Stillbirth - Having your baby by caesarean

A caesarean section birth is when your baby is born through an incision (cut) into your lower abdomen (tummy). Usually the cut is made along the top of your bikini line on the edge of your pubic hair. Caesarean sections can either be done as an ‘elective’ (planned) or as an ‘emergency’ procedure.

Having a caesarean birth will not prevent you from having skin to skin contact with your baby soon after birth.

This information is about having a caesarean birth. If you have any further questions, please ask either your Consultant, Doctor at the hospital or Midwife.

Your Consultant or Doctor at the hospital will discuss your options and choices with you so that you can make an informed decision about the way you can give birth your baby and will take into account your personalised are plan.

Semi-elective caesarean birth is an option after a stillbirth. This is when the caesarean is planned; there may be 1-2 days from confirmation of the death of your baby to birth.

Your Doctor will discuss the risks involved in having a caesarean and ask you to sign a consent form. This form is to say that you understand what is involved in the procedure and that you agree to have the caesarean. This is an ideal time to ask any questions you have about the procedure.

You will have a pre-operative assessment appointment either before your caesarean or on the day itself.

At the pre-operative assessment:

• A healthcare professional will take and record your blood pressure.
• Blood samples are arranged to be taken, usually within 3 days of your caesarean, and sent to the laboratories. This ensures that if a blood transfusion is needed, blood can be obtained quickly. Your haemoglobin (iron levels) will also be checked.

It is very important to let the Doctor or Midwife know if you would not like to have any blood products used in your care.

• We will be guided by the UK Health Security Agency for COVID-19 screening. This will be discussed during your pre-operative assessment.
• Skin swabs will be taken from your nose and groin area for MRSA (methicillin-resistant Staphylococcus aureus) screening. MRSA infections mainly affect people who are staying in hospital. MRSA is a type of bacteria that is resistant to several widely used antibiotics. Infections with MRSA can be harder to treat than other bacterial infections, but can usually be treated with antibiotics.
• You may be given an anti-microbial body wash and you will be asked to bathe or shower with this before your caesarean. The wash helps to reduce bacteria on your skin. Your midwife will provide you with further information and advise
• You should use the body wash as advised by your midwife or doctor. You can use your normal shampoo and body wash afterwards. This schedule may be different depending on when your caesarean is scheduled to take place. You may not have time to start this as early as 5 days before. Your midwife or doctor will advise you accordingly.
• Please bring the medicated body wash with you into hospital and bathe or shower with this whilst you are in hospital.
• Your blood pressure will be checked and a urine sample will be routinely tested.
• You may be weighed, and your legs measured for anti-thrombotic (TED) stockings.
• You will be offered two antacid tablets and advised when these should be taken.
• On the evening before and after you have given birth we advise that you have a daily injection of a blood thinning agent (Low Molecular Weight Heparin – LMWH), usually for at least 10 days and in some cases up to 6 weeks. The midwife caring for you will advise you on how and when to give yourself the injection of LMWH. This goes just under the skin and works with the TED stockings to reduce your risk of developing blood clots. If you are already taking LMWH during your pregnancy you should take the last one on the day before your caesarean at 6pm.

• We would advise that the evening before your caesarean that you have a meal which is rich in carbohydrate such as rice, pasta or pizza.

Please note - If you have diabetes or gestational diabetes you should continue to have your diabetic meal choices on the evening before, to help maintain your blood sugars.

• At 10pm take one of the antacid tablets.
• You can then eat only a small amount of food until 2am (on the morning of your operation).
• Do not eat anything (this includes chewing gum, tea or coffee) after 2am on the morning of your operation.
• From 2am you may only drink water up until the time of your caesarean.

• At 6am take your remaining antacid tablet with water.

Please ignore the following information if you have diabetes or gestational diabetes or know that you are having a general anaesthetic (being put to sleep) for your caesarean.

Also at 6am have ONE of the following:

• A small carton of clear apple juice (400mls max)

OR

• A small carton of Ribena (400mls max)

OR

• A small cup of tea/coffee with 2 sugars and no milk (400mls max)

Do not have anything else to eat - including chewing gum.

You may already be an inpatient, but if not, you will usually be asked to attend the Maternity Unit at 7:30am on the morning of your caesarean. You and your birth partner will meet the Midwife who will care for you during, and immediately after your caesarean. The Midwife will check you over again, ask if you have any concerns or questions, and make sure you are ready to go to theatre. Your caesarean will take place in the theatre, which is on labour ward.

Unfortunately, we may need to delay your caesarean if an emergency happens, in which case we would keep you fully informed of any changes. This does not happen very often.

