What’s happening this week

Your baby…

• may weigh up to 1.5kg
• won’t grow much more in length now but will continue to put on weight
• can probably tell light from dark, day and night
• the digestive tract and the lungs are now nearly fully matured
• the skin is less red and wrinkled
• the fingernails may reach the end of the hands.

You…

• may be leaking colostrum from the breasts
• heartburn may be troublesome as your stomach comes under pressure from the growing baby
• may have backache from the ligaments stretching to accommodate the baby.

About half of the women who have a caesarean section know that they will be having one in advance. We explain why you might need a planned or ‘elective’ caesarean and what happens.

Planned caesareans

Reasons for elective caesarean include:

• the baby is thought to be too big to go through the pelvis
• placenta praevia (see below)
• breech baby
• severe pre-eclampsia (see Week 33)
• baby in an awkward position (such as lying crosswise)
• problems during previous labours

On the day, you will have a drip put into your arm. A catheter (drainage tube) will be used to empty your bladder and the top centimetre of your pubic hair is shaved off. Monitors will be placed on your chest to record your heartbeat and you are likely to be given a spinal or epidural anaesthetic. Very few caesareans are now carried out under a general anaesthetic.

The birth of your baby is quite quick. A screen is put up so that you cannot see the actual operation taking place, but the baby is lifted up for you to see as soon as he or she is born. You may feel some tugging and pulling and hear odd sounds from the machinery used to suck out the fluid and seal the cut. Once the baby is delivered, the wound is stitched up – and this process can take a lot longer than the birth. The wound is closed with clips or a running stitch just below skin level. Read more about recovering from a caesarean in ‘Mum after the birth’.

Spinal and epidural – what’s the difference?

Both these are injections into your back, and both have a numbing effect. An epidural can be ‘topped up’ and last for many hours, but it does take 20 minutes or so to set up. When speed is needed – for instance, for an emergency caesarean section – a spinal can be used instead. This is a single injection that gives pain relief for about 30-60 minutes, depending on the dose.

Once a caesarean?

It used to be said that ‘once a caesarean always a caesarean’ but this is no longer so. VBAC stands for ‘vaginal birth after caesarean’. Many women who have a caesarean with one baby go on to have a vaginal birth the next time. It often depends on the reason for the caesarean last time. If your last baby was breech but this one is head down, then you would probably have a vaginal birth without a problem. You can have an epidural for pain relief and your labour will be carefully monitored. If you had a section last time, talk over the options with your LMC.

Placenta praevia

Some women have a placenta that lies low in the uterus in the early weeks of pregnancy but 90 per cent of these move up out of the way at around 28 weeks. You will have another scan at around 30–32 weeks to check. If it is still low-lying, management may vary depending upon the position of the placenta.

When you go into labour, if the placenta is blocking the usual exit out of the uterus via the cervix, delivery will need to be by caesarean section.

Breastfeeding your baby

Being well informed will help you get breastfeeding off to a good start.  More.