You are receiving this information because you (might) undergo a cesarean section. Here you can read more about this surgical procedure: how to prepare for it, how the operation proceeds, and what possible complications might occur. You will also find information about the birth of your child, breastfeeding, and what happens after the surgery. If you have any questions, please contact us. Our contact details are at the end of this brochure.

What is a cesarean section?

A cesarean section is a surgical procedure where the child is delivered through the abdominal wall. The operation takes about 45 minutes, sometimes longer, sometimes shorter. The baby is usually born within fifteen minutes after the start of the operation. After that, the gynecologist will close the uterus and various layers of the abdominal wall.

The reason for a cesarean section

The gynecologist advises a cesarean section only if a vaginal delivery is not possible or poses too great a risk for you, your child, or both. Because complications can occur with a
cesarean section, we perform the operation only when there is a good reason.

A planned cesarean section

Sometimes, it is clear before pregnancy that a cesarean section will be necessary, for example, if you had previous surgery on the uterus. Sometimes it becomes apparent during pregnancy that a cesarean section is needed. This can be the case with an abnormal fetal position, or if, for example, the placenta (afterbirth) is covering the cervix, if a fibroid/myoma is preventing the baby from descending, or if there are complications, such as a poorly functioning placenta. If a cesarean section is decided upon before delivery, we refer to it as a planned or ‘primary’ cesarean section.

A natural cesarean section

Usually, a so-called natural cesarean section is performed. This is not always possible if the condition of the mother or child does not allow it. A natural cesarean section resembles a regular (vaginal) delivery as much as possible. Immediately after the gynecologist has delivered your baby from the uterus, the pediatrician checks its vital functions, such as heart rate and breathing. Then, you get your baby directly on your chest. Skin-to-skin contact is important as it promotes bonding between you and your child. This also helps initiate breastfeeding earlier. Your skin and a warm air blanket ensure your baby maintains the right body temperature. You, your baby, and your (birth-) partner will stay together continuously if possible. A nurse from the department will guide your partner and baby from the operating room to the maternity ward.

Preparing for a cesarean section

As with any surgery, a planned cesarean section requires a preoperative examination of your health. This can be done by phone or with a visit to the anesthetist's preoperative consultation. There will follow questions about your health and sometimes a physical examination, such as listening to your heart and lungs is performed. The anesthetist will discuss the choice between general anesthesia (anesthesia) and a spinal block with you. You will also have a telephone appointment with the nurse/maternity nurse from the department where you will be admitted.

Day of the surgery

On the day of the surgery, you must be fasting as agreed with the anesthetist. Before reporting to the department, you will have your blood taken at the hospital laboratory. You should drink 500ml of apple juice 24 hours and 2 hours before the surgery to promote your recovery. If you have diabetes, drink 500ml of water or tea. The nurse will check your vitals and listen to the baby’s heartbeat. You will then put on a surgical gown. If necessary, the nurse will partially shave your pubic hair. Shortly before the surgery, you will be brought to the surgical department. You should not wear piercings, jewelry, hairpins, nail polish, or makeup; remove contact lenses or dentures. The nurse will receive a call when you are expected in the holding area. There, the nurse will transfer particulars, and you will receive an intravenous infusion of fluids. Your partner will change into scrubs and join you later. Before the surgery, your bladder must be emptied. In the operating room, the spinal block is administered. Then, the nurse will insert a urinary catheter to allow urine to flow away. A bag will collect the urine. Placing the epidural is a sterile procedure, for this reason the nurse and partner will wait outside the operating room complex.
Placing the epidural is a sterile procedure, for this reason the nurse and partner will wait outside the operating room complex.

What to bring

It is important to pack for a hospital stay of at least one day. Ensure you bring enough clothing for the baby and yourself. We recommend bringing your own water bottle for drinking the 500ml of apple juice and ensuring sufficient fluid intake. Also, consider bringing a camera, bath slippers, possibly a rinse bottle, and loose-fitting underwear (considering the surgical wound). Towels and sanitary pads can be provided by the hospital. Do not forget to bring your own medication if you are using any.

