Some children enter the world by caesarean section, i.e. not through their mother’s vagina, but through incisions made in her abdomen and uterus.
This may be due to an emergency or deemed safer for medical reasons, or it may simply be the mother’s preference.
Bianca Grathwohl has experienced both kinds of childbirth.
Her second child was delivered by caesarean section, also known as a C-section, because the natural, vaginal birth of her first daughter had been ”somewhat traumatic”, she says.
“I felt helpless and stressed.”
So after long reflection, the German woman opted – for psychological reasons – to have a planned C-section the second time around.
Intense anxiety or a mental block against a vaginal delivery are among the so-called relative indications for a planned C-section, says Frankfurt University Hospital obstetrics and prenatal medicine head Dr Frank Louwen.
“These are circumstances in which a normal birth could be chosen under certain conditions”, but a C-section is seen as the better choice, explains the first vice-president of the German Society for Gynaecology and Obstetrics (DGGG).
Besides psychological grounds, they include abnormal positions of the foetus, with either the feet or buttocks closest to the cervix (breech), or the side or shoulder (transverse).
Some indications for a C-section are absolute, i.e. there’s no choice about the delivery method.
This is the case, for instance, if the foetus is severely anaemic or the placenta is blocking the birth canal (placenta praevia).
”There aren’t many women in Germany who opt for a C-section for no reason at all,” says German Midwifery Association (DHV) executive committee member Andrea Ramsell.
Actual fears of a spontaneous birth often play a role, she points out, and “it’s important to take them seriously and accompany the women on their individual paths”.
She says it’s also important that the expectant mother and father be prepared for both the surgical procedure and the recovery period.
So what should they bear in mind?
“First of all, expectant parents can make use of the organisational advantage that a planned C-section offers,” says Berlin-based Society for Birth Preparation, Family Education and Women’s Health (GfG) federal executive board first chairwoman Alexandra Winkel.
“They know the date and can, for instance, calmly make arrangements for the care of any children they may already have.”
A disadvantage though, is that recovery from a C-section generally takes longer than from a vaginal birth, Ramsell says.
“You shouldn’t forget that a C-section is major abdominal surgery that causes pain at the incision site and may of course lead to complications.”
Among the items the woman should include in her hospital bag is low-rise underwear whose waistband is below where the incision will be.
“I advise women to continue wearing maternity underwear for two to three weeks after the operation,” Winkel says, “because it’s generally more comfortable and doesn’t put pressure on any area.”
New mothers can also wear a nightgown for a while to keep contact with the incision site to a minimum.
If it itches, it helps to put a sanitary pad in the freezer and then use it to cool the scar.
Bowel movements following a C-section are often a sensitive subject, remarks Winkel, who notes that “many mothers are afraid that straining could cause damage (to the staples or stitches closing the wound)”.
Although this fear is unfounded, she says, it’s a good idea to drink plenty of fluids and eat high-fibre foods to prevent hard stools and constipation.
To make their recovery at home as stress-free as possible, new mothers should recruit household help for at least two weeks.
“Mobility after the surgery is limited more and longer than after natural childbirth,” Winkel says.
“You should definitely take this into consideration for the post-partum period.” – By Sandra Arens/dpa