Week 31

What’s happening this week

You…

• may feel more breathless as your baby gets bigger
• may get heartburn more frequently as your stomach comes under pressure from the growing baby
• you may want to start wearing support tights, especially if you have swollen ankles or varicose veins
• may feel bored – you’ve been pregnant for a long time now!

Your baby…

• kicks a lot some days, is quieter others
• can probably tell light from dark, day and night
• won’t grow much more in length now but will continue to put on weight.

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 awkward position (such as lying crosswise)
• problems during previous labours
• mother’s request (some doctors can refuse this if there is no clinical complication).

If you are booked in for an elective caesarean, you’ll know your baby’s birthday in advance. Usually you go into the maternity unit the day before and most of the preparation is done then.

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 odds 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 ‘You 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.

If the placenta is blocking the usual exit out of the uterus via the cervix, delivery will need to be by caesarean section. Your baby may be early. In other cases, the position of the placenta will be checked using ultrasound scans at 1–2 weekly intervals. In either case, if there is bleeding you may be admitted to the maternity unit for monitoring.

Skin-to-skin contact

Holding your baby close is a really important part of getting to know each other. It also helps keep your baby warm and helps regulate his temperature, heart rate and breathing. Ideally this bonding should:

• take place within 30 minutes of the birth
• be in a calm, relaxed and unhurried environment
• be for as long as you like (ideally longer than 45 minutes).

If you have had a caesarean birth or cannot hold your baby at first, ask your partner or LMC to help you hold your baby when you feel ready.

Breastfeeding after a caesarean

If you have had a caesarean , you might need help with holding your baby for the first few feeds. Use a pillow on your abdomen to cushion your wound and spread the weight of the baby.

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