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There are three different ways that you can be anaesthetised for an elective caesarean section:

• Spinal anaesthetic,
• Epidural anaesthetic
• General anaesthetic.

At Worcestershire Royal Hospital the preferred method is to use a spinal for most mothers but the ultimate choice of how you are anaesthetised lies with you after a discussion with an obstetric anaesthetist about the pros and cons of the different anaesthetic options.

A spinal uses a very fine needle to inject a mixture of local anaesthetic and a morphine-like drug (diamorphine) into the sack of fluid that surrounds your spinal cord. The drugs then act to numb the nerves directly, as they pass out from your spinal cord to other areas of your body. The injection itself is performed in your lower back at about the level of your hips and will affect all sensation from your toes up to your chest. This will last around two - three hours and then gradually wear off.

A Caesarean section is a surgical procedure and as such needs to be performed in a safe, clean and organised way. However, we try hard to make the environment you deliver in, to be as relaxed and friendly as possible.

• We will ensure you birth partner is with you throughout the procedure, from when you enter the delivery room until the procedure is complete. We usually have music playing and could play your own playlist if you bring your own CD or IPOD (old IPOD dock) playlist.
• We ensure your baby remains attached to your placenta for between 30 seconds and 2 minutes after he/she is delivered. This ensures as much blood is transferred to your baby as possible before the cord is cut. The baby can be held up or the screen briefly lowered at this stage for you to see him/her.
• Once your midwife has dried and briefly checked your baby, she will bring him/her to you and your partner to hold for the rest of the procedure. At this stage we encourage skin to skin contact or breast feeding if you wish.
• As soon as we have transfer you to the recovery area we encourage you to have skin to skin contact, feed your baby, have a drink and even something small to eat.

We would hope to have you back to the post natal ward after about 30 minutes in the recovery area. At this point you will be able to have visitors if you wish and we will be starting to focus on your recovery and establishing care for your baby. The following factors will be very important over the next 24hrs:

• Ensuring you are taking enough of the correct pain relief
• Establishing feeding your baby
• Planning when to remove the catheter tube from your bladder
• Making sure you are well enough to start eating and drinking normally as soon as possible
• Getting you up and out of bed as soon as you are able and is possible
• Planning how to get you home as soon as you are ready and discussing how your journey will continue over the next few weeks.

The following leaflets will give you more information about what to expect:

Read After your Caesarean section for more information

Pain relief after Caesarean section

A caesarean section is a major operation on your tummy which will require an anaesthetic. Your Obstetrician and Anaesthetist will have already spoken to you about the possible complications following both surgery and anaesthetic but if you have any concerns, there is always a member of staff available to talk to you, day or night.

The more common problems that we may do something about routinely or watch you closely to prevent could include:

• Bleeding after delivery – we observe you and possible give you an additional drug infusion for 4 hours to help your womb contract.
• Pain – we will ensure you receive all your prescribed tablets and make stronger painkillers available if you need them AS WELL AS the tablets.
• Blood clots in your leg/lungs – we will encourage you to get up and out of bed as soon as possible and in some cases give you blood thinning injections in your tummy (your obstetrician will talk to you about this)
• Problems passing urine after the procedure – you will have a catheter tube in your bladder until you can get up and out of bed to the toilet. We will also ensure you have passed an adequate amount of urine before you can go home.
• Wound care – Your midwife will discuss this with you before you go home. Some mums may go home with a special PICO dressing if they are seen as a higher risk of wound infections.

There will be plenty of opportunity to discuss any concerns before, during or after your caesarean with any member of staff. We would wish you to be going home feeling reassured and confident about the weeks ahead.