So, your partner wants an elective caesarean?

The rate of elective caesareans is rising. Figures for NHS England show that in 1989/90 4.9% of all births were by elective caesarean. In 2015/16 that figure had risen to 11.5%.

But elective caesareans are a sometimes contentious topic among mothers and media commentators. In part, this is because of the scrutiny placed on celebrities such as Britney Spears, Victoria Beckham and Gwyneth Paltrow, all of whom have been very public in opting for the procedure in preference to birth via vaginal delivery.

So, before we even begin our discussion of your partner’s thoughts about elective caesarean it is important that we separate ourselves from all the media noise around mothers who are supposedly “too posh to push”: it is irrelevant.

Necessary Caesareans

Of course, there are many situations in which a woman might be advised by doctors to undergo a caesarean section. For example, all of the following may present a risk to mother and/or child and may result in the need for a C-section:

• Baby in breech position
• Previous caesarean section
• Placenta raevia
• Contracted pelvis
• Severe pre-eclampsia
• Diabetes
• Twins
• Maternal HIV or herpes
• Sphincter, bladder or rectum problems

However, in contrast, a woman might choose to undergo an elective caesarean for one or more of the following non-medical reasons:

• A previous traumatic birth
• Fear of pain
• Concern about weakening of the pelvic floor
• Anxiety regarding vaginal delivery

Elective Caesareans – the pros and cons

What your partner decides to do is her choice and is based on her thoughts, her discussions with you and, of course, the consultations the two of you have with your midwife, obstetrician and GP.

That said, it is very useful for you to consider the pros and cons of undergoing an elective caesarean so that you can support your partner by helping her to make an informed choice.

First we look at a list of pros:

• Lower risk of haemorrhage and need for transfusion
• Fewer surgical complications
• Lower rate of post-birth urinary incontinence
• Lower risk of vaginal and/or anal pain

Now we look at a list of cons:

• Longer hospital stay
• Increased risk of infant respiratory problems
• Higher risk of complications in subsequent pregnancies
• Heightened risk of future hysterectomy
• Scarring
• There is still post-birth pain
• There is still post-birth blood loss
• possible reaction to anaesthetic

The C-section procedure

The vast majority of caesarean sections are performed under epidural or spinal anaesthetic. This means that your partner can remain conscious and engaged in the birth process.

Doctors will look to perform the procedure around week 38 or week 39 of the pregnancy and should ensure all of the following:

• That a blood sample is taken two days before the procedure to confirm your blood type
• That no food and drink has been consumed by the mother from six hours prior to the operation
• That the mother receives tablets to neutralise stomach acid

The baby’s heart will be monitored throughout and an intravenous drip will be inserted into your partner’s hand to ensure she remains hydrated. In addition, doctors will monitor blood pressure, oxygen saturation and maternal heart rate, while your partner’s pubic hair will be shaved back to allow for the insertion of a catheter.

An anaesthetist will administer the epidural or spinal block – this will begin to take effect within ten minutes, although it may take around 45 minutes before your partner is ready for surgery.

Doctors typically erect a screen over your partner so that she doesn’t have to witness the full surgical process, but you may well be able to see the whole thing.

Be aware, just as with a vaginal delivery, the baby does not always cry straight away – you may have to wait a few minutes for this reassuring noise.

Your role

The good news is that even if your wife is having an elective caesarean, you still have a major role to play. Unless she requires a general anaesthetic, you can be present so that you can hold your partner’s hand and offer warm and gentle words of support.

However, you will need to don some surgical scrubs and show a strong stomach because of the cutting, the blood and the presence of large amounts of amniotic fluid. C-sections can also be noisy; this includes the sound of the incision and the sound of the suction pipe that is used to suck up the blood and fluids released during the operation.

Additionally, it will take up to an hour to stitch your partner back up. During this time it is your job to hold and nurture your new baby!