Types of anesthesia

There are two types of anesthesia for a cesarean section: a spinal block and general anesthesia. You will usually receive a spinal block. General anesthesia is only chosen in case of urgency or after certain back surgeries or clotting problems. If you have a strong preference, let the anesthetist know.

Spinal block

With a spinal block, the anesthetist injects an anesthetic between the vertebrae. Soon your lower body and legs become numb. You might feel temporarily nauseous due to a drop in blood pressure, for which medication will be given. With a spinal block, you are conscious for the birth of your child. During the operation, you can see, hear, and touch your child. You do not feel pain during the operation, though you might feel pressure on your abdomen. Occasionally, the anesthesia reaches slightly higher than just your lower body, making it seem like breathing is difficult. This is unpleasant but not dangerous.

General anesthesia

With general anesthesia, you sleep during the cesarean section. We administer the anesthesia so that your child receives as few medications, such as sedatives and painkillers, through the placenta as possible. The anesthesia is given via an IV. Sometimes you receive oxygen through a mask or nasal tube beforehand. While you sleep, a tube is placed in your trachea for ventilation. You feel no pain and wake up when the surgery is over. If all checks are good, you will return to the department where your partner and baby are waiting.

The operation itself

Due to an increased risk of infection, you will receive antibiotics through an IV before the cesarean section begins. Almost always, the gynecologist makes a ‘bikini cut’: a horizontal (transverse) incision of 10 to 15 centimeters just above the pubic bone, around the hairline. Occasionally, the doctor makes an incision from the navel downwards. After opening various layers, the gynecologist usually makes a transverse incision in the uterus to deliver your child. The doctor then presses on your abdomen.
After your child is born, the umbilical cord is cut. To maintain sterility, your partner cannot do this, unlike in a natural birth. After cutting the umbilical cord, you receive a medication (oxytocin) via IV to contract the uterus. After the placenta is delivered, the gynecologist stitches the uterus and various layers of the abdominal wall using dissolvable material that does not need to be removed. If necessary, adhesive strips and a bandage are applied to cover the wound.

After the birth

The pediatrician examines your child immediately after birth. The umbilical clamp or cordring is then applied, and the partner can symbolically cut the umbilical cord further. If all goes well with the mother and child, the baby is placed in a pouch on the mother. We strive to separate mother and child as little as possible. If the condition of the mother and child allows, the partner and baby accompany the mother to the recovery room. Depending on the reason for the cesarean section, the gestational age, and the condition of your child, your child will either be admitted to the maternity ward or the neonatal unit. During the admission, we will observe your baby, monitor its weight and temperature, and support feeding times. The pediatrician will examine your baby again before discharge.

To protect the privacy of the staff, we ask that you do not take photos of the care personnel around the operating complex. During the operation, the surgical assistant will take photos of the birth with your camera. Of course, you can take photos of the baby and mother afterward.

After a cesarean section

After a cesarean section, we regularly check your blood pressure, pulse, blood loss, and urine output. You will receive fluids and medication against blood loss via an IV. We advise drinking well after the operation. The IV is stopped and removed when you start drinking and eating meals. With a spinal block, you have no control over your legs for the first few hours after the operation. Gradually, you will regain feeling and strength in your legs.
We recommend sitting on the edge of the bed four hours after the operation. The urinary catheter, which drains urine, can be uncomfortable. It is removed six hours after the operation, depending on the surgery time. After this, you can get out of bed to go to the toilet, if necessary with the help of a nurse. We advise going to the toilet every three hours before feeding.

After a cesarean section, you will have pain in the wound and sometimes after-pains. The abdominal wall is often painful, not just at the scar but also higher, up to the navel. This is because the incision in the abdominal wall runs vertically under the skin, from the navel to the pubic bone.
You will be prescribed pain relief. To control the pain, it is advisable to take the pain medication as prescribed. The wound dressing can be removed after six hours, and any adhesive strips can be removed yourself after five to seven days. These may come off naturally while showering.

