The National Institute for Health and Care Excellence (NICE, 2013) guidelines state informed choice/consent is the pinnacle in enabling women to act as equal partners in deciding their mode of birth in a clinical environment. Informed choice is achieved by maternity care providers supplying women with impartial, evidence-based information (D’Souza, 2013; NICE, 2013; Moore, 2016). The long-term benefits of shared decision making in obstetrics are widely recognised and include increased equity in care, decreased litigation because of improved patient satisfaction and better patient outcomes resulting in reduced post-care complications (Gee and Corry, 2012). Results from international studies identify that UK providers score highly in indicators of supporting women’s rights to caesarean section as an informed choice (Habiba et al, 2006; Betrán et al, 2016). However, shared decision making and informed choice are misunderstood by healthcare providers and are mostly comprised of a shallow process of decanting knowledge to lay persons in order to obtain a consent signature (Begley et al, 2019).
- It is clear from women’s accounts that maternity care providers have a role in preparing women for the realities of birth and facilitating agency in situations that are outside women’s control.
- Mixed methods studies were also included if findings from the qualitative component could be extracted.
- The aim of this review is to assess narratives of women’s experiences of caesarean birth as an informed choice and their involvement in this process.
- If you feel worried about the amount of bleeding at any stage, or start to notice clots of blood, you should contact your midwife or doctor straight away (NHS, 2019; NHS 2021).
- Breastfeeding can sometimes be uncomfortable while you are recovering from a caesarean birth.
8 Pregnancy and childbirth after caesarean birth
Overall, staff were described as ‘too busy’ or caught up in their workflow to offer more personalised care. Simple gestures, such as reassuring touches or having staff members talk through the process made women feel more involved in and satisfied with their caesarean section births (Baston, 2006; Porter et al, 2007; Fenwick et al, 2009; Redshaw and Hockley, 2010; Mason, 2015). For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on maternal choice for caesarean birth.
This means it carries all the risks surgeries do including the risk of infection and of causing damage to internal organs. It also means that not all birthing units are equipped to carry it out as it needs to take place in hospitals able to deal with possible complications. Finally, the cost of c-sections to the NHS is higher compared to vaginal births. Some of the reasons for that include that they need to be carried out by a consultant gynaecologist instead of a midwife, they require using an operating theatre, the need the prolonged involvement of an anaesthetist and often result in longer hospital stays. If you ask your midwife or doctor for a caesarean when there are not medical reasons, they’ll explain the overall benefits and risks of a caesarean to you and your baby compared with a vaginal birth.
People have the right to be involved in discussions and make informed decisions about their care, as described in NICE’s information on making decisions about your care. A caesarean may be recommended as a planned (elective) procedure or done in an emergency if it’s thought a vaginal birth is too risky. The cost of a planned Caesarean section was estimated at £2,369, with a planned vaginal birth costing £1,665. Also it had been thought that giving women antibiotics to protect against infection during surgery could be damaging to the baby. NICE says medical evidence says this is not the case and that women should now be given antibiotics before going under the knife.
Thermal care for babies born by caesarean birth
If you’re worried about the dressing or it needs changing, ask a midwife for advice. Avoid housework and don’t drive, exercise, or have sex until you feel able to do so without pain (NHS 2018; NHS 2019). It’s a good idea to avoid lifting anything heavier than the baby for a while What is NASDAQ afterwards.
A number of databases were searched, including MEDLINE via EBSCO, EMBASE via OVID, MIDIRS via OVID, Scopus, Wiley Online Library, Google Scholar and Ethos, as well as the reference sections of the included studies. Primary studies published between 1990–2020 were included and quality was assessed using the critical appraisal skills programme tool. Findings were analysed using a thematic synthesis framework to elicit higher order interpretations. Physical recovery from caesarean birth can typically take around 6 weeks, but everyone is different, and you may need longer. Whatever happens, it’s important you take the time to rest and recover (NHS, 2019). Sex may be uncomfortable during recovery from pregnancy and birth – the caesarean scar may still be tender, and the vagina may be drier due to hormonal changes.
Your scar
We may also share occasional updates on our work supporting people as they become parents, including fundraising and campaigns. Fertility can return from a few weeks after birth, so consider contraception if you don’t want to conceive another baby soon after giving birth (NHS, 2018). This dressing might be removed as soon as 6-24 hours after the birth (NICE, 2021).
Decision-to-birth interval for unplanned and emergency caesarean birth
- With one in four women giving birth via caesarean section currently in the UK (Paranjothy, 2004), there is a responsibility to include caesarean section births as part of routine conversation in obstetric care and the antenatal curriculum offered to expecting women and families.
