It is true that the number of women opting for a Caesarean section (C-section) has increased, not only in Singapore, but around the world. If you consider this an option in your birth plan, it is important that you are aware of its implications to help you prepare for it – especially if you are a first-time mom. Here’s what every expectant mom needs to know.
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Why is a C-section is performed?
C-sections in Singapore have been a widely accepted medical practice. However, you don’t choose it on a whim simply because it is what everybody is doing. Beyond the numbers, there are many considerations that one must take. More importantly, there are certain reasons why a C-section may be deemed necessary.
For mothers, a C-section may be necessary for the following reasons:
- A low-lying placenta that covers the cervix
- Baby is breech or in a transverse position
- The mother has too small a pelvis for the baby to pass through
- The mother is carrying a very large or a very small baby
- The mother is carrying more than one baby, and if the first baby is not in a head-down position
- The mother cannot physically go through the labor process (e.g. high risk for a heart attack)
- The mother is HIV positive with a high viral load
- Genital herpes outbreak
For newborns, the reasons for a C-section may include:
- Fetal distress
- Multiple babies (twins, triplets, etc.)
- Placenta previa (when the placenta covers the cervix)
- Vaginal delivery puts the baby at risk (i.e. mom suffers from an infectious disease in the reproductive area)
Even if you have not included a C-section in your birth plan, there are instances where an unplanned one might be needed. This will depend on how your labor progresses and if certain conditions arise within that span of time. Examples include:
- Failure of labor to progress– A condition where the cervix starts to dilate but then stops before the woman is fully dilated, or the baby stops moving through the birth canal.
- Fetal distress – A complication in labor where the fetus has not been receiving enough oxygen.
- Cord prolapse– This occurs when the umbilical cord comes out of the uterus before the fetus.
- Abruptio placentae – A complication where the placenta separates from the uterine wall even before the baby is born.
- Scar rupture– the scar from a previous caesarean or uterine surgery splits causing internal bleeding and lack of oxygen delivered to the baby.
What can one expect prior to a C-section?
The protocol in each hospital may vary slightly, but in cases where a cesarean delivery is not an emergency, the following steps are standard procedure.
- You will be asked to sign a consent form.
- The anesthesiologist will discuss the type of anaesthesia used, usually spinal anaesthesia is preferable.
- Your vital signs (blood pressure, heart rate, respiratory rate, and temperature) will be taken.
- The incision area will be shaved.
- A catheter will be inserted to empty your bladder.
- Pre-operative medications may be given before you are wheeled into the operating room.
How long does a C-section take?
A C-section is considered major abdominal surgery. The length of the procedure will depend on the situation at hand. A typical non-complicated Caesarean delivery could take about 45-55 minutes.
What should a first-time mom know about C-sections?
What is necessary, especially in invasive procedures, is that a consent form must always come first. You must decide with your obstetrician on the mode of delivery you want to adapt, or if you are willing to undergo a C-section if it is needed in emergency situations.
A C-section doesn’t have to be an unpleasant experience. Even if you plan or hope for a normal spontaneous vaginal delivery, it is still safe to anticipate the possibility of a C-section. One way to prepare yourself is to pay attention to your weight. A study showed that women who were overweight when they got pregnant were twice as likely as lean women to have a caesarean delivery. They also have a higher risk of experiencing surgical complications. This shows that even if women eat for two, they should also be mindful of their overall intake.
If you are already scheduled for a C-section, you may have to fast around 6 hours before delivery. You may have to come to the hospital about 3-4 hours before your scheduled operation. An antacid and an anti-vomiting medication may also be given prior to the procedure.
One concern most expectant moms have is that a C-section deprives them of immediate contact with their baby, depriving them of their skin-to-skin bond (which helps stabilize baby’s temperature, heart rate and breathing). The truth is that some hospitals are ready to have the mom and newborn have skin-to-skin in the OR, while some hospitals are not. In other facilities, the mother would be able to hold her baby once her conditioned is stabilized. Moms-to-be can preempt these potential obstacles by asking ahead about the hospital’s protocol before you choose to deliver your baby there. Speak up if needed, or have someone on your birth team (your OB, partner, or doula) help you advocate for it.
Call us today at +65 6254 2878 to book an appointment with Dr Pamela Tan.
How is a C-section done?
You will be placed under anesthesia, and your vital signs constantly monitored during the entire procedure. An IV will also be inserted into your arm, through which you will receive fluids and medications. If you haven’t received an epidural, you will probably get a spinal block, which can numb you from your chest down to your toes. General anesthesia is not often done anymore and is usually reserved for extreme situations. The doctors will put up a screen, so you will not see the surgery while it is being performed.
Once the anesthesiologist is sure that you are numbed, the doctor will make the first incision. This is usually a 15 cm long low horizontal incision (bikini line). Another incision is then made on your uterus, through which the baby is delivered. This will feel like a slight tugging sensation. After the baby is out, the midwife will immediately check the newborn, and if all is well, you may be allowed to hold him or her. Your OB will then proceed to remove the placenta and then close the incisions.
What is the recovery like?
In a vaginal delivery, recovery takes an average of two weeks. In a post C-section recovery, it can take as long as six weeks. The recovery period would require you to avoid keeping yourself busy around the house, and avoid lifting anything heavier than your new bundle of joy. Allowing your body to heal from the surgery will make it faster for you to bounce back.
The area around your incision will be tender for the first few weeks. You must clean it properly and observe to see if it becomes red or inflamed, or if you start running a fever. This could be a sign of infection and should be reported to your doctor immediately.
Can a woman who has undergone a C-section be able to give birth naturally in her next pregnancy?
Many women believed that “once a caesarean, always a caesarean”, however, this is not always the case. VBAC or Vaginal Birth After C-Section, is now proven to be a safe option for moms who wish to take the natural route in their next delivery. However, you must work closely with your OB to ensure that you are an eligible candidate for the surgery.
There may be many concerns about this procedure, especially risks like uterine rupture. But, recent trends show that VBAC success rates have improved. It also important that if you are aiming for VBAC, your OB should also be on the same page as you. In that way, you can be sure that the professional you are working with is not only experienced but also your best advocate. You may also read more about improving your chances of VBAC success here.
If you want to learn more about Caesarean deliveries in Singapore, or other options you are interested in, book an appointment for a comprehensive consultation with Dr. Pamela Tan today.
Dr Pamela Tan is a board certified obstetrician and gynecologist in Singapore. She finished her undergraduate studies at the National University of Singapore and earned her post-graduate degree at the Royal College of Obstetricians and Gynaecologists in the UK. She is an accredited specialist by the Specialist Accreditation Board (Ministry of Health), and a fellow of the Academy of Medicine, Singapore. She subspecialises in colposcopy and is certified to perform Level 3 minimally invasive keyhole surgeries such as laparoscopic hysterectomy, myomectomy and cystectomy. Dr Pam also supports the natural birthing method and she strives to provide a personalised care and treatment for each patient.