To prevent thrombosis, you will receive an injection of a blood thinner (Fraxiparine) once or twice a day under the skin of your flank (depending on the time of surgery). In some
cases, you may need to continue this at home for up to six weeks after delivery. The nurse on the ward will provide you with the necessary information.

The first days

During the first days, you may still feel weak and somewhat dizzy when standing up; this will gradually decrease. After one or two days, your bowels will start to function again. Your abdomen is likely still bloated, and you may experience painful cramps. Movement is good for getting the bowels moving. We advise you to adhere to the following schedule;

Day 0	6 hours after the cesarean section (C-section): Bladder catheter is removed Start mobilizing to the toilet/shower. The first time under the guidance of a nurse or maternity assistant Toilet use every 3-4 hours before feeding Free movement in the room
Day 1	Showering Toilet visits every 3-4 hours before feeding Meal times at the table (3x 20 minutes) Additional sitting on a chair for 2x 20 minutes besides these meal times Expand mobilization to walking in the hallway: 3x a day 50 to 100 meter Discharge
Day 2-4	Walk 5 times a day 50 to 100 meters Meal times at the table (3 times 20 minutes) Additionally, 3 times 30 minutes out of bed
Day 5-7	Walk 10 times a day 100 meters Meal times at the table (3 times 20 minutes) Expand mobilization

Breastfeeding

You can breastfeed after a caesarean section. It does not matter whether the caesarean section was planned or not and whether you received general anesthesia or an epidural injection. If your child is admitted to the neonatology department, you can start pumping in the department. The baby can possibly practice breastfeeding in the recovery room. The nurse can help you with this. Even after anesthesia, once you have recovered, you can generally quickly start breastfeeding your child. This way, milk production gets started quickly and your child can benefit from the first food: the colostrum. The mother and child center also has lactation consultants who can monitor breastfeeding or provide advice if necessary.

Do you bottle feed? We will then help you give you the first bottles when you return to the maternity suite. We recommend that you bring your own boiled bottle.

Discharge from our hospital

You will be discharged after 24 hours. The speed of your recovery and the health of your child naturally play a role. Discharge time from the maternity ward is 10:00 AM so you have enough time at home with maternity care.

Secondary Cesarean Section

Sometimes it becomes clear during labor that a cesarean section is necessary. The most common reasons are labor not progressing and/or danger to the baby. This may occur during dilation or during the pushing stage. There are various situations where a decision is made for a cesarean section during labor. This is called a "secondary" cesarean section.

Because this is an unplanned surgery, preparations often happen at a different and faster pace. Since you are not fasting, you will receive medications to neutralize stomach acid. After the operation, your partner and baby will go to the postnatal suite and wait there until the mother returns from the recovery room. Depending on the timing of the operation and recovery, removal of the bladder catheter and mobilization may occur in a different sequence. Discharge will occur 24-48 hours after the operation.

Back at Home

At home, you will need to continue recovering gradually. Recovery time after a cesarean section is often longer than after a vaginal delivery. You are not only (re)becoming a mother but also recovering from surgery. Fatigue is a common complaint after a cesarean section; it's best to listen to your body and rest as much as possible. Accept help from family and friends. Maternity care can answer your questions, take on some household tasks, and support your partner. The more support you have when you come home, the easier the transition and the quicker you will adjust to your new life situation.

After the First Few Weeks

After the first few weeks, you will gradually find that you can do more. Heavy lifting (such as garbage bags, heavy shopping bags) is not recommended for the first six weeks, but you can gradually increase your activities (light housework, smaller errands). You can shower soon after the operation.

Bathing is not recommended until bleeding has stopped. If there is any fluid or a little blood from the wound, you can rinse the wound in the shower, gently dry it, and cover it with dry gauze to protect your clothing. You can start abdominal exercises three months after the operation when the different layers of the abdominal wall have healed well. You may feel a pulling sensation from internal stitches along the sides of the scar during the initial period. This is harmless.