- The updated guidelines state that if such women still wanted a C-section, they should get one.
- For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on monitoring after caesarean birth.
- The theme ‘patient-clinician relationships’ illustrates the imbalance of influence between women and clinicians that was found in the reviewed studies.
Consider talking to your birth partner, friends and family, a peer supporter, or your GP. As you recover more, you can go out walking, though you might want to have someone with you at first because you shouldn’t lift anything heavier than your baby for the first few weeks (NHS, 2019). That means you will need help with lifting a pram or buggy up or down steps or lifting your baby in a car seat (NICE, 2021). If you would like us to call you back to discuss a potential claim, please complete the form below and a member of the team will call you at a time convenient to you. «Some women say they have had cost quoted at them – ‘You can’t have a Caesarean because it will cost too much,’ the trust might be fined, that the clinical commissioning groups themselves won’t fund those requests – but there doesn’t seem to be one reason,» she said. Birthrights said it handled more requests for support from women unable to access a Caesarean section than any other issue.
Overall, this theme illuminates the incongruity between clinical decision-making models adapted by staff and the decision-making journey undertaken by women in reframing their childbirth ideologies. It can be observed that women’s decisions or acceptance of caesarean section are shaped by larger constructs that go beyond institutional influence, such as societal pressures over what is defined as normative births. The theme ‘in safe hands’ in Baston (2006) illustrates how some women felt acceptance and even relief in handing over the reins to clinicians to make the decision for them.
Once the initial post-operative pain relief has worn off, ibuprofen and/or paracetamol may be enough to manage the pain, but you may need something stronger. You can request this when you’re in hospital or after being discharged (NICE, 2021). Lying down to feed or using the “rugby ball” hold may also be more comfortable than the cradle hold, as it keeps the baby away from the caesarean wound. For a short explanation of why the committee made the recommendation and how it might affect practice, see the rationale and impact section on closure of the uterus. Healthcare professionals should use their clinical judgement when implementing gender-specific recommendations, taking into account the individual’s circumstances, needs and preferences, and ensuring all people are treated with dignity and respect throughout their care.
3 Factors affecting the likelihood of emergency caesarean birth during intrapartum care
Women described assigning meaning to caesarean section births as a fluid process of internal negotiation. For example, some women thought of caesarean section as a sacrifice they have to go through for the sake of their baby (Baston, 2006; Tully and Ball, 2013). Additionally, some women reflected on how the final decision to undergo a caesarean section should have been facilitated earlier to allow reframing of birth expectations (Redshaw and Hockley, 2010; Mason, 2015; Kenyon et al, 2016). Themes like ‘just another new mother’ exemplify how a clinician’s perception of caesarean section is more in line with the viewpoint of surgical birth as a routine medical procedure (Redshaw and Hockley, 2010). For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on benefits and risks of caesarean and vaginal birth. Forceps delivery can increase the risk of serious vaginal tears including 3rd/4th degree tears (which involve the anal sphincter muscle) resulting in long term consequences.
Touchpoints in decision making
You can shower, or if you don’t feel up to it, you can opt for a bed bath (avoiding the surgical wound). You might be offered opioid pain relief that you can control yourself, through a drip, or you might be given tablets, such as ibuprofen, paracetamol, or morphine. To reduce the side effects of the opioid, you may be offered a laxative or stool softener, or an anti-sickness drug if you need it (NICE, 2021). You and your baby will move from the operating theatre to a recovery room nearby, where a midwife will monitor you both for the next few hours.
Placenta praevia
It is clear from women’s accounts that maternity care providers have a role in preparing women for the realities of birth and facilitating agency in situations that are outside women’s control. As the number of caesarean section births is predicted to increase (Betrán et al, 2016), it is important that women’s decision-making requirements are met in order to foster healthier mother-infant outcomes. This includes giving post-caesarean women opportunities to debrief in a way that is mindful and empowering.
The National Institute of Health and Clinical Excellence (NICE) states that women should be offered counselling and told of the risks first. You’ll probably be in hospital for 1 or 2 days after a caesarean section, and may need to take things easy for several weeks. ‘I can’t remember anyone actually talking to me about post-caesarean, and how I might feel about it. For some women, this sense of detachment was transferred to their infants, with women reporting feeling ‘numb’ (Baston, 2006) and unable to bond immediately after birth (Baston, 2006; Porter et al, 2007; Fenwick et al, 2009). Practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers.