a

Enhanced recovery for your planned caesarean section at the Royal Berkshire Hospital

my name is Samantha Lowe I'm a

consultant obstetrician here at the

Royal Berkshire Hospital I work with

pregnant women both during their

pregnancy and also while they're having

their babies

I work with the team of midwives

maternity care assistants anis 'test and

other obstetricians and our key focus is

on providing the safest possible care

for our women and their babies we're

continually striving to improve the care

we deliver and we're always looking at

ways of enhancing the recovery process

there are many reasons why a women might

have elective cesarean section including

having a breech baby a low-lying

placenta having had cesarean sections in

the past or because the mother has a

particular medical problem we wanted to

produce the short film so that patients

their partners and families could

visualize what might happen where to go

and who they might meet both before the

operation and also on the morning of

their surgery we know that there are

many benefits for women who get home to

their own environment as soon as

possible after both surgery and having a

baby these benefits include lower

instances of hospital-acquired

infections improved mobility which

reduces the risk of blood clots when

women are able to rest and sleep better

in their own homes even with a tiny baby

and they see their families and older

children sooner and this should improve

the overall experience for the whole

family there are lots of reasons that a

woman will have an elective Suren and

that will obviously be discussed with

her obstetrician at one of her antenatal

appointments in clinic it's usually the

decisions actually then made about 35

weeks there'll be an appointment and an

actual date will be given and at that

time the obstetrician will discuss the

consent form go through the risks of

obviously having a cesarean make sure

the woman understands them get them to

sign it and then will actually confirm a

date for the operation itself and also

for a session a week before to give all

the information that's necessary once an

elective section is booked a lady will

be given her date for her pre-op

information class usually about a week

before the elective section date and

this is where a midwife will have a

group of people together and discuss all

of the relevant information about having

an elective section check that all the

patients have read through all the

patient information leaflets at this

time

there is an opportunity for the ladies

to ask any questions that they'd like to

know about having an elective c-section

there won't actually be an anesthetist

present at that time but if the midwife

can't answer any questions she can refer

the patients to go and see analyse 'test

afterwards at the preoperative session

you will also be given a small bag with

medication to take home that you will

need to take before the day before the

operation and the morning off you will

also be given a free voucher for parking

in the multi-story car park the visitors

car park you will also be given a

pathology form to have some blood taken

before the operation this has to be

within 72 hours of the operation and

unfortunately can't be done at your

local doctor's because the hospital

don't get the results in time so you

will need to come to a pathology lab and

have those Bloods taken either one or

two days before your planned operation

on the day of your c-section you need to

park in the multi-story car park you

will be asked to arrive at half-past

seven in the morning and you need to

head to level three of the maternity

block it says delivery suite you need to

ring the buzzer and you will be directed

along the corridor to the day assessment

unit we do advise if you're coming by

car to leave your main bag in the car as

it's very difficult to store it when

you're having your operation and bring a

smaller bag just containing the bare

essentials that would be a dressing gown

and slippers first set of baby clothes

for baby and any valuables that you need

to bring with you as part of our

enhanced recovery scheme it's important

that a patient does arrive having been

starved and you'll be given information

about the last time you can eat and

drink before your operation however we

want this time to be as minimal as

possible so the aneesa's will advise you

about bringing with you a non fizzy

sports drink the way the c-sections work

that we do a maximum of three a day it's

a morning list but it will be decided on

that morning who is first second and

third on the list and that at that time

the initiative will advise you at what

time to stop drinking so when the

patient and their partner arrive on the

day of surgery they are checked over by

a midwife and some basic observations

are done such as blood pressure heart

rate and temperature they will also

ensure the jewelry is removed or taped

the patient and will

meet the obstetrician who will be their

surgeon for the day this gives them the

opportunity to ask more questions about

the operation itself discuss more fine

details about what to expect and also to

ensure that the consent form is properly

filled in then the patient will meet

enemies such as myself we will ask some

basic questions about medical health

ensuring also that the patient hasn't

had breakfast that morning and then

spend a bit of time discussing the type

of anaesthetic they're going to be

having for the majority of women this

will be a spinal anaesthetic which is a

regional technique involving a little

injection of local anaesthetic into the

lower back in order to completely numb

the tummy from the chest and words this

is for most patients the most safe

option it also enables the mum to be

awake and experience the birth of her

child and enables the birth partner to

be present it also has better pain

relief for afterwards when compared to a

general anaesthetic there are however

risks associated with all types of

anaesthetic and this will be further

discussed further information is

available on the hospital internet under

the title anesthetics for cesarean

section and it would be a good idea to

familiarize yourself with this document

prior to the day of surgery so when it's

your turn to have your baby you will

walk to theatre with your birth partner

and there you will meet lots of people

in the operating theatre will be two

obstetricians to do your operation some

theatre nurses to assist with that

probably two or three of them in an ISA

test and a theatre technician and also a

midwife to look after your baby your

name and the procedure that you are

going to have will be confirmed via your

wristband and then the unisys will be

placing a drip or a cannula into your

hand or arm you'll be helped into the

correct position for the spinal

anesthetic and your back will be cleaned

with a cold pink solution after a small

amount of local anaesthetic to numb the

skin which can sting initially the

spinal is placed and you'll be asked to

stay very still during this whole

procedure

it usually takes 10 to

two minutes for the spinal to work

completely and during this time the

anisa test will be assessing the degree

of numbness the whole time you will also

have regular blood pressure and heart

rate monitoring taken but do let the

anis this know if you feel sick or giddy

at any time so the team will go through

another checklist to ensure that

everyone is present and the operation

will start it is common to feel some

pulling some pushing and some pressure

sensations during the procedure but not

to feel any pain

if wherever you do feel some discomfort

the aneesa's can give you more pain

relief and will be assessing you

throughout whilst it is very uncommon

occasionally some women do need a

general anaesthetic

you will have the chance to see your

baby as soon as he or she is born but as

with every birth

the Midwife needs to take the babies to

dry them and wrap them up in something

warm after this you will be able to have

your baby on your chest for some

skin-to-skin contact if you should wish

and that can remain so for the rest of

the procedure before leaving the

operating theatre all babies are weighed

and all are labeled with the mother's

name and the babies date of birth so mum

and baby are transferred to recovery

area to be closely monitored by a

midwife or recovery nurse for about two

hours after the operation it is

important to make sure that the blood

pressure and the pulse are all stable

and this is a chance for the woman to

have something to drink and also for

help to be given to establish baby's

first feed once the team are happy mum

and baby are transferred to the

postnatal ward friends and relatives are

then welcome to come and visit once

you've been transferred to the ward

there will be a midwife there to ensure

that your pain is under control and that

you are up and mobile and that baby is

feeding well the day after your baby's

born you will be assessed by one of the

doctors to make sure you're fit and well

and then you'll be discharged home the

following day after you leave hospital

one of our community midwives will visit

you at home and keep an eye on how baby

is feeding and obviously ensure that

your pain is under control again and

we'll make a plan with you an individual

plan of how often they need to come and

see you whilst you're at home

historically women have often asked if

they could go home earlier than the two

or three days which they currently do

moms are much happier at home with their

families and their home comforts around

them and we know that this improves

their recovery and that they return to

full health much quicker

you