Please bring one of the carton drinks described above with you in case this happens, but do not have it unless a doctor or midwife tells you it is safe to drink it.

Planned caesarean births usually start from 9am onwards. A definite time cannot be given, as there may be more than one planned caesarean on that day, or the Labour Ward may have an emergency.

Before going to theatre:

• Remove nail varnish, false nails (gel and acrylic) and jewellery. Please do this at home before coming into hospital (please leave valuables at home). Contact lenses should be removed just before going to theatre.
• Your wedding ring, which may be worn, or rings that cannot be removed, will be covered with tape.
• The midwife caring for you will provide you with an identity bracelet, TED stockings, and a theatre gown for you to wear. The identity bracelet must be worn throughout your stay in hospital.
• It may be necessary to shave the top of your pubic hair.

You will meet the Anaesthetist, and the Doctor who will be performing the caesarean. An Anaesthetist is a specially trained Doctor responsible for the anaesthetic you will require for your caesarean.

It is usually recommended you have a spinal block or epidural, for planned caesareans. This means you will be numb from the waist down. You can stay awake and your birth partner can stay with you to share the birth of your baby.

If you do not want to be awake, or if for a medical or obstetric reason you are unable to have a spinal block or epidural, you will be offered a general anaesthetic. This is when you go to sleep. Your birth partner cannot stay with you in the theatre if you have a general anaesthetic, but can be very close by. Your birth partner will be able to see the baby as soon as they are born.

When in theatre, you will have a drip in your hand (this is to replace the fluid you lose during surgery). A catheter (tube) will be placed in your bladder; this keeps your bladder empty during surgery, and staff can monitor how much you have urinated more closely. The Anaesthetist may give you a small drink of sodium citrate. This works with the antacid tablets to neutralise any remaining stomach contents.

When you are ready, the Anaesthetist will give you either a spinal, epidural or a general anaesthetic. When the Anaesthetist is happy that you are pain-free, the Doctor will start the caesarean.

Your personalised car plan/birth plan

Your personalised care plan is your chance to discuss with us what you would like for your birth and you
can still make choices if you are having a caesarean.

For example, you may like to think about:

• Do you want staff to tell you what is going on during the operation or would you prefer quiet.
• Would you like music on during the birth - a radio / CD is available in theatre.
• During the operation there is a screen so you cannot see what is happening, but if you wish, you can ask for this to be lowered at the time of the birth.
• Unfortunately it is not possible for a birth partner to cut baby’s cord during the operation. It may be possible for the length of the cord to be longer so that it can be cut at a later time by your birth partner, if you wish.

Skin to skin contact

Would you like to have skin to skin contact as soon as possible after the birth? You might prefer that your birth partner has skin to skin contact with your baby. Alternatively we can wrap baby up and you can have a cuddle when you are ready.

You may have some concerns about your baby’s appearance at birth, please speak to your midwife about any concerns you may have and she will explain everything to you. If you wish she can take baby at birth and wrap him or her up in a towel/blanket before he/she is passed back to you or your birthing partner.

You may not find it easy to hold your baby initially but your midwife is there to help and support you with everything and advise you accordingly. Please do whatever feels right for you and your birth partner at the time – there is no right or wrong answer.

We understand that this is an extremely difficult time for you and your birth partner and do not want you to feel pressured in any way. We are all here to support you.

You can usually expect to meet a minimum of seven staff in theatre. These consist of:

• Obstetricians - Doctors who do the operation
• Anaesthetists - Doctor who gives the anaesthetic
• Operating Department Assistant - helps the Anaesthetist
• Midwives - look after you and support you and your birth partner
• Nurses - provide support for the Obstetricians and Anaesthetists

Just before starting the operation, a catheter will be inserted into your bladder. This is a fine tube that keeps your bladder empty during the operation and lets us monitor how much urine you are passing.

The skin on your stomach area will be cleaned and you will be covered with a sterile sheet to help reduce the risk of infection. You and your partner should not touch this sheet.

Once the operation has started you will feel some pushing and movement. You should not feel any pain. Please let the Anaesthetist know if you feel unwell or are uncomfortable.

Your baby is usually born within 5-10 minutes of starting the operation providing there are no problems encountered e.g. from previous caesareans.

Your baby will be dried and passed to the Midwife caring for you and can be passed straight to you or your birth partner for skin to skin. You can either have baby placed skin to skin or wrapped up and placed with you or your partner for a cuddle or placed in a cot by your side. Please see previous section about skin to skin, alternatively please speak to your midwife caring for you who can answer any questions you may have

The day of your caesarean section

After your caesarean you usually stay on the labour ward until you are discharged.

