can check your iron levels and blood group. Arrangements will be made for you to receive Ranitadine tablets (this is a medicine known as an antacid which works to neutralise acid in your stomach) and your isotonic drink. You will be informed on eating and drinking prior to surgery – please see below Eating, Drinking and Medication Protocol Day before your surgery ? Eat and drink as normal (high carbohydrate diet preferably like bread, pasta or rice). ?
Take your 1st ranitidine tablet at 10pm Morning of your surgery ?
Don’t eat anything after 12midnight. ?
You can drink water, black tea/coffee, flavoured but not fizzy water until 7am.
Do not drink anything else after this. ? At 7am take ranitidine along with isotonic drink. If you are diabetic, you should take your ranitidine tablet with a large glass of water instead.
 
Anaesthetic There are two main types of anaesthetic: Regional anaesthetic is an injection in your back, also known as a spinal or epidural or sometimes a combination of both. This allows you to remain awake during your caesarean section, without feeling any painful sensation in your lower body. This is usually safer for you and your baby, and allows you and your birth partner to experience the birth together. Occasionally a general anaesthetic (which sends you to sleep) may be more appropriate for you or your baby. Your anaesthetist (specialist doctor) will meet you on the morning of your surgery. They will discuss your health, the anaesthetic plan and pain relief. This opportunity allows you to discuss any concerns with them prior to going to theatre. Information about regional anaesthesia is included in the appendix at the back of this document. More information (including foreign language translations) can also be obtained from the website for the Obstetric Anaesthetist Association (OAA): www.labourpains.com
 
After Surgery Eating and drinking During your caesarean section, you will be given fluid directly into a vein, known as an IV infusion or “drip” to ensure you remain hydrated until you feel able to drink fluids normally after the surgery. On return from theatre you will be offered a drink and light snack, such as a sandwich or toast. It is important to try and eat something within the first hour.
If you don’t feel able to eat you may be encouraged to chew gum. Chewing gum has been shown to help the body to produce stomach acid, which encourages your stomach function to return to normal. You should aim to be eating and drinking normally by the evening. Pain relief Effective pain relief is vital to a good recovery, ensuring increased comfort and easier mobilising. Your anaesthetist will discuss this with you. In most cases a long-acting painkiller is put in the spinal, this will help keep you comfortable even after the numb feeling has worn off.
 
After your caesarean you will be offered regular pain relief tablets, usually Paracetamol, Diclofenac and Tramadol. You will also be offered a pain-relieving suppository that is given in your back passage (rectum) immediately after your caesarean as this has been shown to reduce pain levels after surgery. You may not feel the suppository being given, because of the anaesthetic but your anaesthetist will discuss this option with you.
You may experience breakthrough pain, this is the term used to describe recurrent pain or pain that occurs before your next dose of pain relief medicine is due. Please let the midwife looking after you know, who would then be able to offer you additional pain relief (oral morphine solution or extra Tramadol tablet). All the pain relief you are offered will be breastfeeding friendly. On discharge you will be given painkillers to take home and you should take these regularly at least for the first few days. If your pain is well controlled you can then start to reduce them down. Most women need regular painkillers for about a week after caesarean section. Getting out of bed and walking You will be encouraged and helped to get up as soon as possible and should aim to be out of bed on the evening of your operation. The numbness from the anaesthetic will take a few hours to wear off completely so you should only get out of bed for the first time when your midwife or a maternity care assistant is with you. As you start to feel sensation returning, attempt a straight leg lift in bed, if you can do this then you may want to attempt getting up. You will be encouraged to gently mobilise within the ward area. This not only aids your recovery but also helps to reduce the risk of postnatal complications such as blood clots.
Blood loss after birth It’s normal for women to lose blood from the vagina; the term used to describe this blood loss is lochia (a combination of mucous, tissue and blood). Lochia will continue after birth until the womb renews its lining. You may find that your lochia appears to increase when you first stand up after your surgery, it is usually heaviest in the first few days after surgery and you may experience some vaginal bleeding for approximately 7 to 10 days. This will be assessed by your midwife regularly. Catheter Removal A urinary catheter is put in during you operation to ensure your bladder is protected during the operation. We will aim to remove this as soon as you are mobile or by 0700hrs the morning after your operation. Good oral fluid intake is encouraged to ensure your normal bladder function returns. We would expect you to be able to pass at least one good volume (minimum of 200mls) of urine yourself within 6 hours of your catheter being removed. This will be assessed by your midwife prior to discharge.
Blood clots (deep vein thrombosis and pulmonary embolism) Blood normally flows quickly and uninterrupted through our veins. However, during pregnancy and in the postnatal period our blood can become thick and sticky causing a clot to form that either reduces the blood flow or stops it completely. A deep vein thrombosis (DVT) is a blood clot in a vein, usually in the leg or pelvis, and its most common cause is immobility (for example after surgery). A pulmonary embolism (PE) can occur if part of the blood clot breaks off and travels to the lung. It’s important that you are aware of the symptoms of DVT and PE so that you know when to seek medical advice if you are concerned. To help reduce the risk of developing blood clots in your legs after your caesarean section you will receive a daily injection of medicine to thin your blood for 10 days and it is important for you to continue wearing your surgical stockings for the first ten days after surgery. They are to be worn day and night with a maximum 30 minutes break each day, for example when you bathe or shower. If any symptoms develop contact Maternity Assessment, NHS 24 or speak to your midwife/GP.
Symptoms of a blood clot (DVT) ?
pain in the calf or thigh associated with
swelling of the leg - this may be worse when the foot is bending upwards towards the knee ?
heat or redness, particularly in the back of the leg, below the knee ?
you may find it difficult to put weight on the affected leg. Usually only effects one leg.
 