Due to nerves in the abdominal skin being cut during a bikini cut, you may have a numb feeling around the scar for quite some time. Above this area, often midway to the navel, there may be an area that is particularly sensitive. Normal sensation in your abdominal wall may only return six to twelve months after the operation.

The use of contraceptives (birth control) is no different than after a natural delivery. This will be discussed with you during the postnatal check-up. In any case, wait until the bloody discharge has stopped before having intercourse. Upon discharge, you will receive guidelines for living and a mobilization schedule for home.

Possible Complications

Every surgery carries risks, including cesarean section. Serious complications are fortunately rare, especially if you are healthy. Below are the most common complications.

Recovery Period

There is a longer recovery period. Recovery after a cesarean section takes about six weeks. A cesarean section is a moderate surgical procedure. After this procedure, you may also feel more tired than after a normal delivery.

Anemia

There is bleeding with every delivery. Severe bleeding can lead to anemia. If indicated, your blood iron level will be determined, and iron tablets or a blood transfusion may be considered necessary. The risk of more bleeding and a blood transfusion is greater with a placenta previa.

Bladder Infection

Occasionally, a bladder infection may occur after a cesarean section. You will receive antibiotics if necessary.

Bruising at the wound site

Subcutaneous bruising at the wound site occurs when a blood vessel in the subcutaneous fat continues to bleed. The risk of this is greater if blood clotting during a cesarean section is abnormal, for example, due to low platelets caused by severely high blood pressure. You may see it as a bruise under the skin, which almost always resolves spontaneously but can temporarily cause extra pain.

Infection

An infection of the wound occurs occasionally. The risk is slightly higher after a cesarean section following prolonged labor. To prevent infection, you will receive antibiotics during the operation.

Thrombosis

There is an increased risk of thrombosis with every surgery and after every delivery. To prevent this, you will receive blood-thinning medications while you are admitted to the maternity ward.

Bladder damage

Bladder damage is a rare complication. The risk is slightly higher if you have had a previous cesarean section. There may be adhesions around the bladder. It is usually possible to repair bladder damage. However, you may need a urinary catheter for a longer period.

Abdominal bleeding

Bleeding in the abdomen is a rare complication of a cesarean section. It is more common with severely high blood pressure, where blood clotting is less effective. Occasionally, a
second operation is necessary.

Delayed bowel function (Ileus)

After a cesarean section, the bowels need to function properly again. In rare cases, this does not happen or occurs too slowly. Fluid collects in your stomach and intestines, causing nausea and vomiting. A nasogastric tube may be needed to drain this fluid. Only then do the bowels start working again. Fortunately, these complications are rare.

Possible risks for the baby

During birth, lung fluid is squeezed from the lungs. If this does not happen adequately (for example, during a cesarean section), temporary breathing problems can occur. Treatment involves supporting breathing. If this is necessary for a longer period, your baby will be admitted to the neonatology unit. Ideally, a cesarean section is scheduled one week before the due date to minimize the risk of complications.

Another cesarean section for the next delivery?

After a cesarean section, it is advised not to become pregnant again within the first year to allow optimal healing of the uterine scar. Whether another cesarean section is needed depends on the reason for the previous one. Discuss this during the postnatal check-up to assess the likelihood of a vaginal delivery next time. However, you will always have a medical indication to deliver in the hospital. For more information, refer to the brochure 'Giving Birth After a Previous Cesarean Section'.

Emotional aspects of a cesarean section

The experience of a cesarean section varies from person to person. Sometimes feelings of disappointment or failure may arise. During general anesthesia, women do not consciously experience the birth of their child, which can make it difficult to adjust to the new situation. If you experience such feelings, talk about them with your partner, friends, and family members. Discuss your emotions and questions during the postnatal check-up, such as the reason why the cesarean section was necessary. This can help you process your emotions. Write down your questions before the check-up so you don't forget anything. A cesarean section can also be a challenging experience for the partner. Sometimes partners feel helpless because they may feel they have done very little for you. They may also have been worried about potential complications. If these feelings arise, try to discuss them openly with each other.