During the first 30 minutes after your operation, only your birth partner will be allowed to stay with you in the recovery area. The Doctors and Midwives will keep checking on your overall condition.

In the time immediately after your caesarean, you can still have skin to skin contact with your baby. If you are well, your baby can often be placed skin to skin on your chest while still in theatre. Once out of theatre, skin to skin can continue for as long as you like. If you are well and have had a spinal/epidural, you will be offered something to eat and drink in recovery within an hour to help your recovery.

You will be offered pain-relief, as you need it. Do not hesitate to ask for help to hold your baby. You may find it difficult to do this whilst you still have a drip in place. Staff will be here to support you.

It is important to start to move around as soon as possible after your operation, even if your catheter is still in. This helps to prevent blood clots forming. The staff will help guide you as to when is best to do this and we strongly advise you not to attempt to get out of bed the first time without a member of staff to help. Usually your drip and catheter can be removed, but they may remain in if you have any complications.

When you are ready to go home

When you are ready to go home from hospital, it can be daunting and emotionally painful as everything has changed since you came into hospital. You may wish to leave the hospital as soon as you are medically able to; or you may prefer to stay a bit longer until you feel more ready. It is usual for your baby to remain in the hospital in the dedicated area.

You may want to take your baby home in order to spend time with them in your own surroundings, which also allows your friends and family to spend time with your baby. It may not be possible for you to take the baby home straight away if a post-mortem examination is being carried out.

A Community Midwife will visit you at home within 24 hours following discharge from hospital. If they have not made contact within this time, please call our ward clerk on 01709 427441 or 01709 424491.

We try our best to protect you from baby product companies contacting you but we cannot always filter them all.

This is a legal requirement.

If your baby was under 24 weeks gestation and showed no signs of life, you do not need to legally register your baby’s death. However, we can give you a memento certificate of birth and can arrange for a member of the multi-faith chaplaincy team to perform a naming and blessing ceremony if you so wish.

If your baby was 24 weeks gestation or over and showed no signs of life, this is called a stillbirth and your baby needs to be registered as soon as possible to avoid any delays with burial or cremation. You will be given a Stillbirth Certificate and your baby’s NHS number before you leave the hospital. You will need to take these documents with you to the Registry Office. The mother of the baby must be present at the registration. If the staff feel that your baby showed signs of life at any gestation, this will be classified as a neonatal death and you will need to legally register the birth and death of your baby within 5 working days. Please take a form of photo ID and a marriage certificate (if applicable) with you.

You will be given a Medical Certificate of Death and your baby’s NHS number, which you will need to take to the registry office with you. It is advisable that you make an appointment with the Registry Office before you go, if staff have not already made one for you.

Rotherham Register Office,
Riverside house,
Rotherham,
S60 1QY
01709 823543

You may wish to see or hold your baby. Many parents say that spending this time with their baby is a comforting memory. However, there are no rules and if you feel that this would not be helpful for you, please do not feel pressured to do so. The staff in hospital are there to give you choices, make suggestions and offer opportunities so you can do what is right for you and your family.

If you have concerns about what to expect in terms of your baby’s appearance, you could ask a midwife or doctor to describe what they look like or you may wish to see a photograph first.

If you have decided that you would like some mementos of your baby then this is what we can offer you:

• Memory box
• Hand and footprints. This can sometimes be difficult if your baby is very small
• Photographs by the midwives or professional photos by a photographer free of charge. If you would like to know more and see some examples of their work please ask your midwife.

The memory box includes:

• a candle
• a guardian angel
• a card to mount footprints on
• an inkless footprint kit
• a memory card for photos

In addition to the memory box, we can also provide:

• a cot card
• baby name labels
• a lock of hair
• clothes and blankets

Our hospital Chaplain is available to attend to perform a naming and blessing ceremony. The hospital chaplaincy provides services for all faiths.

It is important to start to move around as soon as you are well enough. You should be able to eat and drink normally. You should be able to have a bath or shower.

A blood test will be done to check your iron level, and it may be recommended for you to have iron tablets.

You will generally be recovering from your caesarean. Most people who are well are able to go home on the first day after a caesarean and certainly on day 2. This will depend on your own circumstances and whether you are fit for discharge home. Your Community Midwife will continue your care at home, and ensure you have a safe and healthy recovery. You will be given a leaflet about mobility, rest and exercise after your caesarean before you go home.

Like all operations, there are risks when having a caesarean. The following are some of the complications that may develop.