Symptoms of pulmonary embolus (PE) ?
difficulty in breathing or shortness of breath ?
coughing up blood-stained sputum (a thick fluid produced in the lungs) ?
chest pain that is often worse when breathing in ?
collapse
Caring for your wound and preventing infection Before your Caesarean Section ?
Do not shave or wax your abdominal or pubic area, this will be carried out in hospital using clippers. This reduces potential sources of infection near your wound. ?
It is important to have a shower or bath using soap on the morning of your Caesarean Section; this will reduce potential sources of infection near your wound. ?
It is advised that you wear comfortable underwear which does not press on the wound. Stitches and Wound Dressings ? Your wound will be covered by a clear dressing.
? There will be internal dissolvable stitches repairing and supporting muscles and internal tissues. ? The skin layer of your wound will be repaired with sutures that require to be removed by your community midwife on day 5.
Your wound dressing should stay on until this time. ? You can shower with your dressing in place; if your dressing becomes displaced or soiled your midwife will replace it for you. Showering and Cleaning ?
You will be advised to shower within 24 hours following you Caesarean Section ? Keep your skin clean, especially you groin area ?
Shower daily, wash your wound with water, pat dry with a clean towel ?
Baths are not advisable, they will soak the dressing off and reduce wound healing ?
Always wash your hands before touching your wound ?
Do not apply talc or creams to your wound area ?
Wear loose fitting, high wasted cotton underwear ?
Ensure you have clean sheets on bed for your return from hospital Signs of Infection Your wound is red, hot and swollen ? You have increased wound pain ? Your wound has a green/yellow discharge ? You have a unpleasant vaginal discharge ? You feel feverish or have a temperature ? If you have concerns about your wound , contact your community midwife or Maternity Assessment at the Victoria Hospital (01592 729187)
Discharge
The Enhanced Recovery Programme allows you to recover in such a way that discharge the day after your caesarean section is possible. If you feel this is the right thing for you and your family please tell the midwife looking after you on the postnatal ward as soon as possible so your discharge can be arranged. Prior to going home both you and your baby need to be examined to ensure this is possible.
 
Transport home You should arrange how you get home in advance of your admission to the hospital. Please ensure that whoever is taking you home brings your baby’s car seat to the ward, as your baby needs to be secured in the appropriate car seat when travelling. On discharge you will receive the following information ?
A summary of your care and information for the midwives that visit you at home. Your GP and health visitor will also receive a copy of this summary. ? Information leaflets and feeding pack ? Community Midwife visit pattern and follow up ? Contact telephone numbers, including numbers for breastfeeding support groups and Maternity Assessment ? The medication and pain relief you are prescribed Midwife support at home
The midwife or maternity support worker usually visits you two or three times during your first ten days at home. Arrangements will be made for you to receive a visit on the day after you are discharged from hospital; unfortunately, we cannot guarantee a time for this visit. The midwives undertake home visits between the hours of 9am to 5pm.
 
The health visitor will usually contact you ten days after the birth of your baby. Both the midwife and Health Visitor’s role is to help you care for your new baby and family, to stay well and avoid illness. If you have any concerns about your health or your baby’s health please contact Maternity Assessment (01592 729187) or NHS 24 for advice.
 
NHS Fife provides accessible communication in a variety of formats including for people who are speakers of community languages, who require Easy Read versions, who speak BSL, read Braille or use Audio formats. NHS Fife SMS text service number 07805800005 is available for people who have a hearing or speech impairment. To find out more about accessible formats contact: fife-UHB.EqualityandHumanRights@nhs.net or phone 01592 729130

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 ANAESTHETIC

Your anaesthetist (specialist doctor) will discuss the anaesthetic plan and pain relief options available with you at the group session and again on the day of surgery.

