Cesarean Section in Dubai

Why a cesarean is planned ahead, or decided on during labour

A planned (elective) cesarean is arranged during pregnancy when labour or a vaginal birth is not advisable, usually after antenatal checks and scans and with time to think it over. Common reasons include:

• The baby is breech (bottom or feet down) or lying sideways late in pregnancy, and turning the baby is not possible or has not worked.
• The placenta lies low and covers the cervix (placenta praevia).
• Previous surgery on the womb, including an earlier cesarean.
• Some twin pregnancies, depending on how the babies lie.
• Certain infections that can pass to the baby at birth, and some medical conditions in the mother.

An unplanned or emergency cesarean is decided during labour, or before it if a problem develops suddenly. Common reasons are labour that stops progressing despite support, monitoring that suggests the baby is not coping well, heavy bleeding, or a change in the mother’s health such as rising blood pressure. How urgent it is shapes how quickly things move and which anaesthetic is used.

What happens on the day of a cesarean

Before a planned cesarean you are usually asked not to eat for some hours. On the day you may be given medicine to reduce stomach acid, a drip in your arm and stockings to help prevent blood clots, and a thin tube (catheter) drains the bladder during the operation.

Most cesareans are done under a spinal or epidural anaesthetic, so you stay awake but are numb from the chest down. Many women feel pulling and pressure rather than pain; if anything hurts, tell the anaesthetist, who can add more pain relief. A general anaesthetic, where you are asleep, is used when a spinal or epidural is not possible or there is not enough time.

Antibiotics are given to lower the risk of infection. The cut is usually made across the lower abdomen, just above the pubic hairline. The baby is born within a few minutes; closing the womb and abdomen afterwards takes most of the time.

Where the hospital allows, a birth partner can sit beside you during a cesarean under spinal or epidural. If you are both well, your baby can be placed skin-to-skin on your chest in theatre or soon after, and breastfeeding can begin when you are ready.

If labour starts, your waters break or you bleed before a planned cesarean date, go to the hospital where you plan to give birth.

The benefits and risks of a cesarean, side by side

When there is a medical reason, a cesarean spares mother and baby risks that labour would carry in that situation; with a placenta covering the cervix, a vaginal birth is not possible at all. A planned cesarean also avoids tears to the vagina and perineum, and the date is known in advance.

It is still major surgery. Serious complications are uncommon, but the risks for the mother are real:

• Infection of the wound, the lining of the womb or the urine.
• Heavier bleeding, which occasionally needs a blood transfusion.
• Blood clots in the legs or lungs.
• Injury to a nearby organ such as the bladder or bowel, which is uncommon.
• A longer hospital stay and a longer recovery than after a vaginal birth.

For the baby, breathing difficulties just after birth are more common after a cesarean, particularly before 39 weeks, so a planned cesarean is usually timed from 39 weeks unless there is a reason to deliver sooner. Occasionally the baby’s skin is nicked during the operation; such cuts usually heal well.

A cesarean also affects later pregnancies. The scar makes it more likely that a future placenta lies low or grows too deeply into the wall of the womb (placenta accreta), and there is a small risk of the scar opening in a later labour. These risks rise with each additional cesarean.

How recovery after a cesarean usually goes

Pain relief is given regularly, and taking it on schedule makes moving easier. You can eat and drink once you feel ready, and the catheter comes out when you can get up to the bathroom.

Walking early helps. Moving about, even gently, lowers the risk of blood clots and helps the bowel settle. Some women also need stockings or injections to prevent clots.

Once the dressing is off, keep the wound clean and dry, wear loose clothes and high-waisted underwear, and pat it dry after a shower. Numbness or a pulling feeling around the scar is common and fades slowly.

Lifting anything heavier than your baby, driving, exercise and sex are discussed before you leave hospital, as the timing follows how you heal rather than a fixed date. The postnatal check looks at the wound, your recovery and your mood, and covers contraception and the spacing of pregnancies.

An unplanned cesarean can leave mixed feelings even when mother and baby are well. NICE recommends that women have the chance to discuss the reasons for their cesarean afterwards.

Choosing how to give birth after a previous cesarean

A previous cesarean does not mean every later baby has to be born the same way. Many women can choose between a planned repeat cesarean and a vaginal birth after cesarean (VBAC), and neither suits every woman.

A VBAC that ends in a vaginal birth avoids another operation, usually means a shorter recovery and does not add to the placenta risks of future pregnancies. Its main risk is the scar on the womb opening during labour (uterine rupture), which is uncommon but serious for mother and baby, so labour is usually advised in a hospital labour ward with continuous monitoring of the baby’s heartbeat. Some women who plan a VBAC need a cesarean during labour, and induction of labour, which adds strain on the scar, is discussed carefully.

A planned repeat cesarean avoids labour and gives a known date, usually from 39 weeks. It carries the surgical risks above, and each further cesarean raises the chance of placenta problems later.

What tips the balance differs between women: the reason for the earlier cesarean, how many there have been, the type of cut on the womb, any previous vaginal birth, and how this pregnancy is going. The decision is made with your obstetrician during pregnancy, with time to think, and can be revisited if things change.