Common risks (happens to 1-10 in 100 people (a person on a street)) include:

• Infection - There is a risk of wound, urinary or pelvic infection. To help reduce the chance of getting an infection, you will receive a dose of antibiotic straight into your drip just before your caesarean. The Doctor may also prescribe you a course of antibiotics, if there are any signs of infection.
• Your wound dressing will usually be taken off on day 2 after your caesarean and your Community Midwife will observe your wound for the next 7-10 days to check for any signs of infection. Some dressings are designed to stay on longer and your Doctor or Midwife will discuss the care of your dressing and wound with you during your care. The wound will then be left without a dressing. We advise you to keep your wound clean and dry by taking a daily bath or shower. Avoid touching your wound unnecessarily to prevent contamination and always wash your hands before and after going to the toilet, changing pads or touching your wound. Avoid products such as talcum powder and creams until the wound is well healed. If you either feel unwell, have a temperature, have increasing pain in your wound, your wound becomes red or weepy, your discharge becomes smelly, you have signs of a water infection or any other increase in pain you should consult a Doctor urgently.
• Your baby can be ‘scratched’ (with a scalpel blade) during the operation.
• Persistent wound or abdominal discomfort.

Uncommon risks (happens to 1-10 in 1,000 people (a person in a village)) include:

• Extra procedures that may become necessary during the caesarean such as a blood transfusion or procedures to control bleeding that includes a balloon insertion into your womb during your caesarean, compression sutures on your womb or emergency hysterectomy, particularly if there is heavy bleeding at the time of your caesarean. A hysterectomy would mean you are unable to have any further children. The risk of needing to have a hysterectomy at the end of a subsequent pregnancy increases with each caesarean birth but overall is still very low (7-8 in 1000 people).
• The risk of returning to theatre after your caesarean is uncommon but this may be necessary for control of bleeding or to deal with any other complication.

Rare risks (happens to 1-10 in 10,000 people (a person in a small town)) include:

• Damage to your bowel or bladder (1 in 1000 people) or ureter (the tube connecting the kidney to the bladder) (3 in 10,000 people).
• Thrombosis (blood clots). Being pregnant increases your risk of developing a blood clot. This is further increased when you have a caesarean, because you are not as mobile as usual. You are given an injection of blood thinning medication (Low Molecular Weight Heparin), pressure stockings, and encouraged to move around as soon as possible. The Midwife will explain how long you need this treatment for. It is very important that you take all of your injections, keep moving and wear your stockings for the length of time that you are advised to take your injections for. Clots are rare with the prevention above but if you have any pain in your calf / chest or shortness of breath, you should go straight to accident and emergency.

Risks in your future pregnancies

• If you have had two caesarean births before and have a low placenta in your third pregnancy, you have a higher chance of a serious complication called placenta accreta. This is where the placenta does not come away as it should when your baby is born. If this is the case, you may lose a lot of blood, be recommended a blood transfusion, and you are likely to need a hysterectomy. The risk of placenta accreta increases with each caesarean birth.
• For reasons we don’t yet understand, the chances of experiencing a further stillbirth in a future pregnancy are higher if you have previously had a caesarean birth (4 in 1000 people, rare) compared with a vaginal birth (2 in 1000 people).

Very rare risks (happens to less than 1 in 10,000 people (a person in a large town)) include:

• Risk of admission for intensive care unit is 9 in 1,000 people (rare) and risk of death in caesarean is one per 12,000 people (very rare).

These are rare complications. If the Doctor noticed a problem at the time of the caesarean, you would be fully informed, and followed up very closely.

What stitches do the Doctors use?

The stitches used can vary, but usually they are ‘sub-cutaneous’, which means they are under the skin. They may be dissolvable. Sometimes, the Doctors use one long sub-cutaneous stitch, which is held in by two beads. This does not dissolve, and is removed about five days after the caesarean by a Midwife. Metal clips can also be used. Occasionally, the Doctors insert a ‘drain’ at the time of the caesarean. This prevents blood ‘pooling’ in the tissue layers under the skin and is usually removed within 24 hours after your caesarean.

Does having a caesarean in this pregnancy mean that I will require a caesarean in future pregnancies?

No. This depends entirely on why the caesarean was performed. In future pregnancies, you will be able to discuss your options with your Consultant or Doctor at the hospital. When you are discharged home you should receive the leaflet “Choices for birth after caesarean” as well as this one - if you do not get this please contact us and we can send you one, or this is available from our website.

When can I drive?

You must check with your insurance company when you will be covered to drive after your caesarean. Most companies say not until 6 weeks after your caesarean. It is better to avoid driving for a few weeks, as your wound will be very tender. To drive, you must be absolutely sure you would be able to do an emergency stop. This means you must be able to respond quickly enough, and not damage your wound.