There are two main types of anaesthetic:

Regional anaestheticwhich is an injection in your back also known as a spinal or epidural or sometimes a combination of both. This allows you to remain awake during your caesarean section, without feeling any pain sensation in your lower body. This is usually safer for you and your baby, and allows you and your birth partner to experience the birth together.

Occasionallya general anaesthetic (which sends you to sleep) may be more appropriate for you or your baby.

Your anaesthetist will also discuss the pain relief available after your caesarean section and answer any questions that you may have.

 

AFTER SURGERY

a. Eating and drinking:

During your caesarean section, you will be given fluid directly into a vein, known as an IV infusion or ‘drip’’ to ensure you remain hydrated until you feel able to drink fluids normally after the surgery. While you are in the labour ward recovery area you will be offered a light snack, such as a sandwich or toast and a drink.

If you don’t feel able to eat you may be encouraged to chew gum. Chewing gum has been shown to help the body to produce stomach acid, which encourages your stomach function to return to normal.

When you are transferred to the postnatal ward you will be encouraged to drink what you prefer (although you are advised to avoid fizzy drinks). You should aim to be eating normally on the evening of your operation.

b.     Pain relief:

We will talk to you about your pain levels and you will be offered regular pain relief tablets known as paracetamol, ibuprofen and tramadol. If appropriate, you will be offered a pain-relieving suppository that is given in your back passage (rectum) immediately after your caesarean as this has been shown to reduce pain levels after surgery. You may not feel the suppository being given, because of the anaesthetic.

Later you may experience breakthrough pain, this is the term used to describe recurrent pain or pain that occurs before your next dose of pain relief medicine is due. If you still experience pain, please let the midwife or recovery staff nurse looking after you know, who would then be able to offer you additional pain relief (such as a medicine known as oral morphine solution).

Your midwife will discuss the frequency and dose of pain relief medications with you before you go home.  All the pain relief you are offered will be safe to use, if you have chosen to breastfeed your baby.

C. Getting out of bed and walking:

You will be encouraged and helped to get up as soon as possible and should aim to be out of bed on the evening of your operation. The numbness from the anaesthetic will take a few hours to wear off completely so you should only get out of bed for the first time when your midwife or a maternity care assistant is with you, in case your legs are still weak. You will be encouraged to gently mobilise within the ward area. This not only aids your recovery but also helps to reduce the risk of blood clots.

D.     Blood loss after birth:

It’s normal for women to lose blood from the vagina, the term used to describe this blood loss is lochia (a combination of mucous, tissue and blood). Lochia will continue after birth until the womb renews its lining. You may find that your lochia appears to increase when you first stand up after your surgery, it is usually heaviest in the first few days after surgery and you may experience some vaginal bleeding for approximately 7 to 10 days.  This will be assessed by your midwife regularly.

Your blood will be checked before you are ready to go home, in case you need to take medicines.

E. Catheter Removal:

We will aim to remove your urinary catheter ( tube which drain your urine) either at 6AM or 6PM following surgery; continued good oral fluid intake is important. We would expect you to be able to pass at least one good volume (minimum of 200mls) of urine yourself within 6 hours. You should have normal sensation and midwife will assess volume to ensure normal bladder function has returned.

 

E. Blood clots (deep vein thrombosis and pulmonary embolism)

Blood normally flows quickly and uninterrupted through our veins. However, sometimes clots can form that either reduce the blood flow or stop it completely. A deep vein thrombosis (DVT) is a blood clot in a vein, usually in the leg or pelvis, and its most common cause is immobility (for example after surgery). A pulmonary embolism (PE) can occur if part of the blood clot breaks off and travels to the lung. In severe cases, PE can cause a collapse and may prove to be fatal. During pregnancy, swelling and discomfort in both legs is common and does not always indicate a problem. However, it’s important that you are aware of the symptoms of DVT and PE so that you know when to seek medical advice if you are concerned. To help reduce the risk of developing blood clots in your legs after your caesarean section you may receive a daily injection of medicine to thin your blood for 10 days and it is important for you to continue wearing your surgical stockings for the first ten days after surgery. They are to be worn day and night with a maximum 30 minutes break each day, for example when you bathe or shower.

 Symptoms of a blood clot (DVT)

  • pain in the calf or thigh associated with swelling of the leg - this may be worse when the foot is bending upwards towards the knee
  • heat or redness, particularly in the back of the leg, below the knee
  • you may find it difficult to put weight on the affected leg. DVT usually affects one leg

 Symptoms of pulmonary embolus (PE)

 

  • difficulty in breathing or shortness of breath
  • coughing up blood-stained sputum (a thick fluid produced in the lungs)
  • chest pain that is often worse when breathing in
  • collapse

If you have any of these symptoms while in hospital please inform your midwife.

 

If you have been discharged home and have any of these symptoms please call the obstetric day unit on 0159229185 for advice.

 

 

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