Caesarean section in Marrakech: when it is needed and how it goes

It is a surgical operation in which the baby is born through an incision in the abdominal wall and then the uterus, most often low and horizontal, above the pubic bone. It protects the mother, the baby or both in situations where a vaginal birth would be riskier. It is neither a failure nor an easy way out.

It is decided in advance, case by case, for example in the case of:

• a placenta covering the cervix (placenta praevia);
• a baby in an abnormal position, depending on the situation (breech, lying across);
• a uterus weakened by several caesareans or a particular scar;
• a baby too large for the pelvis, or a pelvis too narrow;
• some twin pregnancies;
• some maternal infections (active genital herpes, high HIV viral load) or certain maternal illnesses.

When there is no emergency, it is generally scheduled from 39 weeks of amenorrhoea.

It may be decided quickly when:

• the baby's heartbeat becomes worrying;
• labour stops progressing despite suitable management;
• the baby does not descend into the pelvis;
• significant bleeding occurs (placental abruption);
• the cord comes ahead of the baby;
• a serious maternal complication arises (severe pre-eclampsia, suspected uterine rupture).

The decision is quick, but you are told the reasons as soon as possible.

An anaesthesia consultation is needed. You are given fasting instructions, a blood test may be requested, and a drip and urinary catheter are placed. Whether your birth partner can be in theatre depends on the facility and conditions: to be clarified in advance.

Most often the anaesthetic is a spinal (or an epidural already in place): you stay awake and feel no pain. General anaesthesia is kept for some emergencies. The baby is generally born within the first minutes; the rest of the operation (delivery of the placenta, closing the layers) takes a few dozen minutes. Skin-to-skin contact is possible as soon as the health of mother and baby allows, sometimes in the operating room itself.

Pain is controlled with regular painkillers. Getting up is encouraged early, a few hours after the operation, and eating resumes quickly. The stay generally lasts a few days. Breastfeeding is possible and supported.

At home, activities resume gradually: avoid lifting heavy things and driving for several weeks, according to the instructions given at discharge. Keep the scar clean and dry.

Contact the clinic or go to the emergency department in case of:

• fever;
• increasing pain;
• a scar that is red, hot, swollen or leaking;
• heavy bleeding or foul-smelling discharge;
• a painful, swollen calf, breathlessness or chest pain;
• burning when passing urine.

A caesarean is common and safe surgery, but it carries higher risks than a vaginal birth: infection, bleeding, a clot in a vein (phlebitis), rare injury to a neighbouring organ (bladder, bowel), adhesions, scar pain. For the baby, temporary breathing difficulty is slightly more frequent when it is done before labour starts, hence the usual scheduling from 39 weeks unless there is a reason otherwise.

The uterus keeps a scar. A new pregnancy is generally possible, with a gap of about a year and a half often advised. The next birth can sometimes be vaginal, under certain conditions and with suitable monitoring. Repeated caesareans increase the risk of placental attachment problems, which is why they should never be multiplied without reason.

A caesarean can feel like relief, disappointment or a shock, especially when decided in an emergency. It is normal to talk about it. Do not hesitate to bring up your feelings at the check-up after the birth.