Where do I have my postnatal check?

You will be seen by your Community Midwife on the day after discharge and regularly until 7-10 days after your caesarean. Unless you are given an appointment to attend the hospital for your postnatal check, you should see your GP at 6 weeks. It is really important that you have this postnatal check. By 6 weeks, you should be more or less back to normal. Your GP will be able to advise you about going back to work, and other matters such as contraception and family planning.

When can I resume sexual relationships?

When you feel ready, but don’t forget you will require contraception. It is important to delay pregnancy for 18 to 24 months after a caesarean birth.

Good contraception is very important and we advise that this be arranged sooner rather than later preferably before day 21 after your caesarean with your GP or family planning clinic.

• Registering at the Register Office affiliated with your hospital.
• Visit from a Midwife within 24 hours following your discharge from hospital.
• Arrange a private funeral with a Funeral Director or Religious Leader of your choice. Alternatively, with the Chaplaincy Service for a hospital funded funeral.
• Make an appointment with your GP within two weeks following discharge from hospital for a postnatal check.
• Attend an appointment with an Obstetric Consultant in 16-20 weeks after delivery to discuss events and results.

Your appointments will be sent out once all your results are available.

Please make note of any questions you may have.

Grief for you, your partner and family following the death of a baby can be severe and last a long time.

If you want to speak to someone, we can put you in touch with our Bereavement Counsellor.

Please contact the Specialist Bereavement Midwife:

Specialist Bereavement Midwife

07917 243049 or 01709 427274

If not available, please leave a message, in an emergency please contact Labour Ward / triage on numbers listed below.

Alternatively please telephone the labour ward on 01709 427441 or 01709 424491 and ask to speak to the Sister in Charge who will arrange this for you.

Chaplaincy

01709 427015

Maternity Triage

01709 427700

Delivery Suite

01709 424491

Early Pregnancy Advisory Unit (EPAU)

01709 427072

Community Midwifery Office

07109 424058
Monday to Friday, 9am to 4pm

Ward B11

01709 424349

Rotherham Counselling Service

01709 427636

NHS Talking Therapies

01709 447755

Sands

Sands is a stillbirth and neonatal death charity that offers emotional support and practical help to anyone affected by the death of a baby before, during or shortly after birth. As well as supporting mothers and partners, Sands can help other members of the family, especially grandparents and other children, as well as friends. Information and support can be found at:

Call 0808 164 3332 or email helpline@sands.org.uk
Visit Sands website

Stillbirth & Neonatal Death Support (SANDS)

General enquiries
0207 4367940 or 0203 897 6094

TOMMY’S

If you would like to talk to a Tommy’s midwives about any aspect of stillbirth, they are experienced in talking about baby loss and bereavement. You can all them free on 0800 0147 800 or email them at midwife@tommys.org (Monday to Friday, 9am to 5pm).

Samaritans

116 123

ARC

0845 077 2290 or 0207 713 7486
Email: info@arc-uk.org

PETALS

0300 688 0068
Email: counselling@petalscharity.org

BLISS

Visit the Bliss website.
Email: ask@bliss.org.uk

Child Bereavement UK

0800 028 8840
Email: support@childbereavementuk.org

The Lullaby Trust

0808 802 6868
Email: support@lullabytrust.org.uk

Miscarriage Association

01924 200799
Email: info@miscarriageassociation.org.uk

Multiple Birth Foundation

Visit the Multiple Birth Foundation website.

Twins Trust

0800 138 0509
Email: helenturier@tamba.org.uk

Bereavement Trust

0800 435 455

Muslim Bereavement Support Service

020 3468 7333
Visit the Muslim Bereavement Support Service website.

Children of Jannah

Visit the Children of Jannah website.

Child Death Helpline

0800 282 986

Cruise Bereavement Care

0808 808 1677

Compassionate Friends

0345 123 2304

Wellbeing of Women

020 7772 6400
Email: wellbeingofwomen@rcog.org.uk

4Louis

Visit the 4Louis website.

The National Child Birth Trust

01709 545760

National Fertility Association

01922 722888

Nova foundation

Visit the Nova Foundation website.

Bereavement Advice Centre

0800 6349494
Practical advice, 9am to 5pm

Teddy’s Wish

Visit the Teddy's Wish website.

Saying Goodbye

0300 323 1350
Email: support@sayinggoodbye.org
Visit the Saying Goodbye website.

The Lily Mae Foundation

01676 535716
Visit the Lily Mae Foundation website.

Call grief Talk

0808 802 0111
Monday to Friday, 9am to 9pm

Aching Arms

07464 508994